For timing of HAART is less more? CD4+/CD8+ ratio and CD4+ percentage as surrogate markers for more complex immunological features.

There is disagreement on the optimal timing of HAART initiation based on absolute CD4+ T-cell count (CD4+ count). We investigated if naive patients with CD4+ T-cell percentage (%CD4+) <29% or CD4+/CD8+ ratio <1 display signs of immune deterioration notwithstanding CD4+ count ?500 cells/?l. We found that these patients show B-cell aberrations and an impaired control of Torque Teno Virus replication. By contrast, patients with CD4+?500/?l, %CD4+?29% and CD4+/CD8+?1 displayed features of healthy subjects. Results obtained suggest that a combination of these parameters could be an adequate surrogate marker of immunological competence. This will be helpful in deciding when to start HAART.