HAART治疗AIDS患者基线CD4^+细胞水平对免疫重建效果的预测价值

Predictive value of baseline CD4^+Cell Counts and CD4/CD8 ratio in immune reconstitution in HIV/AIDS patients receiving highly effective antiretroviral therapy

目的探讨高效抗逆转录病毒治疗(HAART)AIDS患者基线CD4+细胞计数和CD4/CD8水平对免疫重建效果的预测价值。方法选取2008年6月至2017年12月于南京市第二人民医院完成24个月HAART治疗且病毒载量<50拷贝/毫升的患者共90例纳入研究,根据其治疗完成后CD4+细胞数分为3组:免疫无反应者(INRs)(<200个/μL),免疫应答不足(IIRs)(200~500个/μL)和免疫应答(IRs)(>500个/μL);比较3组之间的特征及动态CD4+细胞计数,进行免疫重建的因素分析。结果3组基本特征比较发现,CD4+细胞基线值与确认HIV至HAART治疗开始时间的方面差异具有统计学意义(P<0.05)。经抗病毒治疗后,IRs组CD4+细胞计数明显高于INRs和IIRs组,差异具有统计学意义(P<0.001)。ROC曲线下面积表明HAART治疗1年时CD4+细胞数达到最高预测价值。结论早期开启HAART可以减少免疫重建失败率。结合CD4+细胞基线数和CD4/CD8比值可以作为一个有效预测HAART治疗后免疫重建诊断的指标。

Objective To explore the predictive value of baseline CD4+cell counts and CD4/CD8 ratio in immune reconstitution among HIV/AIDS patients receiving highly effective antiretroviral therapy(HAART).Methods A total of 90 HIV/AIDS patients who had received over 24 months of HAART regimen and had viral road<50 copies/ml were enrolled in this study.The patients were subgrouped into immunological non-responders(INRs)(<200 cells/μL),immunological inadequate responders(IIRs)(200~500 cells/μL)and immunological responders(IRs)(>500 cells/μL)according to the CD4 cell counts after two-year HAART regimen.The characteristics and dynamic CD4+cell counts among the three groups were compared,and the factors of immune reconstitution were analyzed.Results The CD4+cell counts in the immunological responders(IRs)were significantly higher than those in the immunological non-responders(INRs)and immunological inadequate responders(IIRs)(P<0.001).The analysis of area under the ROC curve reveled that the number of CD4+cells reached the highest predictive value at 1 year of HAART.Conclusion Our findings suggested that early initiation of HAART could reduce the failure of immune reconstitution.The combination of baseline CD4+cell counts and baseline CD4/CD8 ratio may serve as a valid predictor of immune reconstitution prognosis after HAART.