不同免疫状态下启动HARRT后的CD4~+T淋巴细胞重建效果分析

目的了解浦东新区医学随访管理艾滋病毒感染者/艾滋病患者(HIV/AIDS)的早治疗情况,分析在不同CD4~+T淋巴细胞计数水平下启动高效抗逆转录病毒治疗(HAART)后的免疫重建效果。方法采用历史队列研究的方法,收集2004年1月至2016年7月期间在上海市浦东新区启动HAART的HIV/AIDS人群的人口学特征、CD4~+T淋巴细胞检测时间、检测结果等信息进行统计描述与分析。结果共入组953名对象,研究对象启动HARRT时的CD4~+T淋巴细胞计数水平呈逐年升高的趋势,早治疗的比例逐年升高。CD4~+T淋好巴细胞计数随着治疗时间的延长而增加,基线CD4~+T淋巴细胞计数在500个/μL以下对象的CD4~+T淋巴细胞计数与治疗时间呈明显的线性关系,对象之间的CD4上升幅度比较接近;基线CD4~+T淋巴细胞计数500个/μL对象的CD4~+T淋巴细胞计数与治疗时间呈不明显的线性关系,治疗12个月后CD4的上升幅度有所下降。基线CD4~+T淋巴细胞计数水平较高的对象启动HAART后CD4~+T淋巴细胞计数也始终维持在较高水平。结论晚治疗HIV/AIDS的免疫功能虽然可以不断恢复,但免疫状态始终处于相对较低的水平,通过早治疗可以一直保持较高的免疫水平,因此应进一步提高早治疗的比例。

Variation of CD4+T cell number at different baseline cell immunity levels after initiation of HARRT among HIV/AIDS patients

Objective To understand the immune state of HIV infectors and AIDS patients (HIV/AIDS) who initiated highly active anti-retroviral therapy (HARRT),and analyze the effect of HARRT in different baseline CD4 +T cell numbers.Methods Historical cohort study was carried out to collect the characteristics of the demographic information among the HIV infectors and AIDS patients (HIV/AIDS) initiating highly active anti-retroviral therapy (HARRT) from January,2004 to July,2016 in Pudong New Area,and CD4+T cell numbers and relevant data were analyzed.Results 953 subjects were analyzed.The study showed that the number of CD4+ T cell in HIV/AIDS patients initiating HARRT increased with years.The proportion of early treatment increased with years.The number of CD4 + T cell increased steadily with HARRT treatment.Linearrelationship was found between the increase of the number of CD4+ T cell and the time of HARRT treatment for those whose baseline number of CD4+T cell was less than 500 cell/μL.The increase range of CD4 between cases was relatively close.For those whose baseline CD4+ T cell number was more than 500 cell/μL,no obvious linear relationship was found,and the range of CD4 increase showed somewhat reduction 12 months after HARRT initiation.For those with higher baseline CD4+T cell number,after initiating HARRT,the number of C4+T cell still maintained at a relatively higher level.Conclusion Although the immune function could continue to recover in the delayed anti-retroviral therapy cases,the immune state was always at a relatively low level.Early initiation of HARRT might always maintain a relatively higher immune level,therefore,the proportion of early treatment should be promoted.