Correlation Of Baseline CMV Infection Status With Suboptimal Immune Responders After ART In AIDS Patients

Objective:Analysis of patients who received antiretroviral therapy(ART)for at least 96weeks and achieved sustained virologic suppression(HIV RNA<50 copies/mL)and ruled out resistance to HIV-infected human immunodeficiency virus(HIV)Pre-ART baseline risk factors for suboptimal immune responders(SIR),especially the association of baseline cytomegalovirus(CMV)infection status with SIR.Methods:The patients was collected from the First Affiliated Hospital of China Medical University from January 1,2009 to December 31,2014,was diagnosed as having been admitted to the Infectious Diseases Department,followed by a regular follow-up visit in our hospital,and received ART treatment for at least 96 weeks and achieved sustained virologic suppression(HIV RNA<50 copies/mL)of AIDS patients as the research objects,the time points of follow-up were baseline(Before ART),24 weeks after ART,48 weeks after ART,72 weeks after ART.According to whether the absolute count of CD4~+T lymphocytes was less than 200/?L at 96 weeks after ART,the patients were divided into the optimal immune responders(OIR)group and SIR group.Baseline risk factors of SIR were retrospectively analyzed.32 baseline factors,including age,gender,body weight,baseline absolute CD4~+T-lymphocyte counts,baseline CD8~+T-lymphocyte absolute counts,HIV RNA,WHO clinical staging,first-line ART regimens containing fumaricacid tenofovir two imidacloprid furosemide esters or not,Pneumocystis carinii pneumonia,CMV infection or not,CMV DNA,CMV IgM,CMV IgG,cytomegalovirus retinitis,anti-CMV treatment or not,factors of P<0.1 and important demographic population characteristics factors were put into multiple regression models to assess the correlation of baseline risk factors with SIR.Results:Among 104 patients,17 were excluded from the follow-up of drug resistance.Of the 87 patients enrolled in the study,29 were SIR,with a ratio of 33.3%and 58patients with OIR.Before ART,two groups of age,sex,body weight,total white blood cell count,neutrophil count,hemoglobin,platelet,glutamate-pyruvate transaminase,total bilirubin,serum albumin,prothrombin time,sodium ion concentration,creatinine,C-reactive protein,CMV IgM,CMV IgG,HIV RNA,low sodium,common bacterial infections,central nervous system diseases,hepatitis,neoplasms,tuberculosis,cytomegalovirus retinitis,first-line ART regimens containing fumaricacid tenofovir two imidacloprid furosemide esters,and anti-CMV therapy were not statistically different(P>0.05).Absolute CD4~+T-lymphocyte counts at baseline,baseline CD8~+T-lymphocyte counts at baseline,CMV DNA,Pneumocystis carinii pneumonia,WHO clinical stage,CMV infection were statistically significant(P<0.05).Logistic regression analysis showed that only the age of?50 years(HR=4.125,95%CI:1.230-13.835,P=0.022)and the absolute count of baseline CD4~+T lymphocytes<100/?L(HR=15.26,95%CI:3.265-71.328,P=0.001)are the relevant baseline risk factors for SIR at 96 weeks after ART.Conculsions:AIDS HIV-infected individuals,aged?50 years and baseline absolute CD4~+T-lymphocyte count<100/?L are baseline risk factors for SIR at 96 weeks after ART,and baseline CMV infection status includes CMV infection,CMV DNA,baseline CMV IgM levels,baseline CMV IgG levels,cytomegalovirus retinitis,and anti-CMV therapy were not associated with SIR.