Among virally suppressed HIV patients in France, tobacco, alcohol, and cannabis use were not significantly associated with worse CD4/CD8 ratios, though chemsex-associated drug users showed a trend toward greater immune inflammation.
Read this if you are living with HIV and wonder whether cannabis or other substance use affects your immune recovery.
47.7%Nearly half of virally suppressed HIV patients had CD4/CD8 ratios below 1
What the researchers found
In 660 virally suppressed people living with HIV, nearly half (47.7%) had CD4/CD8 ratios below 1, indicating persistent immune activation. However, tobacco, alcohol, and cannabis use were not significantly associated with differences in this ratio. The only notable finding was that chemsex-associated drug users (poppers, GHB/GBL, amphetamines, synthetic cathinones) had CD4/CD8 ratios that were 0.226 lower on average, though this just missed significance in the adjusted analysis (p=0.068).
Why it matters
The CD4/CD8 ratio is a marker of chronic inflammation and immune health beyond viral suppression. This study suggests that common substance use may not be the primary driver of persistent immune activation in treated HIV, but chemsex-related drugs warrant further investigation.
The numbers in context
- 660 participants, mean age 54.7 years
- 47.7% had CD4/CD8 ratio < 1
- Mean CD4/CD8 ratio: 1.1 ± 0.6
- 35% smoked tobacco; ~40% hazardous drinkers
- 19.9% used cannabis; 11.9% other drugs
- Chemsex drug users: 0.226 lower CD4/CD8 ratio (p=0.005 unadjusted; p=0.068 adjusted)
How the study worked
Multi-center cross-sectional analysis from 2018-19 in the QuAliV study (ANRS CO3 AQUIVIH-NA cohort) in Nouvelle Aquitaine, France. Self-reported substance use was linked to medical record data. Multivariable linear regression adjusted for age, sex, HIV risk group, time since diagnosis, and other drug use.
Who was studied
660 virally suppressed people living with HIV in Nouvelle Aquitaine, France
What this study cannot tell us
Cross-sectional design cannot establish causation. Self-reported substance use may underestimate actual consumption. CD4/CD8 measurements within a 2-year window of self-report introduce temporal imprecision. The study was conducted in a single French region.
How to read the evidence
Cross-sectional observational study with multivariable adjustment. Adequate sample size but limited by self-reported exposure data and temporal imprecision.
When this study was published
Published in 2023 using 2018-2019 data. Reflects current treatment era for HIV.
The bigger picture
As HIV becomes a manageable chronic condition, understanding what drives persistent immune activation in treated patients is increasingly important. This study suggests the focus should be on factors beyond common substance use, though party drug culture may present unique immune risks.
Questions still open
- What specific mechanisms might explain the lower CD4/CD8 ratio in chemsex drug users?
- Does long-term cannabis use have different immune effects than the cross-sectional snapshot captured here?
- Would interventions targeting chemsex-associated drug use improve immune markers?
Read the original research
Tobacco, alcohol, cannabis, and illicit drug use and their association with CD4/CD8 cell count ratio in people with controlled HIV: a cross-sectional study (ANRS CO3 AQUIVIH-NA-QuAliV).
BMC infectious diseases, 23(1), 16
Citation
Devos, Sophie; Bonnet, Fabrice; Hessamfar, Mojgan; Neau, Didier; Vareil, Marc-Olivier; Leleux, Olivier; Cazanave, Charles; Rouanes, Nicolas; Duffau, Pierre; Lazaro, Estibaliz; Dabis, François; Wittkop, Linda; Barger, Diana. (2023). Tobacco, alcohol, cannabis, and illicit drug use and their association with CD4/CD8 cell count ratio in people with controlled HIV: a cross-sectional study (ANRS CO3 AQUIVIH-NA-QuAliV).. BMC infectious diseases, 23(1), 16. https://doi.org/10.1186/s12879-022-07963-6