| Objectives To explore the changing trend of CD4~+T lymphocyte count(CD4 cells),CD8~+T lymphocyte count(CD8 cells)and CD4~+T lymphocyte/CD8~+T lymphocyte ratio(CD4/CD8 ratio)in HIV/AIDS patients under long-term antiviral treatment,as well as the factors affecting the CD4/CD8 ratio.To elucidate the dynamic changes and influencing factors of HIV-1 DNA in patients with HIV-1 RNA lower than the minimum detection value,and to analyze the correlation between CD4 cells,CD8 cells,CD4/CD8ratio and HIV-1 DNA,so as to provide a new laboratory basis and a new evaluation index for the study of immune recovery in HIV/AIDS patients.Methods(1)Retrospective study was conducted on the patients who received antiviral treatment for 5 years and whose HIV-1 RNA was consistently lower than the minimum detection value in Yunnan Infectious Diseases Hospital and were selected from the national free antiviral treatment database of the National Data Information System for Comprehensive AIDS Prevention and Treatment.The changes of CD4 cells,CD8 cells,CD4/CD8 ratio and the factors affecting the ratio of CD4/CD8 were analyzed after 0,12,24,36,48 and 60 months of antiviral treatment.(2)Blood samples of subjects at 24,36,48 and 60 months were searched in the HIV blood sample bank of our hospital for quantitative HIV-1 DNA detection.(3)The curves of CD4 cells,CD8 cells,CD4/CD8ratio and HIV-1 DNA over time were plotted by Graph Pad Prism 8.0 software,and SPSS20.0 software was used to complete statistical processing of the data.Results In this study,47 eligible patients were enrolled and divided into two groups:CD4≤350 cells/μl group and CD4≥351 cells/μl group according to ART 24 months.Among them,23 patients were in the≤350 cells/μl group and 24 patients were in the CD4≥351 cells/μl group.Among the enrolled patients,the male to female ratio was33:14;The mean age was(38.30±11.05)years old.Marital status was mainly married or cohabiting,accounting for 70.21%(33/47);The main route of infection was heterosexual transmission,accounting for 53.19%(25/47).The majority of WHO clinical stages wereⅠstage,accounting for 46.81%(22/47);The primary treatment regimen consisted of a combination of non-nucleoside reverse transcriptase inhibitors+2-nucleoside reverse transcriptase inhibitors(NNRTIs+2NRTIs),which was 95.74%(45/47).The time from HIV diagnosis to ART initiation was less than 6 months in 70.21%(33/47)patients;Baseline BMI of 63.83%(30/47)patients ranged from 18.50 to 23.90;59.57%(28/47)of the patients had changed treatment regimens during the observation period.The median number of CD4 cells at baseline was 176(71.50,285.50)cells/μL.The median number of CD8 cells at baseline was 763(606.50,1184.00)cells/μL.The baseline median CD4/CD8 ratio was 0.21(0.11,0.29).1.Trend of changes in CD4 cells,CD8 cells,and CD4/CD8 ratio in patients with long-term ART(1)General trend:CD4 cells and CD4/CD8 ratio increased with the prolongation of treatment time;CD8 cells showed an upward trend in ART 12months and a downward trend after 12 months,and the slope of change after 24 months was less than that after 12 months.(2)Grouping trend:CD4 cells and CD4/CD8 ratio in both groups showed an increasing trend with the prolongation of treatment time;In the CD4≤350 cells/μL group,the CD8 cells showed an upward trend during ART 24 months,and the slope of change during ART 12 months was higher than that after ART 24months.After ART 24 months,the CD8 cells decreased slowly and tended to be flat.The ratio of CD4/CD8 increased in 12 months and the change slope was greater than that after 12 months.In the CD4≥351 cells/μL group,the CD8 cells showed an increasing trend in ART 12 months,then a decreasing trend after 12 months,and finally leveled off.The ratio of CD4/CD8 increased in ART 24 months and the slope of change was greater than that after 24 months,and the rising trend turned to decline after 48 months.2.The influencing factors for the change of CD4/CD8 ratio The generalized estimation equation(GEE)of the influencing factors for the change of CD4/CD8 ratio showed that CD4 level at 24 months,duration of treatment,baseline age and marital status were all influencing factors for the change of CD4/CD8 ratio.3.Dynamic change trend of HIV-1 DNA in patients with long-term ART(1)General trend:HIV-1 DNA showed no significant increase or decrease trend with the extension of treatment time,and basically remained stable.(2)Grouping trend:HIV-1DNA of different groups showed a stable trend on the whole,which was the same as the general situation,and there was no statistically significant difference between groups.4.The influencing factors for the dynamic changes of HIV-1 DNA in patients with long-term ART The generalized estimation equation(GEE)of the influencing factors for the dynamic changes of HIV-1 DNA in long-term ART patients showed that the course of HIV is related to the dynamic changes of HIV-1 DNA.5.Correlation between CD4 cells,CD8 cells,CD4/CD8 ratio and HIV-1 DNA CD8 cells were positively correlated with HIV-1 DNA,while CD4/CD8 ratio was negatively correlated with HIV-1 DNA,while CD4 cells were not correlated with HIV-1DNA.Conclusion(1)Long-term ART can restore the immunity of patients to different degrees,which was reflected in the continuous increase of CD4 cells,CD4/CD8 ratio,and partial recovery of CD8 cells.(2)The immune recovery of patients was affected by many factors.Age≥50 years old and absence of fixed companion were not conducive to the recovery of immune function.On the contrary,the high level of CD4 in ART 24months and long treatment duration were the protective factors for the recovery of CD4/CD8 ratio.(3)The level of HIV-1 DNA remained at a relatively low level in ART2～5 years,but the start of ART in the late stage of AIDS was not conducive to the elimination of HIV-1 DNA.(4)The level of HIV-1 DNA was correlated with CD8 cells and CD4/CD8 ratio.Clinically,the immune recovery can be comprehensively evaluated by CD4 cells,CD8 cells,CD4/CD8 ratio and HIV-1 DNA. |
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