Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Clinical Immunology Center, Chinese Academy of Medical Sciences, Beijing, China.
BMC Immunol. 2021 Jun 3;22(1):36. doi: 10.1186/s12865-021-00426-8.
Some long-term non-progressors (LTNPs) have decreasing CD4 T cell counts and progress to AIDS. Exploring which subsets of CD4 T cell decreasing and the determinants associated with the decay in these patients will improve disease progression surveillance and provide further understanding of HIV pathogenesis.
Twenty-five LTNPs infected with HIV by blood products were classified as decreased (DG) if their CD4 cell count dropped to < 400 cells/μL during follow-up or as non-decreased (non-DG) if their CD4 cell count was ≥400 cells/μL. Laboratory and clinical assessments were conducted at 6 consecutive visits to identify DG characteristics.
The LTNPs were infected with HIV for 12 (IQR: 11.5-14) years, and 23 were classified as the B' subtype. Six individuals lost LTNP status 14.5 (IQR: 12.5-17.5) years after infection (DG), and the CD4 T cell count decreased to 237 (IQR: 213-320) cells/μL at the latest visit. The naïve CD4 T cell count decrease was greater than that of memory CD4 T cells [- 128 (IQR: - 196, - 107) vs - 64 (IQR: - 182, - 25) cells/μL)]. Nineteen individuals retained LTNP status (non-DG). At enrolment, the viral load (VL) level (p = 0.03) and CD8CD38 percentage (p = 0.03) were higher in DG than non-DG individuals. During follow-up, viral load and CD8CD38 percentage were significantly increased and negatively associated with CD4 cell count [(r = - 0.529, p = 0.008), (r = - 0.476, p = 0.019), respectively]. However, the CD8CD28 percentage and B cell count dropped in DG and were positively correlated with CD4 T cell count [(r = 0.448, p = 0.028), (r = 0.785, p < 0.001)].
Immunological progression was mainly characterized by the decrease of naïve CD4 T cell in LTNPs infected with HIV by blood products and it may be associated with high HIV RNA levels.
一些长期不进展者（LTNPs）的 CD4 T 细胞计数下降，并进展为艾滋病。探索 CD4 T 细胞下降的亚群以及与这些患者细胞衰减相关的决定因素，将改善疾病进展监测，并进一步了解 HIV 发病机制。
25 名经血液制品感染 HIV 的 LTNPs，如果其 CD4 细胞计数在随访期间降至 < 400 个/μL，则被分类为降低（DG），如果其 CD4 细胞计数为 ≥400 个/μL，则被分类为未降低（non-DG）。在连续 6 次就诊时进行实验室和临床评估，以确定 DG 的特征。
这些 LTNPs 感染 HIV 已有 12 年（IQR：11.5-14），其中 23 人被归类为 B'亚型。6 人在感染后 14.5 年（IQR：12.5-17.5）失去 LTN 状态（DG），CD4 T 细胞计数在最近一次就诊时降至 237（IQR：213-320）个/μL。幼稚 CD4 T 细胞计数下降大于记忆 CD4 T 细胞计数 [-128（IQR：-196，-107）比-64（IQR：-182，-25）个/μL]。19 人保持 LTN 状态（non-DG）。在入组时，DG 个体的病毒载量（VL）水平（p=0.03）和 CD8CD38 百分比（p=0.03）高于 non-DG 个体。在随访期间，病毒载量和 CD8CD38 百分比显著升高，与 CD4 细胞计数呈负相关[（r=-0.529，p=0.008），（r=-0.476，p=0.019）]。然而，DG 个体的 CD8CD28 百分比和 B 细胞计数下降，与 CD4 T 细胞计数呈正相关[（r=0.448，p=0.028），（r=0.785，p<0.001）]。
免疫进展主要表现为血液制品感染 HIV 的 LTNPs 中幼稚 CD4 T 细胞的减少，这可能与高 HIV RNA 水平有关。
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