National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, People's Republic of China.
Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of PLA General Hospital, Beijing, People's Republic of China.
Emerg Microbes Infect. 2020 Dec;9(1):2550-2561. doi: 10.1080/22221751.2020.1840928.
Using normalization of CD4 counts as the main evaluation parameter of complete immune restoration for HIV-1 patients under antiretroviral therapy (ART) might be not enough. A comprehensive evaluation system more accurately reflecting immune restoration are urgently needed. Totally, 91,805 HIV-1 patients from 17 tertiary hospitals in China during 2005-2018 were included in this study. Immune restoration and mortality were assessed. Patients initiated ART with baseline CD4 counts <50, 50-199, 200-349, 350-499, and ≥500 cells/μL, and results showed an increase in the median CD4 counts to 445 (12-year), 467 (12-year), 581 (11-year), 644 (7-year), and 768 cells/µL (5-year), as well as the CD4/CD8 ratio to 0.59 (12-year), 0.65 (12-year), 0.79 (11-year), 0.82 (7-year), 0.9 (5-year), respectively. The median CD8 count was relatively high (median range 732-845 cells/μL), regardless of the baseline CD4 counts. Furthermore, the probabilities of death in patients achieving CD4 counts ≥500 cells/μL and CD4/CD8 ratio ≥0.8 simultaneously were significantly lower than those in patients achieving either CD4 counts ≥500 cells/μL (2.77% vs 3.50%, =0.02) or CD4/CD8 ≥ 0.8 (2.77% vs 4.28%, <0.001) after 12-year of ART. In this study, a new binary-indicator would accurately assess immune restoration in the era of "treat all."
使用 CD4 计数的标准化作为接受抗逆转录病毒疗法 (ART) 的 HIV-1 患者完全免疫恢复的主要评估参数可能还不够。需要一种更准确反映免疫恢复的综合评估系统。本研究共纳入了来自中国 17 家三级医院的 2005 年至 2018 年间的 91805 例 HIV-1 患者。评估免疫恢复和死亡率。患者在基线 CD4 计数 <50、50-199、200-349、350-499 和 ≥500 个细胞/μL 时开始接受 ART，结果显示 CD4 计数中位数增加至 445（12 年）、467（12 年）、581（11 年）、644（7 年）和 768 个细胞/μL（5 年），以及 CD4/CD8 比值增加至 0.59（12 年）、0.65（12 年）、0.79（11 年）、0.82（7 年）和 0.9（5 年）。无论基线 CD4 计数如何，CD8 计数中位数均相对较高（中位数范围为 732-845 个细胞/μL）。此外，在达到 CD4 计数≥500 个细胞/μL 和 CD4/CD8 比值≥0.8 的患者中，达到 CD4 计数≥500 个细胞/μL 的患者（2.77%比 3.50%，=0.02）或 CD4/CD8 比值≥0.8 的患者（2.77%比 4.28%，<0.001）的死亡概率在 12 年后均显著降低。在这项研究中，一种新的二元指标可以在“治疗所有”的时代准确评估免疫恢复。
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