HIV/AIDS抗病毒治疗前CD4+T淋巴细胞计数自然变化与治疗后免疫恢复及死亡率的相关性

目的 探讨云南省玉溪市艾滋病病毒感染者/艾滋病病人（human immunodeficiency virus/acquired immunodeficiency syndrome，HIV/AIDS）获得抗病毒治疗（antiretroviral therapy，ART）前CD4+T淋巴细胞（简称CD4）自然变化与ART后免疫恢复及死亡率的相关性。方法 将HIV/AIDS获得ART前CD4自然变化分为四组，描述不同组间ART后免疫恢复情况，应用非条件Logistic回归进行单因素和多因素分析HIV/AIDS病例ART后免疫无应答（immune non-responses，INRs）的相关因素，采用Kaplan-Meier法绘制不同组间ART后生存曲线。结果 777例HIV/AIDS中ART前快速上升组、平缓上升组ART后CD4月均上升速率慢于ART前快速下降组，差异均具有统计学意义（均有P<0.05）。多因素Logistic回归分析发现:ART前CD4自然变化为上升（OR=2.416，95%CI:1.264~4.616，P=0.008；OR=1.997，95%CI:1.067~3.737，P=0.031）、基线CD4值>500 cell/μL（OR=6.550，95%CI:3.315~12.941，P<0.001）、ART时年龄≥ 50岁（OR=4.276，95%CI:1.761~10.3865，P=0.001）的病例ART后更容易出现INRs。ART前平缓上升组ART后累计生存率低于ART前平缓下降组和快速下降组（χ2=8.979，P=0.003；χ2=4.158，P=0.041），在基线CD4值<200 cell/μl层，ART前平缓上升组在ART后累计生存率低于ART前平缓下降组和ART前快速下降组，差异均有统计学意义（均有P<0.05）。结论 HIV/AIDS患者ART前CD4自然变化与ART后免疫恢复、INRs及死亡率存在一定关联。

Trends of CD4+T cell count among HIV/AIDS patients prior to antiretroviral therapy initiation and its association with immunological recovery and mortality after treatment

Objective To examine the association between the natural trends of CD4+T cell prior to antiretroviral therapy (ART) initation and immunological recovery and mortality after ART among HIV/AIDS patients in Yuxi Prefecture, Yunnan. Methods The natural changes of the CD4+T cell before ART were divided into four groups among HIV/AIDS patients, the immunologic recovery was described and Kaplan-Meier method were used to describe survival curve among different groups of patients initiated ART. Multivariate logistic regression were used to analyse factors associated with immune non-responses. Results Among 777 HIV/AIDS patients, the natural changes of CD4+T cell after ART was significantly lower in gently and rapidly increased groups than rapidly decline groups among ART-naive HIV/AIDS patients. Multivariate logistic regression analysis indicated that patients with natural increase of CD4+T cell counts before ART initiation (OR=2.416,95% CI:1.264-4.616,P=0.008;OR=1.997,95% CI:1.067-3.737,P=0.031), with baseline CD4+T cell counts more than 500cell/μL (OR=6.550, 95%CI:3.315-12.941, P<0.001) and those older than 50 years old at ART initiaiton (OR=4.276, 95%CI:1.761-10.3865, P=0.001) were more likely to have immune non-responses after ART. The cumulative survival rate was significantly lower in gently increased groups than the gently and rapid decline groups (χ2=8.979,P=0.003;χ2=4.158,P=0.041), further stratified analysis showed that those with baseline CD4 counts less than 200 cell/μl, as well (all P<0.05). Conclusions An association was identified between the natural changes of CD4+T cell before ART and the immunologic recovery after ART, INRs and mortality.