Research On Influencing Factors Of Poor Immune Response In HIV/AIDS Patients

Objectives:To explore the factors that influence the recovery of immune function in HIV-AIDS patients who have received long-term Antiretroviral Ther apy(ART),and the viral load is completely suppressed.And to explore the corre lation between HIV-DNA and immune response,to provide data support for cli nical diagnosis and treatment.Methods:This study is based on the antivirus treatment database of the Nationa 1 AIDS comprehensive prevention and treatment data information system.In the first part,we used a case control study to analyze the influencing factors of poor immune response.The HIV/AIDS patients with 5 years of ART were selected as the study sub jects,the patients with poor immune response in the case group(PIR group)and the p atients with a good immune response in the control group(IR group).Clinical data co llected included basic demographic data,baseline and laboratory data of Art Yea r 5.The whole population data was randomly divided into modeling database(trainin g set,70%)and validation data set(validation set,30%).The training set is used t o determine the fitting model of multi-factor Logistic regression and draw the line ch art.The validation set is used to validate the model internally,and the calibration an d discrimination of the model are calculated respectively to evaluate the prediction ab ility of the model.In the second part,a cross sectional study was utilized to analyze the correlatio n between HIV-DNA and poor immune response.Twenty-four samples were randoml y collected from PIR Group and IR group in the first part of the study,and HIV-D NA was quantified by PCR with Polymerase Chain Reaction(PCR).Binary Logistic regression was used to analyze the relationship between HIV-DNA and Immune res ponse,linear regression was used to analyze the related factors of HIV-DNA Load.Results:A total of 1025 patients with HIV/AIDS were included in this study,including 888(86.63%)patients with good immune response and 137(13.36%)patients with a poor immune response.(1)Logistic regression model analysis of training set found:age(OR=2.233;95%CI:1.234,4.069),the current ART program(OR=0.346;95%CI:0.157,0.714),baseline CD4+T cell count(OR=0.986;95%CI:0.980,0.992)and platelet count(OR=0.992;95%CI:0.987,0.997)are factors influencing the occurrence of poor immune response.Old age is a risk factor for PIR,HIV/AIDS patients over 50 years are more likely to develop PIR.While use TDF/AZT+3TC+LPV/r/INSTIs regimen,higher baseline CD4+T cell count and higher platelet count are protective factors.(2)The internal population verification of the prediction model found that:Discrimination:the area under the ROC curve AUC is 0.868(95%CI:0.814,0.922),P<0.001,that is,the prediction model can accurately distinguish HIV/AIDS patients with PIR in the validation set.Calibration:GOF test analysis shows χ2=9.941,P=0.269>0.05,that is,the fit of the prediction model is good.Internal verification shows that the predictive model can accurately predict the probability of PIR and has good clinical applicability.2.A total of 48 subjects were included in this study,24 cases in each of the PIR group and the IR group.(1)The correlation analysis between PIR and DNA showed that the HIV-DNA of PIR patients was 48.99(IQR:23.57,79.66)copies/106cells,and the HIV-DNA of IR patients was 14.19(IQR:0.02,32.28)copies/10bcells.The difference in HIV-DNA between the two groups of patients was statistically significant(Z=7.310,P=0.007),that is,the levels of HIV-DNA in the PIR group were higher than those in the IR group.Multiple linear regression analysis showed that when confounding variables were not adjusted,there was a positive correlation between HIV-DNA and poor immune response(OR=1.020;95%CI:1.003,1.038).After adjusting the confounding variables,no significant correlation was found between HIV-DNA and poor immune response(OR=0.989;95%CI:0.947,1.032).(2)Analysis of influencing factors of HIV-DNA load found that:baseline CD4+T cell count and HIV-DNA load are negatively correlated(β=-0.09,95%CI:-0.14,-0.03),the higher the baseline CD4+T cell count,the lower the HIV-DNA load.Conclusions:1.Advanced age and PIR is positively correlated,HIV/AIDS patients over 50 years are more likely to develop PIR.The current TDF/AZT+3TC+LPV/r/INSTIs regimen,high baseline CD4+T cell count,and high platelet count and PIR are negatively correlated.2.This study has not yet found a correlation between HIV-DNA and PIR,which needs to be further verified.3.The baseline CD4+T cell count is negatively correlated with the HIV-DNA.The higher the baseline CD4+T cell count,the lower the HIV-DNA load.