Yu H L, Yang Y C, Zhao Y, Cao D D, Jin C, Ye R H, Cao Y F, Liu X J, Yao S T, Chen C, Duan S, Wu Z Y
National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
Dehong Dai and Jingpo Autonomous Prefecture Center for Disease Control and Prevention, Mangshi 678400, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2021 Jun 10;42(6):1050-1055. doi: 10.3760/cma.j.cn112338-20210326-00250.
To analyze the longitudinal characteristics of CD4T lymphocytes (CD4) among the adult HIV/AIDS on antiretroviral therapy (ART) and the related factors. A retrospective cohort of adult HIV/AIDS starting ART in Dehong Dai and Jingpo Autonomous Prefecture (Dehong) in 2007-2016 was followed up to December 31, 2018. Group-based trajectory models were utilized to identify CD4 subgroups based on immune recovery (whether and when CD4 reached the average level of >500 cells/μl). The demographics and information at ART baseline were described, and the related factors were analyzed with polytomous logistic regression. The SAS 9.4 software was used for statistical analysis. A total of 7 605 adults with HIV/AIDS were included, of which the median (,) age at ART were 36 (30,43) years old, 61.0% were male, 42.5% were Han nationality, and 60.8% with the education of primary school or below. The follow-up duration (, ) was 6.1 (4.1,8.1) years. HIV/AIDS in Dehong showed four CD4 trajectory subgroups from low to high: below the average level, primary recovery to a normal level, full recovery to a moderate level, and normal steady level, accounting for 34.4%, 39.8%, 20.6%, and 5.2%, respectively. When compared with corresponding control groups, age <35 years at ART, female, education of middle school or above, sexual transmission, no opportunistic infection, CD4 ≥200 cells/μl, baseline regimen with tenofovir (TDF) and time from HIV diagnosis to ART <1 year were the related factors facilitating the higher CD4 subgroups. The various CD4 immune recoveries of HIV/AIDS were changing patterns after ART. Starting ART with a high CD4 level was beneficial to CD4 recovery to normal level during the follow-up period. Early initiation of ART and exceptional attention to CD4 immune recovery should be encouraged after the ART.
分析接受抗逆转录病毒治疗（ART）的成年HIV/AIDS患者CD4 T淋巴细胞（CD4）的纵向特征及相关因素。对2007 - 2016年在德宏傣族景颇族自治州（德宏）开始接受ART的成年HIV/AIDS患者进行回顾性队列研究，随访至2018年12月31日。采用基于群体的轨迹模型，根据免疫恢复情况（CD4是否以及何时达到>500个细胞/μl的平均水平）确定CD4亚组。描述ART基线时的人口统计学和信息，并采用多分类逻辑回归分析相关因素。使用SAS 9.4软件进行统计分析。共纳入7605例成年HIV/AIDS患者，其中ART时的年龄中位数（四分位数间距）为36（30，43）岁，男性占61.0%，汉族占42.5%，小学及以下文化程度占60.8%。随访时间（四分位数间距）为6.1（4.1，8.1）年。德宏地区的HIV/AIDS患者显示出从低到高的四个CD4轨迹亚组：低于平均水平、初步恢复到正常水平、完全恢复到中等水平和正常稳定水平，分别占34.4%、39.8%、20.6%和5.2%。与相应对照组相比，ART时年龄<35岁、女性、中学及以上文化程度、性传播、无机会性感染、CD4≥200个细胞/μl、基线方案含替诺福韦（TDF）以及从HIV诊断到ART的时间<1年是促进CD4亚组水平升高的相关因素。HIV/AIDS患者的各种CD4免疫恢复情况在ART后呈变化模式。以较高的CD4水平开始ART有利于随访期间CD4恢复到正常水平。应鼓励早期开始ART并在ART后特别关注CD4免疫恢复情况。
