Wan Xinrui, Li Mingyu, Wang Hongye, Zhang Ruixian, Lu Xiaoning, Song Yu, He Chenglu, Zhang Renning, Sun Ming, Chen Hongying, Li Ya
Department of Clinical Laboratory, The Third People's Hospital of Kunming, Kunming, China.
Department of Laboratory Medicine, Yunnan Provincial Institute of Infectious Diseases, Kunming, China.
Front Cell Infect Microbiol. 2024 Dec 17;14:1436123. doi: 10.3389/fcimb.2024.1436123. eCollection 2024.
This study aims to investigate the differences of clinical indices in HIV patients between three different first-line antiretroviral treatment strategies in Yunnan Province, China. Furthermore, the hematologic system, liver function, kidney function, blood lipid levels of HIV patients and its association with CD4+ count, CD8+ count, CD4/CD8 ratio and antiretroviral treatment were also assessed.
This retrospective cohort study included 81 participants who underwent highly active antiretroviral treatment from September 2009 to September 2019. Baseline sociodemographic and clinical characteristics were collected from each study participant. Routine blood tests, liver and renal function, lipid levels as well as lymphocyte subset counts were measured and recorded for evaluation before and 3, 6, 9, and 12 months after the treatment. Paired t-test was used to compare clinical indices changes after antiretroviral treatment. Univariate linear regression was performed to determine the association between clinical indices and CD4+ count, CD8+ count, CD4/CD8 ratio and antiretroviral treatment.
There were no statistical differences in baseline demographic and clinical characteristics in either treatment group. Compared with the initiation of HARRT treatment, the CD4+ count(p < 0.001), CD4/CD8 ratio(p < 0.001) and PLT(p < 0.001) were increased in the three treatment groups. The TC(p < 0.01) and TG(p < 0.05) were increased in 3TC+AZT+EFV group after treatment. The ALT(p < 0.05), AST(p < 0.01) were decreased in 3TC+EFV+TDF group after treatment. The study indicated statistical differences in CD4+ count (p < 0.001), CD8+ count (p < 0.001), and CD4/CD8 ratio (p < 0.001) in the three treatment cohorts. Furthermore, a strong positive correlation was observed between WBC (p < 0.001), platelet (p < 0.001), Hb (p < 0.001), and CD4+ count in the three treatment cohorts. Moreover, ALT and AST were negatively associated with CD4+ count in the 3TC + AZT + EFV group. Whereas WBC were positively correlated with CD8+ count in the three treatment methods. In addition, platelet and TG were positively correlated with CD8+ count in the 3TC + EFV + TDF. The study also indicated that TC was positively associated with CD8+ count in the 3TC + AZT + NVP group. Furthermore, WBC was negatively related to CD4/CD8 ratio in the 3TC + EFV + TDF group. The platelet level analysis revealed a positive, while TG indicated a negative association with CD4/CD8 ratio in the 3TC + AZT + NVP group. Moreover, ALT and AST were negatively correlated with the CD4/CD8 ratio in the 3TC + AZT + EFV and 3TC + AZT + NVP groups.
The results showed that HIV/AIDS patients treated with different first-line antiretroviral treatment strategies had different hematopoietic, liver, renal and immune system functions. Furthermore, some clinical indicators such as WBC, PLT, TC, TG, and ALT could predict the CD4+ count, CD8+ count, CD4/CD8 ratio levels and recuperation of HIV/AIDS patients, therefore, should be monitored by clinicians.
本研究旨在调查中国云南省三种不同一线抗逆转录病毒治疗策略的HIV患者临床指标的差异。此外，还评估了HIV患者的血液系统、肝功能、肾功能、血脂水平及其与CD4 + 计数、CD8 + 计数、CD4/CD8比值和抗逆转录病毒治疗的关联。
这项回顾性队列研究纳入了81名在2009年9月至2019年9月期间接受高效抗逆转录病毒治疗的参与者。收集了每位研究参与者的基线社会人口统计学和临床特征。在治疗前以及治疗后3、6、9和12个月测量并记录常规血液检查、肝肾功能、血脂水平以及淋巴细胞亚群计数，以进行评估。采用配对t检验比较抗逆转录病毒治疗后临床指标的变化。进行单变量线性回归以确定临床指标与CD4 + 计数、CD8 + 计数、CD4/CD8比值和抗逆转录病毒治疗之间的关联。
各治疗组的基线人口统计学和临床特征无统计学差异。与开始高效抗逆转录病毒治疗相比，三个治疗组的CD4 + 计数（p < 0.001）、CD4/CD8比值（p < 0.001）和血小板（p < 0.001）均有所增加。治疗后，3TC + AZT + EFV组的总胆固醇（p < 0.01）和甘油三酯（p < 0.05）升高。治疗后，3TC + EFV + TDF组的谷丙转氨酶（p < 0.05）、谷草转氨酶（p < 0.01）降低。研究表明，三个治疗队列的CD4 + 计数（p < 0.001）、CD8 +计数（p < 0.001）和CD4/CD8比值（p < 0.001）存在统计学差异。此外，三个治疗队列中白细胞（p < 0.001）、血小板（p < 0.001）、血红蛋白（p < 0.001）与CD4 + 计数之间存在强正相关。此外，在3TC + AZT + EFV组中，谷丙转氨酶和谷草转氨酶与CD4 + 计数呈负相关。而在三种治疗方法中，白细胞与CD8 + 计数呈正相关。此外，在3TC + EFV + TDF组中，血小板和甘油三酯与CD8 + 计数呈正相关。研究还表明，在3TC + AZT + NVP组中，总胆固醇与CD8 + 计数呈正相关。此外，在3TC + EFV + TDF组中，白细胞与CD4/CD8比值呈负相关。血小板水平分析显示，在3TC + AZT + NVP组中，血小板与CD4/CD8比值呈正相关，而甘油三酯呈负相关。此外，在3TC + AZT + EFV和3TC + AZT + NVP组中，谷丙转氨酶和谷草转氨酶与CD4/CD8比值呈负相关。
结果表明，采用不同一线抗逆转录病毒治疗策略治疗的HIV/AIDS患者具有不同的造血、肝脏、肾脏和免疫系统功能。此外，一些临床指标如白细胞、血小板、总胆固醇、甘油三酯和谷丙转氨酶可以预测HIV/AIDS患者的CD4 + 计数、CD8 + 计数、CD4/CD8比值水平和恢复情况，因此，临床医生应进行监测。
