CD4/CD8 ratio in pregnant women with HIV and its association with pregnancy outcome: data from a national study in Italy

Floridia, M.; Pinnetti, C.; Masuelli, G.; Spinillo, A.; Savasi, V. M.; Liuzzi, G.; Degli Antoni, A. M.; Sansone, M.; Guaraldi, G.; Dalzero, S.; Maso, G.; Francisci, D.; Sterrantino, G.; Ravizza, M.; Tamburrini, E.; Floridia, M.; Ravizza, M.; Tamburrini, E.; Ravizza, M.; Tamburrini, E.; Di Lorenzo, F.; Sterrantino, G.; Meli, M.; Campolmi, I.; Vichi, F.; Del Pin, B.; Marocco, R.; Mastroianni, C.; Mercurio, V. S.; Zanaboni, D.; Guaraldi, G.; Nardini, G.; Stentarelli, C.; Beghetto, B.; Degli Antoni, A. M.; Molinari, A.; Crisalli, M. P.; Donisi, A.; Ruggieri, A.; Piepoli, M.; Cerri, V.; Zuccotti, G.; Giacomet, V.; Paradiso, L.; Forlanini, F.; Longoni, E.; Placido, G.; Milini, P.; Savalli, F.; Sabbatini, F.; Papalini, C.; Bernini, L.; Grossi, P.; Rizzi, L.; Portelli, V.; Maso, G.; Bernardon, M.; Bussolaro, S.; Della Pieta, I.; Sorz, A.; Meloni, A.; Chiodo, A.; Dedoni, M.; Ortu, F.; Piano, P.; Citernesi, A.; Bordoni Vicini, I.; Luzi, K.; Roccio, M.; Vimercati, A.; Calabretti, D.; Gigante, S.; Guerra, B.; Cervi, F.; Simonazzi, G.; Margarito, E.; Capretti, M. G.; Marsico, C.; Faldella, G.; Sansone, M.; Martinelli, P.; Agangi, A.; Capone, A.; Maruotti, G. M.; Tibaldi, C.; Trentini, L.; Todros, T.; Masuelli, G.; Frisina, V.; Savasi, V.; Cardellicchio, E.; Giaquinto, C.; Fiscon, M.; Rubino, E.; Franceschetti, L.; Badolato, R.; Forleo, M. A.; Tassis, B.; Ruggiero, M.; Genovese, O.; Cafforio, C.; Pinnetti, C.; Casadei, A. M.; Cavaliere, A. F.; Cellini, M.; Marconi, A. M.; Dalzero, S.; Ierardi, M.; Simonetti, S. C.; Alfieri, N.; Agrati, S.; Polizzi, C.; Mattei, A.; Pirillo, M. F.; Amici, R.; Galluzzo, C. M.; Donnini, S.; Baroncelli, S.; Floridia, M.; Cerioli, A.; De Martino, M.; Parazzini, F.; Tamburrini, E.; Vella, S.; Martinelli, P.; Ravizza, M.

doi:10.1007/s15010-021-01619-4

Purpose: To evaluate associations between CD4/CD8 ratio and pregnancy outcomes in women with HIV. Methods: We evaluated, in a national study of pregnant women with HIV receiving antiretroviral treatment (ART), values of CD4/CD8 ratio at entry in pregnancy, changes between first and third trimester, and possible associations with preterm delivery, low birthweight, and HIV-RNA < 50 copies/ml at third trimester in univariate and multivariate analyses. Results: Among 934 women, 536 (57.4%) were already on ART at conception. CD4/CD8 ratio (baseline value 0.570) increased significantly between the first and third trimesters, particularly in women who started ART in pregnancy (+ 0.163, vs. + 0.036 in women already on treatment). The rate of CD4/CD8 ratio normalization, defined by achieving a ratio ≥ 1 at the third trimester, was 13.2%. In multivariable analyses, women who entered pregnancy with a CD4/CD8 ratio < 0.3, compared to women with ratio ≥ 1, were almost four-times less likely to have third-trimester HIV-RNA < 50 copies/ml (AOR 0.258, 95%CI 0.111–0.601), and more than twice as likely to have preterm delivery (AOR 2.379, 95%CI 1.082–5.232). For preterm delivery, also a baseline CD4/CD8 ratio between 0.3 and 0.45 was significantly associated with an increased risk (AOR: 3.415, 95%CI 1.690–6.900). Conclusion: We described for the first time independent associations of low CD4/CD8 ratio with preterm delivery and HIV-RNA suppression.