基线CD4^(+)T淋巴细胞计数水平与HIV/AIDS患者抗病毒治疗后免疫重建结局的关系研究

Relationship between baseline CD4^(+) T lymphocyte count and immune reconstitution after antiviral therapy in HIV/AIDS patients

目的探讨基线CD4^(+)T淋巴细胞计数水平与人类免疫缺陷病毒/获得性免疫缺陷综合征(HIV/AIDS)患者抗病毒治疗后免疫重建结局的关系。方法回顾性选取2021年9月至2022年3月中国科学技术大学附属第一医院(安徽省立医院)感染科收治的新确诊HIV/AIDS的患者110例,所有患者均接受高效抗逆转录病毒治疗(HAART),对患者进行1年随访,按照末次随访CD4^(+)T淋巴细胞计数<200个/μL或增长未超过基线的20%作为判定免疫重建不良的标准,对患者免疫重建结局进行分组,其中78例患者纳入免疫重建良好组,32例患者纳入免疫重建不良组,对患者治疗前后不同时间的CD4^(+)、CD8^(+)T淋巴细胞计数水平进行监测,并探究影响患者免疫重建结局的影响因素。结果治疗后3、6、9、12个月时,免疫重建不良组患者的病毒载量分别为26983(456,52239)、9126(316,14012)、1622(215,4501)、212(98,325)拷贝/mL,均高于免疫重建良好组[21598(412,48236)、6533(264,9154)、1231(152,2105)、135(52,287)拷贝/mL],差异均有统计学意义(P<0.05)。两组患者治疗前后各时间段的CD8^(+)T淋巴细胞计数水平组间比较,差异均无统计学意义(P>0.05)。单因素分析结果显示,感染途径、性别、学历水平、婚姻状态对其免疫重建效果无影响(P>0.05),年龄偏大、确诊至治疗时间在1年以上、基线CD4^(+)T淋巴细胞水平低、基线病毒载量高均会对患者的免疫重建效果产生负面影响(P<0.05)。多因素Logistic回归分析结果显示,年龄偏大、确诊至治疗时间在1年以上、基线CD4^(+)T淋巴细胞水平低、基线病毒载量高均会影响患者的免疫重建效果(OR=2.567,95%CI:1.075~6.127;OR=4.067,95%CI:1.690~9.785;OR=2.550,95%CI:1.096~5.934;OR=2.816,95%CI:1.203~6.591)。结论较高的基线CD4^(+)T淋巴细胞计数水平、较低的病毒载量有利于HIV/AIDS患者抗病毒治疗后的免疫重建,而基线CD4^(+)T淋巴细胞计数水平的低下可能是免疫重建不良的重要危险因素。

Objective To explore the relationship between baseline CD4^(+)T lymphocyte count and immune reconstitution after antiviral therapy in human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS) patients.Methods A total of 110 HIV/AIDS patients who admitted to in Department of Infectious Diseases,The First Affiliated Hospital of USTC(Anhui Provincial Hospital) from September 2021 to March 2022 were selected,all of whom were treated with highly active antiretroviral combination therapy.Patients were followed up for one year,according to the criteria for determining poor immune reconstructive at the last follow-up,CD4 CD4^(+)T lymphocyte count<200/μL or the increase did not exceed 20% of baseline,the outcome of patients with immune reconstructive was classified:78 patients were included in the good immune reconstructive group,32 patients were included in the poor immune reconstructive group.The levels of CD4^(+)T lymphocyte and CD8^(+)T lymphocyte were monitored at different times before and after treatment,and the influential factors affecting the immune reconstructive of patients were explored.Results At 3,6,9 and 12 months after treatment,the viral load of patients in the poor immune reconstructive group were 26 983(456,52 239),9 126(316,14 012),1 622(215,4 501),and 212(98 325) copies/mL,respectively,which were higher than thsoe in the good immune reconstructive group[21 598(412,48 236),6 533(264,9 154),1 231(152,2 105),and 135(52 287) copies/mL],the differences were statistically significant(P<0.05).There were no statistically significant differences in CD8^(+)T lymphocyte level between the two groups before and after treatment(P>0.05).Through univariate analysis,the results showed that the infection route,gender,educational level and marital status had no effect on the immune reconstructive effect of patients(P>0.05),but older age,more than one year from diagnosis to treatment,low baseline CD4 cell level and high baseline viral load all had negative effects on the immune reconstructive effect of patients(P<0.05).The results of multivariate analysis showed that older age,more than one year from diagnosis to treatment,low baseline CD4^(+)T lymphocyte level,and high baseline viral load all affected the immune reconstructive effect of patients(OR=2.567,95%CI:1.075-6.127;OR=4.067,95%CI:1.690-9.785;OR=2.550,95%CI:1.096-5.934;OR=2.816,95%CI:1.203-6.591;P<0.05).Conclusion The baseline level of CD4^(+)T lymphocyte lymphocyte count is associated with immune reconstitution in HIV/AIDS patients after antiviral therapy,and low baseline CD4^(+)T lymphocyte level may be a risk factor for poor immune reconstitution.These findings have important clinical implications for improving treatment strategies and immune recovery in HIV/AIDS patients.