Premature atherosclerosis in patients with acquired immunodeficiency syndrome

Background Increased risk of atherosclerosis has been reported in patients with human immunodeficiency virus (HIV)infection since highly active antiretroviral therapy (HAART) has come into use. However, there is no clear evidence of premature atherosclerosis in Chinese HIV-infected patients. Our study was designed to determine the relationship between HIV infection and atherosclerosis in Chinese HIV-infected patients.Methods One hundred and forty-five patients were enrolled in this study. These included 82 HIV-infected patients (41HAART-treated and 41 antiretroviral therapy (ART) naive patients) and 43 HIV-negative control subjects. Data on traditional cardiovascular risk factors, HIV infection parameters, and treatment regimens were collected. Pulse wave velocity (PWV) was determined using a pulse pressure analyzer to evaluate the function of the arterial wall as an indicator of atherosclerotic vascular damage.Results A higher PWV ((1358.3±117.8) cm/s vs. (1270.2±189.2) cm/s, P=0.010) was found in ART na(i)ve HIV-infected patients compared with control subjects. However, HAART treated patients had lower PWV compared to ART na(i)ve patients ((1283.8±181.4) cm/s vs. (1358.0±117.8) cm/s, P=0.033). Multiple regression analysis revealed that age (B=5.218, 95% confidence interval (CI) 1.420-9.016, P=0.008), current smoking (B=-74.671, 95% CI -147.003 to -2.339, P=0.043) and HAART (92.7% patients on a protease inhibitor-free regimen) (B=-169.169, 95% CI-272.508 to -65.831, P=0.010) were associated with reduced PWV in HIV-infected patients.Conclusions Reduced PWV in HIV-infected Chinese patients indicates that they are more likely to develop arterial wall stiffness, possibly by atherosclerosis. A protease inhibitor-free regime may be protective for arterial wall of HIV infected patients.     

Overview of HIV drug resistance and its implications for China

Since the initiation of China＇s nationwide free antiretroviral therapy （ART） in 2002, the availability of highly active antiretroviral therapy （HAART） in China has increased dramatically. HAART has been proven to prolong survival and control HIV disease progression. At the same time, experience in developed countries indicates that the high mutation rate of the virus in the presence of HAART is associated with drug resistance and diminished efficacy. The increase in HAART availability and use in China therefore also comes with the potential for increased resistance. Transmission of drug-resistant strains to individuals who have never been exposed to ART is on the rise. Moreover, studies have shown that new infections by drug-resistant virus result in suboptimal response to ART. With the rapid scale up of ART in China in recent years, the prevalence of HIV drug resistance will likely increase, posing a major public health concern in China. This review article provides an overview of ART resistance, the current worldwide trends in HIV drug resistance, the effect of HIV drug resistance in clinical management, and the implications for China＇s HIV treatment and care.     

Immune reconstitution of acquired immune deficiency syndrome

Acquired immune deficiency syndrome （AIDS） is a chronic infectious disease,which the patients are infected with human immunodeficiency virus （HIV）.HIV damages the human＇s immune function and causes CD4 cell decline in the number and function.Immune reconstitution is an important treatment to AIDS.Bone marrow transplantation,adoptive immune cell therapy and cytokines infusion can all assist the immune reconstitution;highly active antiretroviral therapy （HAART） can effectively control the virus replication and benefit the immune reconstitution.HAART combined with immunotherapy is an important method of immune reconstitution in AIDS patients.Chinese medicine is playing a more and more important role in immune reconstitution.Immune reconstitution has always been effective in the whole treatment of AIDS.     

Experimental and clinical research of HIV-1 resistance in three AIDS patients who had experienced multiple regimens

Highly active antiretroviral therapy （HAART） for HIV/AIDS has efficiently controlled the progression of the disease, extended life expectancy and decreased HIV/AIDS related morbidity and mortality since the advent of HIV protease inhibitors in 1996.1 Recent emergence of HIV resistance has severely affected the efficacy of antiretroviral therapy. The prevalence of HIV resistance has been increasing from the usage of AZT. Studies in US indicated that the prevalence was approximately 50% in patients who had experienced antiretroviral therapy.2 Antiviral regimens based on resistance tests could efficiently decrease viral load, increase CD4 cell counts and significantly improve the efficacy of antiretroviral therapy.3 There are two methods commonly used to test HIV resistance at present： one is genotypic resistance assay which predict HIV resistance based on resistance mutations in the viral genome; the other is a phenotypic resistance assay which directly evaluates HIV resistance through analyzing drug sensitivity in vitro.     

