Factors affecting immune reconstitution in HIV/AIDS patients after antiretroviral therapy
Objective To investigate the immune reconstitution of HIV/AIDS patients and its influencing factors after re-ceiving antiviral therapy(ART)in Hangzhou City,so as to provide insights into improving the treatment effects and quality of life in HIV/AIDS patients.Methods A retrospective cohort of HIV/AIDS patients who began antiviral treat-ment between January 1,2016 and August 31,2021 and had a baseline CD4+T lymphocyte(CD4)counts of less than 500 cells/μL or a baseline CD4/CD8+T lymphocyte(CD8)ratio of less than 0.8 in Hangzhou City was followed up until August 31,2023.Demographic information,antiviral therapy in formation,CD4 counts,and CD4/CD8 were collected from the Chinese Disease Prevention and Control Information System.A good immune reconstitution was defined as hav-ing CD4≥500 cells/μL and CD4/CD8≥0.8.The immune reconstitution status of HIV/AIDS patients were analyzed,and factors affecting immune reconstitution were identified using a multivariable Cox proportional risk regression model.Re-sults A total of 3 349 HIV/AIDS patients were enrolled,with a median age at ART of 31(interquartile range,20)years.There were 3 075 males(91.82%),1 600 cases with college education and above(47.78%)and 2 455 cases at WHO clinical stage Ⅰ-Ⅱ(73.31%).There were 1 368 cases with good immune reconstitution,accounting for 40.85%,and the proportion of HIV/AIDS patients with good immune reconstitution that began ART in 2016 was the highest,reaching 51.90%.Multivariable Cox proportional risk regression model identified WHO clinical stage(Ⅰ-Ⅱ,HR=2.529,95%CI:2.023-3.162),timely ART(HR=1.196,95%CI:1.027-1.394),initial treatment regimen(TDF+3TC+NVP/EFV,HR= 2.185,95%CI:1.891-2.524;integrase inhibitors,HR=8.509,95%CI:6.706-10.795),baseline CD4/CD8(≥0.1,HR:1.600-4.515,95%CI:1.061-6.661),baseline hemoglobin(<90 mg/dL,HR=0.327,95%CI:0.121-0.880),hepatitis B infection(HR=0.619,95%CI:0.457-0.840)and hepatitis C infection(HR=0.308,95%CI:0.099-0.956)as factors affecting immune reconstitution in HIV/AIDS patients.Conclusion The immune reconstitution in HIV/AIDS patients after ART is associat-ed with WHO clinical stage,timely ART,initial treatment regimen,baseline CD4/CD8,baseline hemoglobin and hepati-tis B or C infection.
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