期刊
BMC IMMUNOLOGY
卷 20, 期 1, 页码 -出版社
BMC
DOI: 10.1186/s12865-019-0311-2
关键词
HIV/AIDS; Clinical predictor; Immune reconstitution; Prognosis; HAART
类别
资金
- National Natural Science Foundation of China [81371812, 81560325, 81860553, 81660094, 3171101074]
- National Science and Technology Major Project of China [2018ZX10301-101]
- Fund for Innovative Talent of Science and Technology in University of Henan Province, China [17HASTIT049]
- Medical Leadership Foundation of Health and Family Planning Commission of Yunnan Province, China [L-201613]
- Project for Innovation Team of Department of Science and Technology of Yunnan Province, China [2018HC005]
- Joint Fund of Science and Technology Department of Yunnan - Kunming Medical University [2017FE467-005]
Background The immune reconstitution after initiation of highly active antiretroviral therapy (HAART) among HIV-infected individuals substantially affects patients' prognosis. However, the dynamic characteristics and predictors of reconstitution outcome remain unclear. Methods In this study, the HIV/AIDS patients with sustained virological suppression (viral load < 50 copies/ml) after HAART were enrolled. The patients were subgrouped into immunological non-responders (INRs) (< 200 cells/mu l), immunological inadequate responders (IIRs) (200 500 cells/mu l) and immunological responders (IRs) (> 500 cells/mu l) according to the CD4 cell count after two-year HAART. The immune reconstitution data based on the CD4(+) and CD8(+) cell counts with 8-year follow-up were collected for analysis. Results The CD4(+) cell counts in the immunological responders (IRs) were significantly higher than in the immunological non-responders (INRs) and immunological inadequate responders (IIRs) (P < 0.001). The overall CD4(+) cell count and CD4/CD8 ratio in the IRs increased faster than the IIRs and INRs. The CD4(+) cell count growth at 0.5 year and 1 year after HAART in the IRs was significantly higher than the IIRs and INRs. The ROC curve demonstrated that 1 year CD4(+) cell count had the highest predictive value, with the best cut-off value of 188 cells/mu l, the predictive sensitivity was 81.0%, the predictive specificity was 85.2%, false positive rate was 14.8%, false negative rate was 19.0%, positive predictive value (IR) was 63.0%, negative predictive value (INR) was 93.5%. Conclusions Taken together, our findings suggest that early initiation of HAART can reduce the immune reconstitution failure. The combination of baseline CD4(+) cell count and baseline CD4/CD8 ratio may serve as a valid predictor of immune reconstitution prognosis after HAART.
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