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Pretreatment CD4s and CD4/CD8 Ratio Lower in Trial Participants Over 50
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First International Workshop on HIV and Aging, October 4-5, 2010, Baltimore
Mark Mascolini
Antiretroviral-naive people enrolling in GlaxoSmithKline antiretroviral trials at age 50 or older had significantly lower CD4 counts and CD4/CD8 ratios than younger trial participants [1]. The older group gained significantly fewer CD4 cells than the younger group through 48 weeks of treatment, but on-treatment changes in CD4/CD8 ratio did not differ significantly between the two age groups.
The comparison involved 6439 previously untreated people with CD4 and CD8 values measured when the trial began and again after 48 weeks of treatment. Everyone began at least triple combination therapy. The 5774 people under 50 years old and the 665 older people did not differ significantly in proportions of men (79% overall) or race/ethnicity (45% Caucasian, 25% Hispanic, 20% black, and 5% Asian).
Median baseline CD4 count was significantly lower in the 50-and-older group (246 versus 288, P < 0.0001), as was baseline median CD4/CD8 ratio (0.27 versus 0.33, P < 0.0001). (A higher CD4/CD8 ratio is better.) Median pretreatment CD4 percent was lower in the older group (17% versus 19%), as was CD8 count (800 versus 825), but those differences were not statistically significant. Median baseline CD8 percent was higher in the older group (62% versus 58%), but that difference lacked statistical significance.
After 48 weeks of treatment, older trial participants gained significantly fewer CD4 cells than younger people (153 versus 173, P = 0.0037). But at the 48-week point, the two age groups did not differ significantly in CD4 percent change (+8% in both groups), CD8-cell change (-55 versus -45 in older versus younger people), CD8 percent change (-12% versus -10% in older versus younger people), or CD4/CD8 ratio change (+0.2 versus +0.3 in older versus younger people).
This analysis could not determine whether the T-cell differences between older and younger antiretroviral-naive people at trial entry reflect only age or also delayed diagnosis and entry into care by older people with HIV.
Reference
1. Shaefer M, Demarest J, Zhao H, et al. Effect of age on baseline CD4+and CD8+ cells and response to antiretroviral therapy (ART) over 48 weeks in a large clinical trial database. First International Workshop on HIV and Aging. October 4-5, 2010. Baltimore. Abstract O_05.
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