Low CD4:CD8 ratio associated with higher risk of cancer among people with HIV in multi-nation study

A large European and Australian cohort study found a significantly higher risk of certain cancers when the CD4:CD8 ratio was <0.5, compared to ratios >1. TheCD4:CD8 ratio may be a proxy for altered immune function, which may affect the risk of malignancy in people with HIV, the researchers suggested.

About This Study

“Measures of Longitudinal Immune Dysfunction and Risk of AIDS and Non-AIDS Defining Malignancies in Antiretroviral Treated People With Human Immunodeficiency Virus (HIV)” was published online on Dec. 13, 2023, in Clinical Infectious Diseases. The lead author is Frédérique Chammartin, Ph.D., of the Division of Clinical Epidemiology in the Department of Clinical Research at University Hospital Basel and the University of Basel, Switzerland. Study authors include employees of ViiV Healthcare and Gilead Sciences, both manufacturers of HIV medications.

Key Research Findings

This prospective observational cohort study assessed the association of CD4:CD8 ratio and cancer risk in 19,247 adults on HIV treatment in Europe and Australia. Sixty-seven percent of participants were white, 77% of participants were men, and 71% of participants were <50 years old.

Between 2012-2020, 730 participants developed a first cancer, and 610 of these were non-AIDS defining malignancies. Lung cancer was the most common non-AIDS defining and smoking-related malignancy, while non-Hodgkin lymphoma was both the most common AIDS-defining malignancy and infection-related malignancy. Pancreatic cancer was the most common body mass index-related malignancy.

CD4:CD8 ratios <0.5 were associated with a greater risk of AIDS-defining and infection-related cancers compared to ratios >1, independent of CD4 counts. Viral loads ≥200 copies/mL were also associated with these types of malignancies. CD4 counts <350 cells/µL, but not CD8 counts, were associated with a greater risk of all cancer types.

Discussion Highlights and Implications for Practice

Study limitations reported included a lack of data on cancer-associated behaviors and viruses, including variables such as alcohol consumption, human papillomavirus or cytomegalovirus infections, or additional inflammation markers, such as interleukin-6 or D-Dimer levels. Unmeasured confounders may have also affected the findings, the researchers said.

In this study, the CD4:CD8 ratio was associated with a significantly higher risk of AIDS-defining and infection-related cancers, independent of CD4 counts, the researchers concluded. Using this ratio in addition to CD4 cell counts may identify people living with HIV who could benefit from additional cancer screenings, they said.

Further research is needed into whether such screening is useful in people with low immune function (CD4:CD8 ratio <1, CD4 cell count <350 cells/µL) who also smoke, the authors commented.

By Barbara Jungwirth