Charles River Medical Group.
Unit of Internal Medicine, Department of Primary Healthcare Sciences, University of Zimbabwe, Harare, Zimbabwe.
AIDS. 2023 Dec 1;37(15):2311-2318. doi: 10.1097/QAD.0000000000003695. Epub 2023 Aug 17.
HIV/AIDS mortality remains significantly high in sub-Saharan Africa, mostly driven by opportunistic infections and advanced HIV disease (AHD). This study aimed to assess CD4 + cell count recovery following ART initiation and factors associated with immune reconstitution.
We conducted a prospective cohort study between 2015 and 2016. HIV-infected adults (≥18 years) with AHD (CD4 + cell count ≤100 cells/μl) receiving care at 20 outpatient HIV treatment facilities in Harare, Zimbabwe were enrolled. CD4 + cell count recovery (CD4 + cell count >200 cells/μl) was assessed following 12-month ART initiation and factors associated with immune reconstitution were investigated using logistic regression analysis. All statistical analyses were performed on Statistical Package for the Social Sciences (SPSS) version 23.
1320 participants were enrolled and 56.4% were males. The median (interquartile range, IQR) age was 37 (32-43) years. Tuberculosis was seen in 16.0%. Of the 739 participants that had CD4 + cell count at 12 months, CD4 + cell count recovery above 200 cells/μl was observed in 163 (22.1%) participants. Median (IQR) CD4 + cell count at 12-months increased to 127 (75-190) cells/μl from 31 (14-55) at baseline. Factors associated with CD4 + cell count recovery were younger age at baseline [odds ratio (OR) ≥40/<40 = 0.58, 95% confidence interval (CI): 0.40-0.85, P = 0.005), sex (OR female/male = 2.07, 95% CI: 1.44-2.99, P < 0.0001) and baseline CD4 + cell count (OR ≥50/<50 = 1.60, 95% CI: 1.10-2.33, P = 0.013).
A significant proportion (77.9%) of patients seeking care with AHD in a resource limited setting failed to recover a CD4 + cell count >200 cells/μl. Male sex, older age and low CD4 + cell count at ART initiation were factors associated with poor immune reconstitution. Better differentiated care deliveries targeting this vulnerable population are critical for improving clinical outcomes and quality of life of the patients.
在撒哈拉以南非洲，艾滋病毒/艾滋病的死亡率仍然很高，主要是由机会性感染和晚期艾滋病（AHD）引起的。本研究旨在评估接受抗逆转录病毒治疗（ART）后 CD4 + 细胞计数的恢复情况，并探讨与免疫重建相关的因素。
我们于 2015 年至 2016 年进行了一项前瞻性队列研究。在津巴布韦哈拉雷的 20 个门诊艾滋病毒治疗机构接受治疗的患有 AHD（CD4 + 细胞计数≤100 个/μl）的成年艾滋病毒感染者（≥18 岁）被纳入研究。在开始接受 ART 治疗 12 个月后，评估 CD4 + 细胞计数的恢复情况（CD4 + 细胞计数>200 个/μl），并使用逻辑回归分析探讨与免疫重建相关的因素。所有统计分析均使用社会科学统计软件包（SPSS）版本 23 进行。
共纳入 1320 名参与者，其中 56.4%为男性。中位（四分位距，IQR）年龄为 37（32-43）岁。16.0%的参与者患有结核病。在 739 名有 CD4 + 细胞计数的参与者中，有 163 名（22.1%）参与者的 CD4 + 细胞计数恢复到 200 个/μl 以上。中位（IQR）CD4 + 细胞计数在 12 个月时从基线时的 127（75-190）个/μl 增加到 31（14-55）个/μl。与 CD4 + 细胞计数恢复相关的因素包括：年龄较小[年龄基线≥40/＜40 的比值比（OR）=0.58，95%置信区间（CI）：0.40-0.85，P=0.005]、性别（女性/男性的 OR=2.07，95%CI：1.44-2.99，P＜0.0001）和基线 CD4 + 细胞计数（OR≥50/＜50=1.60，95%CI：1.10-2.33，P=0.013）。
在资源有限的环境中，寻求 AHD 治疗的患者中，有很大一部分（77.9%）未能恢复 CD4 + 细胞计数>200 个/μl。男性、年龄较大和 ART 开始时 CD4 + 细胞计数较低是与免疫重建不良相关的因素。针对这一脆弱人群提供更好的差异化护理服务对于改善患者的临床结局和生活质量至关重要。