Side effects and tolerability of post-exposure prophylaxis with zidovudine, lamivudine, and lopinavir/ritonavir: a comparative study with HIV/AIDS patients

Background In the era of highly active antiretroviral therapy （HAART）, the use of antiretrovirals as post-exposure prophylaxis （PEP） was the most important strategy for preventing occupational exposure to blood or fluids containing human immunodeficiency virus （HIV）. The objective of this study was to retrospectively evaluate the tolerability, safety, and side effects of a HAART regimen containing three antiretroviral drugs, consisting of zidovudine, lamivudine, and Iopinavir/ ritonavir, in healthcare personnel （HCP） who experienced occupational exposure to HIV. Methods The tolerability, safety, and side effects in 26 HCPs who experienced PEP and in 27 HIV/AIDS patients with HAART regimen, AZT＋3TC＋Lpv/r, were evaluated between January 2010 and December 2012. Results The most frequent clinical side effect was fatigue （in 23 cases, 88.5%）, and gastroenterological symptoms were the second most common side effects in HCP with PEP. Liver dysfunction was found in 10 cases （38.5%）, while drug rash was found in 18 cases （69.2%） after PEP. The prevalence of side effects in HCPs who experienced PEP was higher than that in HIV/AIDS patients P 〈0.05. One nurse （3.8%） experienced severe gastrointestinal symptoms, which led to withdrawal of PEP. No HIV infection was found during 6-month follow-up period. Conclusion HCPs who received occupational PEP with triple-drug regimen, AZT＋3TC＋Lpv/r, experienced different side effects, and the tolerability and safety of PEP regimen were good in this cohort. Chin Med J 2014;127 （14）： 2632-2636     

Incidence and factors associated with hepatitis B surface antigen seroclearance in patients co-infected with HBV/HIV during antiretroviral therapy in Guangdong,China

Background: Hepatitis B surface antigen (HBsAg) clearance is vital for a functional cure of hepatitis B virus (HBV) infection. However, the incidence and predictors of HBsAg seroclearance in patients co-infected with HBV and human immunodeficiency virus (HIV) remain largely unknown in Guangdong, China.Methods: Between 2009 and 2019, patients co-infected with HBV/HIV undergoing antiretroviral therapy (ART) in Guangzhou Eighth People’s Hospital affiliated to Guangzhou Medical University were retro...     

Prevalence of CMV in arterial walls and leukocytes in patients with athero sclerosis

Objective To investigate the association of cylomegalovirus with atherosclerosis.Methods The presence of cylomegalovirus (CMV) nucleic acids was demonstrated in carotid and coronary arteries of patients with and without atherosclerosis by polymerase chain reaction (PCR).CMV was detected by PCR in the blood of patients with an d without atherosclerosis.Results 83.3%-86.7% of the samples obtained from atherosclerotic patient arterial wall s were shown to contain viral nucleic acids (CMV), CMV could be found among 6.7 % of patients’ arterial wall without atherosclerosis, significant difference can be found between them (P<0.01).In blood CMV could be found in 42.4% of patients with atherosclerosis, in the control group, only 3% of samples had CMV, P<0.01.Conclusion CMV plays an important role in the pathologic process of the atherosclerosis and the atherosclerotic cerebral infarction.     

HIV/AIDS research in China: arising up from skyline

One of the major advances and few real breakthroughs in HIV/AIDS research is the discovery of anti-retroviral drugs and highly active anti-retroviral therapy （HAART）. HAART, achieved by the collective efforts of many scientists and industrials, has significantly improved life expectancy and quality of life of people living with HIV/AIDS. It has also been proven that effective treatment for viral infection is possible. HIV-1 infection chronically depletes CD4~ T lymphocytes and compromises normal function of the immune system of infected persons.1 May et al2 have found that impaired immune function could be restored with continuous HAART. The global HIV/AIDS epidemic is characterized by a great diversity of HIV clades prevalent in various parts of the world.3 The host immune responses to the diversified HIV strains as well as the metabolic patterns to the drugs are also various. Therefore, simply taking the data collected from the other countries＇ HAART is not recommended. It is important that indigenous scientists and clinicians in their respective countries start their own HAART program to conduct research on their patients to obtain local treatment data. Such kinds of research efforts by several Chinese research groups have been published in this issue of Chinese Medical Journal     

