Research Article Coinfection by Hepatitis C Is Strongly Associated with Abnormal CD4/CD8 Ratio in HIV Patients under Stable ART in Salvador, Brazil Clara Brites-Alves, Eduardo Martins Netto, and Carlos Brites Laboratorio de Pesquisas em Infectologia, Complexo Hospital Universit´ ario Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil Correspondence should be addressed to Carlos Brites; crbrites@gmail.com Received 15 April 2015; Accepted 16 July 2015 Academic Editor: Paola Nistico Copyright © 2015 Clara Brites-Alves et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Proper immune restoration (CD4 count >500 and normal CD4/8 ratio) is reached only by a fraction of HIV patients, despite stable viral suppression. Methods. We present a case-control study to compare HIV patients with viral suppression >1 year, according to immune restoration pattern: adequate response (AR) defned by CD4 > 500 cells/mm 3 and CD4/8 ratio >1; partial response (PR = patients with CD4 > 500, but CD4/8 ratio <1); inadequate response (IR = CD4 < 500 cells). Results. We evaluated 293 consecutive patients (89 AR, 112 PR, and 92 IR), 70% males. Male gender ( < 0.01), lower mean CD4 nadir ( < 0.001), higher baseline VL ( = 0.01), previous diagnosis of Tb ( = 0.03), or HCV ( < 0.01) was associated with IR. Likelihood of AR/PR was similar regardless of gender, afer adjusting for nadir CD4+ cells count. Longer time under suppressive ART was also associated with a greater chance of AR, but logistic regression identifed coinfection by HCV as the main factor associated with abnormal CD4/CD8 ratio. Conclusion. Early initiation of ART and longer time since frst undetectable PVL were predictors of AR. Previous HCV diagnosis signifcantly increases the risk of abnormal CD4/CD8 ratio. 1. Introduction Te use of highly active antiretroviral therapy (HAART) dra- matically changed the natural history of AIDS. Te develop- ment of new antiretroviral drugs/classes made treating even highly experienced patients possible, with success rates sim- ilar to those obtained in therapy of drug-na¨ ıve individuals. Tese advances extended the life expectancy for early treated AIDS patients but also revealed the increased frequency of noninfectious events presented by treated HIV patients [1– 4]. One explanation for this phenomenon resides in the facts that even individuals achieving sustained suppression of HIV RNA plasma viremia ofen fail in restoring CD4 count to a normal range [5–7]. Progressive CD4+ cell depletion is the main landmark of untreated HIV infection. Te immunological goal of antiretroviral therapy is to restore the levels of that lym- phocytes subpopulation to normal range [6]. However, only a minority of patients starting ART with CD4+ cells count lower than 200 will reach a CD4 count above 500 cells/mm 3 , despite virological suppression [7–9]. In addition, even indi- viduals presenting with CD4 count above that threshold ofen fail in achieving a normal CD4/CD8 ratio (equal to or above 1.0). Failure to reach a normal CD4/8 ratio is associated with an increased frequency of non-AIDS events and death [10, 11]. Several factors have been associated with inadequate immune restoration (failure in reaching a CD4 count >500 cells/mm 3 ), such as low CD4 nadir, older age, high pretherapy HIV viral load, and gender [5–9]. However, we have scarce studies focusing on predictors of normalization of CD4/8 ratio. In the present work, we used a case-control design to defne the factors driving an adequate CD4 gain and normal CD4/CD8 ratio in HIV patients under suppressive therapy, in Salvador, Brazil. Hindawi Publishing Corporation Journal of Immunology Research Volume 2015, Article ID 174215, 6 pages http://dx.doi.org/10.1155/2015/174215