Yu Hailiang, Yang Yuecheng, Cao Dongdong, Cao Yanfen, Shi Yun, Xiao Guifang, Li Pinyin, Feng Yanling, Wei Hua, Sun Jinting, Duan Song, Ye Runhua, Jin Cong
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, Dehong, 678400, China.
BMC Infect Dis. 2025 Apr 23;25(1):586. doi: 10.1186/s12879-025-10940-4.
The impact of human immunodeficiency virus (HIV) low-level viremia (LLV) on CD4 + T lymphocyte (CD4) cell count recovery during antiretroviral therapy (ART) remains unknown in China. This study aimed to investigate the association between LLV and CD4 count recovery among adults on ART in Southwest China.
A longitudinal cohort study of persons living with HIV (PLHIV) were conducted in Dehong Prefecture, Southwest China. Incidence of CD4 count recovery (CD4 cell count ≥ 500 cells/µl) was calculated for each follow-up year and characteristics of LLV (VL between 50 and 999 copies/ml) were described. Group-based trajectory model (GBTM) was used to identify and characterize the trajectories of CD4 cell count and VL during follow up. Longitudinal associations between LLV and CD4 count recovery were examined using a generalized estimating equation (GEE) with LLV as a time-updated variable.
The study included a total of 7,485 PLHIV who received ART between 2008 and 2021 in Dehong. The median follow-up duration was 8.5 years. At baseline, the participants had a median age of 36 years, with males accounting for 60.5%. The median CD4 cell count at baseline was 268 cells/µl. Results of GBTM demonstrated that 730 patients (9.8%) experience LLV trajectories and 2,125 patients (28.4%) reached CD4 count recovery during follow-up. Compared to participants with the trajectory of VL < 50 copies/ml, the probability of CD4 count recovery were lower among participants with the trajectories of LLV 50-199 copies/ml (adjusted odds ratio [aOR] 0.69, 95% confidence interval [CI] 0.63-0.76) and LLV 200-999 copies/ml (aOR 0.51, 95% CI 0.45-0.59), CONCLUSION: Sustained LLV is associated with poorer CD4 recovery among HIV patients who are receiving ART. Interventions to ensure that PLHIV maintain durably undetectable VL during treatment should be prioritized to achieve immune recovery.
在中国，抗逆转录病毒治疗（ART）期间人类免疫缺陷病毒（HIV）低水平病毒血症（LLV）对CD4 + T淋巴细胞（CD4）细胞计数恢复的影响尚不清楚。本研究旨在调查中国西南部接受ART治疗的成年人中LLV与CD4细胞计数恢复之间的关联。
在中国西南部的德宏州对HIV感染者（PLHIV）进行了一项纵向队列研究。计算每年随访时CD4细胞计数恢复（CD4细胞计数≥500个/µl）的发生率，并描述LLV（病毒载量在50至999拷贝/ml之间）的特征。使用基于组的轨迹模型（GBTM）来识别和描述随访期间CD4细胞计数和病毒载量的轨迹。使用广义估计方程（GEE），将LLV作为时间更新变量，研究LLV与CD4细胞计数恢复之间的纵向关联。
该研究共纳入了7485例2008年至2021年期间在德宏接受ART治疗的PLHIV。中位随访时间为8.5年。基线时，参与者的中位年龄为36岁，男性占60.5%。基线时CD4细胞计数的中位数为268个/µl。GBTM结果显示，730例患者（9.8%）经历了LLV轨迹，2125例患者（28.4%）在随访期间实现了CD4细胞计数恢复。与病毒载量轨迹<50拷贝/ml的参与者相比，病毒载量轨迹为50 - 199拷贝/ml（调整后的优势比[aOR] 0.69，95%置信区间[CI] 0.63 - 0.76）和200 - 999拷贝/ml（aOR 0.51，95% CI 0.45 - 0.59）的参与者中CD4细胞计数恢复的概率较低。
持续的LLV与接受ART治疗的HIV患者较差的CD4恢复相关。应优先采取干预措施，以确保PLHIV在治疗期间持续保持无法检测到的病毒载量，从而实现免疫恢复。
