Abstract
INTRODUCTION: The aim of this study was to identify the heterogeneous classes of CD4/CD8 ratio trajectory and their impacts on prognosis in people living with HIV (PLHIV) during long-term antiretroviral therapy. METHODS: A retrospective cohort study of PLHIV receiving ART treatment was conducted in the Eighth Affiliated Hospital of Guangzhou Medical University, and the latent growth mixture model (LGMM) was used to identify the trajectories of longitudinal changes in the CD4/CD8 ratio between February 10, 2004, and January 31, 2019. Cox proportional hazard model and proportional subdistribution hazard model were conducted to explore the impact of CD4/CD8 ratio trajectory on prognosis. RESULTS: Three heterogeneous trajectories were identified: the baseline-low-level slow increase class (Class 1: 57.45%), the baseline-moderate-level rapid increase class (Class 2: 34.29%), and the baseline-high-level sharp increase class (Class 3: 8.26%). Cox proportional hazard model showed that CD4/CD8 ratio trajectory was associated with all-cause mortality among PLHIV, with adjusted hazard ratios (aHR) (95% confidence interval [CI]) for Class 2, and Class 3 being 0.53 (0.38-0.75), and 0.35 (0.14-0.86) respectively, compared with Class 1. The result of the proportional subdistribution hazard model showed that the CD4/CD8 ratio trajectory was associated with the risk of AIDS-related and non-AIDS-related mortality. CONCLUSIONS: Our study demonstrated that there were three different trajectories of CD4/CD8 ratio during long-term ART. Personalized interventions and treatment plans can be developed based on individual changes in CD4/CD8 ratio, which is important for improving the survival of the PLHIV and reducing disease burden.