HIV感染孕产妇启动抗病毒治疗情况及影响因素分析

  目的  HIV感染孕产妇抗病毒治疗比例是妇女发展纲要重点考核指标,我省该项指标达标情况不容乐观,本研究主要分析我省近20年HIV感染孕产妇抗病毒治疗率及其影响因素,为提高我省治疗率提供科学依据。  方法  通过《预防艾滋病、乙肝、梅毒母婴传播管理信息系统》下载2004—2020年期间HIV确诊阳性的孕产妇的EXCEL数据库,包括孕产妇基本信息、丈夫或性伴侣信息、孕产妇抗艾滋病病毒药物使用情况等。采用Pearson χ2检验、Poisson回归模型分析数据。  结果  2004—2020年我省共报告834名HIV感染孕产妇病例,平均年龄为(28.65±6.39)岁。我省HIV感染孕产妇孕产期启动抗病毒治疗(antiviral therapy, ART)率呈现逐年增长趋势,从2004—2010年期间的57%(61/107)增长到2020年的95%(19/20,趋势χ2=47.658,P < 0.001)。多因素Poisson回归模型分析结果显示,与产后确诊的孕产妇相比,孕前、孕期、产时确诊的孕产妇启动ART的可能性分别增大了5.15倍(95% CI:2.91~9.13)、5.06倍(95% CI:2.85~8.97)和1.83倍(95% CI:1.00~3.64)。  结论  本研究结果提示,可通过加强孕产妇的管理,将发现孕产妇感染的时期前移至孕前,这对提高艾滋病母婴阻断效果具有重大意义。      

吸毒感染艾滋病患者高效抗逆转录病毒治疗依从性及相关因素研究

目的 探讨吸毒感染艾滋病患者高效抗逆转录病毒治疗(HAART)依从性及相关因素.方法 在2007年7～9月抽取湖南省衡阳、岳阳、郴州3个地区HAART治疗点,对接受国家免费HAART疗法的111名吸毒感染艾滋病患者进行调查,采用美国社区艾滋病临床研究抗逆转录病毒用药自陈式问卷(CPCRA),来评估抗病毒治疗服药依从性,并分别用抑郁自评量表、家庭关怀度指数问卷来评估患者抑郁症状和家庭功能状况.结果 本组患者服药平均依从水平为83%,有30人(28.8%)服药量在90%或以下,达不到服药量的要求,属于服药依从性差.抑郁标准评分为(60.81±13.03)分,有抑郁症状者占83.9%,而家庭功能良好者仅占30.6%.非条件Logistic回归分析显示抑郁程度(β=-0.48,P=0.024)和治疗时间(β=-1.11,P=0.036)对服药依从率有负性影响,而家庭功能(β=0.65,P=0.043)、脱毒时间(β=0.55,P=0.040)对服药依从率有正性的影响.结论 吸毒感染艾滋病患者HAART治疗依从水平偏低,应通过综合干预如治疗抑郁、帮助脱毒、提高家庭功能、定期评价依从性等来提高患者的服药依从性.     

四川省西昌市2008—2018年初始抗病毒治疗HIV感染者死亡和脱失情况

目的 了解四川省西昌市2008–2018年初始抗病毒治疗HIV感染者死亡和脱失的情况及其影响因素。方法 采用回顾性队列研究的方法,从艾滋病基本防治信息系统选取2008–2018年在西昌市首次开始抗病毒治疗（ART）的HIV感染者,分析抗病毒治疗者的死亡和脱失情况。采用Cox比例风险回归模型对影响抗病毒治疗HIV感染者病死率和脱失率的相关因素进行分析。结果 共计2 723例HIV感染者进入队列,总体病死率为1.92/100人年,总体脱失率为2.49/100人年。在开始抗病毒治疗的第1年内病死率和脱失率分别为10.83/100人年、13.89/100人年。Cox回归分析结果显示接受抗病毒治疗患者主要的死亡风险是年龄≥40岁（HR=2.30,95%CI：1.53~3.48）、男性（HR=1.94,95%CI：1.14~3.30）、ART前一年内结核感染（HR=1.92,95%CI：1.01~3.65）、ART前三个月出现艾滋病相关疾病/症状（HR=2.44,95%CI：1.50~3.99）、ART前乙肝感染（HR=2.50,95%CI：1.32~4.71）、CD4⁺T淋巴细胞计数< 200 cells/ul（HR=1.79,95%CI：1.12~2.86）。接受抗病毒治疗患者主要的脱失风险是年龄≥40岁（HR=1.53,95%CI：1.07~2.18）、男性（HR=5.60,95%CI：2.60~12.08）、静脉吸毒（HR=2.18,95%CI：1.46~3.27）、初始抗病毒治疗方案为EFV+3TC+TDF（HR=2.57,95%CI：1.32~5.01）。结论 西昌市HIV感染者的抗病毒治疗效果显著,但在开始治疗的第1年内病死率和脱失率较高。抗病毒治疗工作需采取针对性的措施,重点要减少静脉吸毒人群刑满释放后的脱失,从而提高抗病毒治疗效果。     

