有效抑制HIV复制下AIDS患者CD4+T淋巴细胞的动态变化

目的研究强效抗逆转录病毒治疗（HAART）持续有效抑制HIV复制下AIDS患者的T淋巴细胞免疫动态变化。方法45例AIDs患者予以2年以上HAART治疗,在治疗前（D0）,治疗第3、6、12、18和24个月（M3、M6、M12、M18和M24）时用bDNA病毒定量检测仪检测血浆病毒载量,流式细胞仪检测外周血T淋巴细胞亚群,分析CD4＋、CD8＋ T淋巴细胞及其相关亚群的动态变化。结果45例患者中有24例（53．3％）在治疗6个月后血浆病毒载量持续低于500copies／ml,按M24时（与D0相比）CD4＋T淋巴细胞计数的增量分为A组（〈100／mm^3）、B组（100—200／mm^3）和C组（〉200／mm^3）。与D0时相比,所有患者M3、M6、M12、M18和M24时的CD4＋T淋巴细胞计数、CD4＋纯真细胞计数和CD4＋CD28＋亚群的比例均有不同程度升高,CD8＋CD38＋激活亚群的比例则下降。3组相比,C组变化最显著,其D0时血浆病毒载量最高而CD4＋T淋巴细胞计数最低,经过24个月治疗后,不仅CD4＋T淋巴细胞数量增加最明显,CD4＋纯真细胞数量和CD4＋CD28＋功能亚群比例的增加也明显高于A组和B组（P〈0．05）。结论HAART能有效地重建AIDS患者的T淋巴细胞免疫。CD4＋CD28＋和Naive CD4＋亚群的不同动态变化可能对CD4＋T淋巴细胞数量和功能上的恢复有重要作用。

Dynamics of T lymphocyte subsets in HAART treated AIDS patients with successful suppression of HIV replication and different CD4 + T cell restoration

OBJECTIVE: To study the dynamic changes of T lymphocyte subsets of AIDS patients during more than 24 months of highly active antiretrovirus therapy (HAART) with successful suppression of HIV replication and different CD4 + T cell restoration. METHODS: Totally 45 AIDS patients who had received HAART for more than 24 months were included. During HAART (including DO, M3, M6, M12, M18, and M24), the number of plasma HIV-1 RNA was measured quantitatively using the bDNA assay, and T lymphocyte subsets including CD3 + CD4 + cells, CD3 + CD8 + cells, naive CD4 + cells (CD4 + CD45RA + CD62L +), CD4 + CD28 + cells , and CD8 + CD38 + cells were detected with flow cytometer. RESULTS: Among 45 patients, 24 patients (53.3%) whose plasma viral load decreased to less than 500 copies/ml at M6 and maintained to M24 were classified into three groups according to the CD4 + T cell count increments on M24 (compared with DO): group A (< 100/mm3), group B (100-200/mm3), and group C (> 200/mm3). After the initiation of HAART, T lymphocyte response, including CD4 + T cell counts, naive CD4 + cell counts, percentages of CD4 + CD28 + cells in these patients were improved gradually, while CD8 + CD38 + percentage decreased. The improvement of T lymphocyte response in group C was most remarkable even with highest plasma viral load and lowest CD4 T cell count on DO. Compared with group A and B, group C had significantly better improvement not only in the quantities of CD4 + T cell, but also in the CD28 + expression and naive CD4 + T cell populations. CONCLUSIONS: T lymphocyte response of AIDS patients can be effectively reconstituted by HAART. Different dynamics of CD4 + CD28 + and naive CD4 + populations may considerably contribute to the quantity and cellular function restoration of CD4 + T lymphocyte.