接受抗逆转录病毒治疗的男男性行为艾滋病毒感染者的死亡率和免疫指标：中国南方一项为期10年的回顾性队列研究

Mortality and immunological indicators of men who have sex with men living with HIV on antiretroviral therapy: a 10-year retrospective cohort study in Southern China.

作者信息

Lu Huaxiang, Chen Huanhuan, Liang Shujia, Ruan Yuhua, Jiang He, Huang Jinghua, Tan Guangjie, Wu Xiuling, Li Jianjun, Gong Chen, Zhu Qiuying, Lan Guanghua

机构信息

Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, 530028, China.

Chinese Field Epidemiology Training Program (CFETP), Beijing, 102206, China.

出版信息

BMC Infect Dis. 2025 Jan 28;25(1):135. doi: 10.1186/s12879-025-10531-3.

DOI:10.1186/s12879-025-10531-3

PMID:39875835

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11773718/

Abstract

BACKGROUND

The proportion of people living with HIV (PLHIV) in Guangxi who are men who have sex with men (MSM) increased rapidly to nearly 10% in 2023; notably, over 95% of this particular population is currently receiving antiretroviral therapy (ART). This study aimed to describe the survival of MSM PLHIV, depict the characteristics and trends of changes in CD4 T cell counts, CD4/CD8 T cell ratio, and viral load, and explore immunological indicators that may be related to mortality during different stages of treatment.

METHODS

Immunological indicators of MSM PLHIV receiving ART were extracted and categorized into baseline, mid-treatment, and last values. These were then incorporated into the Cox models in the form of repeated measurements to evaluate the associations (Adjusted-hazard ratios, aHRs) and 95% confidence intervals (95% CIs) of these immunological indicators with mortality at different stages.

RESULTS

A total of 5,642 patients who met the criteria were enrolled in the study, and 160 died, representing a mortality of 2.8%. The first, median, and last values of the CD4 count and the CD4/CD8 ratio in surviving patients were significantly greater than the corresponding values in nonsurviving patients (P < 0.001). Except for the first viral load (P = 0.379), the median and last viral loads of the former were significantly lower than those of the latter (P < 0.001). In Cox model, with 2,144 cases, immunological indicators of increased mortality risk included a baseline CD4 count below 200 cells/µL (aHR: 4.58, 95% CI: 2.28-9.19), a median (aHR: 8.46, 95% CI: 3.05-23.46), and a final (aHR: 4.43, 95% CI: 1.06-18.45) ratio below 0.7 and a median (aHR: 9.47, 95% CI: 4.02-22.35) and final (aHR: 14.46, 95% CI: 4.50-46.50) viral load 100,000 copies/mL and above.

CONCLUSIONS

Mortality among MSM PLHIV on ART in Guangxi is relatively low, and both high viral loads and low CD4/CD8 T cell ratios during treatment and at recent follow-up are strongly predictive of a serious prognosis and should be closely monitored.

摘要

背景

广西男男性行为者（MSM）中人类免疫缺陷病毒（HIV）感染者的比例在2023年迅速上升至近10%；值得注意的是，这一特定人群中超过95%目前正在接受抗逆转录病毒治疗（ART）。本研究旨在描述MSM HIV感染者的生存情况，描绘CD4 T细胞计数、CD4/CD8 T细胞比值和病毒载量的变化特征及趋势，并探索治疗不同阶段可能与死亡率相关的免疫指标。

方法

提取接受ART的MSM HIV感染者的免疫指标，并分为基线、治疗中期和末次值。然后将这些指标以重复测量的形式纳入Cox模型，以评估这些免疫指标在不同阶段与死亡率的关联（调整风险比，aHRs）和95%置信区间（95% CIs）。

结果

共有5642名符合标准的患者纳入研究，160人死亡，死亡率为2.8%。存活患者的CD4计数和CD4/CD8比值的首次、中位数和末次值显著高于非存活患者的相应值（P < 0.001）。除首次病毒载量外（P = 0.379），前者的中位数和末次病毒载量显著低于后者（P < 0.001）。在Cox模型中，纳入2144例病例，增加死亡风险的免疫指标包括基线CD4计数低于200个细胞/µL（aHR：4.58，95% CI：2.28 - 9.19）、中位数（aHR：8.46，95% CI：3.05 - 23.46）和末次（aHR：4.43，95% CI：1.06 - 18.45）比值低于0.7，以及中位数（aHR：9.47，95% CI：4.02 - 22.35）和末次（aHR：14.46，95% CI：4.50 - 46.50）病毒载量100,000拷贝/mL及以上。