血友病A合并艾滋病患者高效抗逆转录病毒治疗六年疗效评价

目的 对上海市39例血友病A合并艾滋病(血友病/艾滋病)患者高效抗逆转录病毒治疗(HAART)6年后予以临床回顾.评价在血友病/艾滋病患者当中,HAART治疗对其出血状况、关节功能和体能状况的影响;同时观察HAART治疗对患者HIV病毒复制的控制及促进CD4+T细胞恢复的效果.方法 收集2002-2008年间39例血友病/艾滋病患者的临床资料,对其HAART治疗6年前后的平均门诊次数(次/年)、平均出血次数(次/年)、平均Ⅷ因子输注次数(次/年)、平均Ⅷ因子使用总量(IU/年)以及Ⅷ:C活性指标进行分析;同时观察患者外周血血常规、CD4+T细胞计数和HIV病毒载量的改变;采用计量表的方式进一步对患者体能状况和关节功能进行评分和比对.结果 39例患者HAART治疗前后平均门诊次数、平均出血次数、平均Ⅷ因子输注次数和平均使用Ⅷ因子总量组间比较差异无统计学意义(P>0.05);39例患者中仅1例出现Ⅷ:C活性由1%～5%以降至<1%,1例患者体能和关节功能有所减弱,其余未发生改变;HAART治疗前后,血红蛋白(Hb),白细胞(WBC)、血小板计数(PLT)差异无统计学意义(P>0.05).治疗前HIV RNA为(4.8±1.0)log拷贝/ml,治疗6年后为(2.4±1.0)log拷贝/ml(P<0.05);CD4+T细胞计数:治疗前平均为(183 ±97)个/mm3,治疗6年后平均为(456±157)个/mm3(P<0.05).结论 HAART治疗对血友病/艾滋病患者出血状况、关节功能和体能无明显影响;HAART治疗对于在血友病/艾滋病患者中控制HIV复制及CD4+T细胞恢复是有效的.     

血管回声跟踪技术评价 HAART 治疗后艾滋病患者颈动脉弹性

目的：应用血管回声跟踪技术（ET）检测艾滋病患者高效抗反转录病毒疗法（HAART）治疗后颈动脉弹性,探讨 ET 对艾滋病患者 HAART 治疗后预防颈动脉粥样硬化的指导价值。方法：应用血管回声跟踪技术跟踪描记 HAART 治疗后艾滋病患者50例及健康志愿者30例颈总动脉（CCA）的运动轨迹,测量其僵硬度（β）,弹性系数（Ep）,顺应性（AC）以及脉搏波传导速度（PWVβ）,并测量颈动脉内-中膜厚度（IMT）。结果：HAART 治疗后艾滋病患者较健康志愿者测量颈动脉 IMT 稍增厚,但差异无明显统计学意义;β,Ep 以及 PWVβ均增高,AC 降低,差异均有统计学意义。结论：血管回声跟踪技术可评价艾滋病患者 HAART 治疗后颈动脉粥样硬化的早期改变。     

