Garrido-Rodríguez, Vanesa , Bulnes-Ramos, Ángel , Olivas-Martínez, Israel , Pozo-Balado, María Del Mar , Tejerina-Picado, Francisco , Gutiérrez, Félix , Marco-Sánchez, Cristina , Tiraboschi, Juan Manuel , Castillo-Navarro, Antonia , Bernal, Enrique , Garcia-Guerrero, Maria C , Puertas, Maria C , Peraire, Joaquim , Rull, Anna , Martinez-Picado, Javier , Pacheco, Yolanda María
No
Front. Immunol.
Article
Científica
08/09/2025
001576288300001
BACKGROUND: People living with chronic HIV (PLWH) show immune dysfunction, despite viral suppression and normal CD4 recovery, particularly those with low CD4/CD8 ratios. Subjacent cellular alterations of such a reliable marker of clinical progression remain elusive. METHODS: Categorization by CD4/CD8 ratio after three year of therapy (R < 0.8/R > 1.2, n = 28/n = 24) and post-hoc reclassification by nadir-CD4 (N = 350/N > 350) were performed in PLWH achieving viral suppression and CD4 = 500. CD4 T cell-associated viral reservoir, as well as metabolism-related gene expression, glucose uptake ability, relative telomere length (RTL), and thymic output for CD4 and CD8 T cells, were determined. RESULTS: Patients with a CD4/CD8 ratio < 0.8 exhibited reduced CD8 T-cell glucose uptake ability after stimulation (p = 0.007) and trends to shorter RTL (p = 0.093) and to larger CD4-associated viral reservoir (p = 0.068) than R > 1.2. Differently, patients with nadir =350 exhibited altered CD4 and CD8 T-cell expression of metabolism-related genes, although no differences in glucose uptake ability, and shorter RTL in both cell subsets, but similar viral reservoir to patients with nadir >350. Remarkably, viral reservoir and both CD4 and CD8 thymic output showed inverse associations (r = -0.623, p = 0.01 and r = -0.661, p = 0.038, respectively). CONCLUSION: A low CD4/CD8 ratio in chronic PLWH stands on a larger viral reservoir in CD4 T cells and metabolic alterations in CD8 T cells, probably related to its exhaustion and compromised effector functionality, and thymic output could contribute to such alterations. Patients with lower nadir-CD4 showed a resting-like CD4 phenotype and a metabolically active CD8 subset, without further viral reservoir extension. Persistence of low CD4/CD8 ratio and low nadir-CD4 counts seems to rely on different immune damage.
CD4/CD8 ratio; HIV-infection; immunometabolism; nadir-CD4 T cell; thymic output; viral reservoir