广西2004—2019年初始抗病毒治疗儿童HIV感染者生长发育情况分析

目的 了解初始抗病毒治疗儿童HIV感染者的生长发育情况及其影响因素。方法 采用回顾性队列研究方法,从国家艾滋病抗病毒治疗信息系统下载广西2004—2019年初始抗病毒治疗儿童HIV感染者数据库。根据中国儿童生长发育标准计算Z评分,趋势性分析采用Cox-Stuart检验,广义估计方程用于分析HAZ（height-for-age Z-score）≥-2和WAZ（weight-for-age Z-score）≥-2的影响因素。结果 共计943例儿童HIV感染者进入队列。基线和治疗后第1、2、5、10年的HAZ中位数分别为-2.47、-2.14、-1.94、-1.55、-1.23,WAZ中位数分别为-1.85、-1.40、-1.30、-1.21、-1.09。经Cox-Stuart趋势检验,HAZ和WAZ随治疗时间均呈上升趋势（P<0.05）。基线和治疗后第1、2、5、10年HAZ≥-2的比例分别为38.1%、46.5%、51.6%、66.8%和74.6%,WAZ≥-2的比例分别为57.1%、76.9%、81.1%、85.8%和89.2%。经Cox-Stuart趋势检验,HAZ≥-2和WAZ≥-2的比例随治疗时间均呈上升趋势（P<0.05）。多因素广义估计方程分析结果显示,与HAZ≥-2的关联性因素有初始抗病毒治疗年龄为3~7岁（aOR=0.71,95%CI：0.53~0.94）、初始抗病毒治疗年龄为>7岁（aOR=0.66,95%CI：0.47~0.93）、治疗前CD4⁺T淋巴细胞计数<200个/μL（aOR=0.64,95%CI：0.47~0.87）、治疗前WHO临床分期为Ⅲ/Ⅳ期（aOR=0.74,95%CI：0.56~0.97）以及治疗时间（aOR=1.01,95%CI：1.01~1.01）;与WAZ≥-2的关联性因素有男性（aOR=0.72,95%CI：0.53~0.97）、治疗前WHO临床分期为Ⅲ/Ⅳ期（aOR=0.63,95%CI：0.45~0.86）以及治疗时间（aOR=1.01,95%CI：1.01~1.01）。结论 抗病毒治疗有效改善了儿童HIV感染者的生长发育状况,但治疗后第10年仍有较大比例的儿童生长发育迟缓,需加强抗病毒治疗工作人员培训和儿童HIV感染者父母宣传教育以提高抗病毒治疗效果并合理指导儿童营养。     

127例HIV/AIDS患者抗病毒治疗1年CD4~+T淋巴细胞结果

目的分析HIV/AIDS患者抗病毒治疗前后CD4~+T淋巴细胞数的变化情况,为全省的抗病毒治疗提供科学依据。方法对青海省2013—2015年间接受抗病毒治疗的127名HIV/AIDS患者治疗前、治疗后3个月、6个月、9个月及12个月CD4~+T淋巴细胞数进行检测和统计学分析。结果 127例HIV/AIDS患者的平均开始治疗年龄为(37.6±10.8)岁,治疗前CD4~+T淋巴细胞数平均水平为(321.2±108.4)个/μL;患者治疗3个月、6个月、9个月和12个月时与进入治疗时点相比,其CD4~+T淋巴细胞数平均增加了52.2个/μL、75.8个/μL、75.3个/μL和76.5个/μL,差异均有统计学意义(P0.01);经抗病毒治疗1年后,CD4~+T淋巴细胞数500个/μL的患者从0例增至37例,占患者总数的29.1%;CD4~+T淋巴细胞数分为≤200个/μL、201~350个/μL和350个/μL三组患者,经抗病毒治疗1年后,CD4~+T淋巴细胞数平均分别增加了80.7个/μL、84.7个/μL和65.8个/μL,不同组患者HAART治疗1年后CD4~+T淋巴细胞数均值变化差异有统计学意义(P均0.05)。结论青海省目前的HAART治疗效果明显,同时提高HIV/AIDS患者的依从性,并尽早开展抗病毒治疗,有利于提高患者的生命质量,延缓疾病进程,降低病死率。     

接受抗病毒治疗HIV/AIDS患者艾滋病心理痛苦现状及影响因素

目的：调查接受抗病毒治疗的HIV/AIDS患者艾滋病心理痛苦现状及影响因素。方法：2022 年3月—2022年6月,采用便利抽样法从北京地区艾滋病社会组织招募765例HIV/AIDS患者进行在线调查,调查内容为一般资料调查表和艾滋病心理痛苦量表。采用χ2检验、Fisher确切概率法和Logistic回归分析艾滋病心理痛苦的影响因素。结果：本次调查共收集有效数据765 份,被调查HIV/AIDS患者艾滋病心理痛苦检出率83.27%。Logistic回归分析结果表明没有固定工作（OR =5.004,95%CI =1.867～13.410,P =0.001）、接受抗病毒治疗1～3 年（OR =2.613,95%CI =1.354～5.044,P =0.004）、不按时服药（OR =31.277,95%CI =4.143～236.092,P =0.001）是艾滋病心理痛苦发生的危险因素,而已婚（OR =0.320,95%CI =0.187～0.550,P ＜0.001）、坚持使用安全套（OR =0.267,95%CI =0.127～0.563,P =0.001）、确诊时间长（OR =0.115,95%CI =0.024～0.550,P =0.007）、月收入＞1 0000元（OR =0.265,95%CI =0.095～0.737,P =0.011）是保护性因素。结论：接受抗病毒治疗的HIV/AIDS患者普遍存在艾滋病心理痛苦,其发生率较高,医护人员应重视艾滋病心理痛苦的评估,并及时对存在危险因素的患者进行干预,以期提高患者的生活质量。     

B7-H1在HIV/艾滋病患者外周血髓样树突状细胞上的表达及临床意义

目的 观察病情不同的HIV/AIDS患者外周血髓样树突状细胞(mDC)上B7-H1表达频率和疾病进展的关系.方法 采集2006年3月至2008年4月北京佑安医院门诊或住院的82例未经抗逆转录病毒治疗(ART)的HIV/AIDS患者、28例ART病毒学完全应答者(CR)和14名健康人的外周血,采用流式细胞术分析mDC上B7-H1表达频率.所有病例均用流式细胞仪检测外周血CD4细胞计数,用bDNA法检测血浆HIV-1病毒载量.结果 AIDS患者外周血mDC上B7-H1表达频率为14.15%±2.63%,HIV无症状感染者为3.31%±0.51%,健康对照为0.52%±0.10%,显示AIDS患者>HIV感染者>健康对照(均P<0.05).长期不进展者(LTNP)和典型进展者(TP)mDC上B7-H1的表达频率分别是3.12%±1.14%和8.12%±1.37%,均显著高于健康对照组(均P<0.05),且TP患者高于LTNP(P=0.001);HIV/AIDS患者mDC上B7-H1表达频率与CD4细胞计数呈显著负相关,而与血浆病毒载量显著正相关(r值分别为-0.631及0.482,均P<0.01).28例CR患者mDC上B7-H1表达频率为6.59%±1.43%,显著低于AIDS患者(P<0.01).CR患者中,CD4细胞计数<250个/μl的患者mDC上B7-H1表达频率高于CD4细胞计数>250个/μl的患者(P<0.001).ART纵向观察结果显示,6例患者在14-52周的抗病毒治疗后,血浆病毒载量均显著降低,有不同程度的CD4细胞计数升高,而mDC上B7-H1表达有不同程度降低,CD4细胞计数显著升高的病人mDC上B7-H1表达显著降低.结论 共刺激分子B7-H1在HIV/AIDS患者外周血mDC上高表达,并与疾病进展密切相关,是疾病进展的指标.     

HIV感染者初始抗病毒治疗48周CD4/CD8比值变化分析

目的 探讨HIV感染者使用替诺福韦（TDF）+拉米夫定（3TC）+依非韦伦（EFV）方案初始抗反转录病毒治疗（ART）48周CD4/CD8比值变化及影响比值标准化的因素。方法 收集使用TDF+3TC+EFV方案初始ART 48周的HIV感染者相关数据并进行统计学分析。以二分类Logistic回归分析48周比值标准化的影响因素。结果 2014年1月—2015年12月成都市公共卫生临床医疗中心门诊282例HIV感染者,均经性传播,其中男男同性传播组（MSM组）196例,异性传播组（非MSM组）86例。HIV感染者基线CD4/CD8比值<1.0有278例（占98.6%）,ART 48周CD4/CD8比值<1.0有246例（占87.2%）。治疗48周CD4增长（157.00±136.33） 个/µL,CD8下降（337.95±489.86） 个/µL,CD4/CD8比值增长（0.35±0.31）。治疗前MSM组与非MSM组CD4/CD8比值差异无统计学意义（P=0.448）,治疗48周两组比值增长分别为（0.32±0.29）和（0.43±0.35）,差异有统计学意义（P=0.004）。二分类Logistic回归分析显示影响比值标准化的因素：感染途径MSM[OR=0.33,95%CI（0.140~0.779）]、基线CD4<200 个/µL[OR =0.171,95%CI（0.034~0.865）]、基线CD8>750 个/µL [OR=0.255,95%CI（0.092~0.701）]、基线比值≤0.4[OR=0.167,95%CI（0.062~0.453）]。结论 HIV感染者CD4/CD8比值倒置普遍,经TDF+3TC+EFV初始治疗48周,CD4/CD8比值倒置改善;感染途径为MSM、低基线CD4、高基线CD8、低基线CD4/CD8比值的感染者ART治疗48周比值不易达到标准化,尽早启动ART,以促进免疫功能恢复。