Scholarlink

Background <p>Immune reconstitution following combined antiretroviral therapy (cART) varies across populations and remains suboptimal in certain subgroups. This study assessed the trajectory and predictors of CD4<sup>+</sup> T cell recovery among heterosexual (HET) and men who have sex with men (MSM) living with HIV-1 in Guangxi, China.</p> Methods <p>A prospective cohort of 458 newly diagnosed HIV-1 positive individuals (244 HET and 214 MSM) was followed from 2015 to 2024. Generalized additive models (GAM) were applied to evaluate CD4<sup>+</sup> T cell trends. A Bayesian Markov Chain Monte Carlo (MCMC) generalized linear model (glm) estimated the posterior probability of immune recovery (Complete immune recovery (CIR), defined as two consecutive CD4<sup>+</sup> T cell counts &gt; 500 cells/µL after cART initiation.). Multivariable logistic regression identified risk factors for immune non-responsiveness.</p> Results <p>Median CD4<sup>+</sup> T cell counts increased from 346 to 700 cells/µL in the HET group and from 404 to 778 cells/µL in the MSM group. However, CD4<sup>+</sup> T cells declined during the first year among HET, and counts remained below 500 cells/µL after four years, while MSM surpassed this threshold earlier. Those with baseline CD4<sup>+</sup> T cell counts &lt; 150 cells/µL failed to achieve complete immune reconstitution even after six years. The risk of immune non-response among those with CD4<sup>+</sup> T cell percentage ≤ 20%, 20%-30%, and 30%-40% were 10.82 (95% confidential interval (CI): 7.54–15.64, <i>P</i> &lt; 0.001), 0.68 (95%CI: 0.49–0.94, <i>P</i> &lt; 0.023), and 0.06 (95%CI: 0.02–0.12, <i>P</i> &lt; 0.0001) times higher than other groups. Longer cART duration was correlated with improved recovery. Key factors associated with lower probability of immune recovery included being age ≥ 50 years, absence of cotrimoxazole prophylaxis (SMZ), heterosexual transmission, baseline CD4<sup>+</sup> T cell &lt; 350 cells/µL, and CD4<sup>+</sup> T cell percentage ≤ 20%. Those who were divorced and those with shorter cART duration also exhibited reduced immune reconstitution rates.</p> Conclusions <p>Immune recovery after cART was slower and less complete in HET individuals and those with low baseline CD4<sup>+</sup> T cell counts and low baseline CD4<sup>+</sup> T cell percentage. Early diagnosis, prompt initiation of cART, long-term treatment adherence, and SMZ prophylaxis were critical to optimize immune reconstitution, particularly in high-risk subgroups.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Immune reconstitution efficacy and the risk factors of immune non-responsiveness after combined antiretroviral therapy in HIV-1 positive MSM and heterosexual population – a prospective cohort study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年3月28日

查看全文
  • Jiangshan Wang,
  • Wancha Huang,
  • Ying Liu,
  • Yanan Hou,
  • Jinda He,
  • Liuqin Chen,
  • Haoge Lin,
  • Hai Li,
  • Zhaohua Lu,
  • Jian Xiao,
  • Zhigang Zheng

摘要

Background

Immune reconstitution following combined antiretroviral therapy (cART) varies across populations and remains suboptimal in certain subgroups. This study assessed the trajectory and predictors of CD4+ T cell recovery among heterosexual (HET) and men who have sex with men (MSM) living with HIV-1 in Guangxi, China.

Methods

A prospective cohort of 458 newly diagnosed HIV-1 positive individuals (244 HET and 214 MSM) was followed from 2015 to 2024. Generalized additive models (GAM) were applied to evaluate CD4+ T cell trends. A Bayesian Markov Chain Monte Carlo (MCMC) generalized linear model (glm) estimated the posterior probability of immune recovery (Complete immune recovery (CIR), defined as two consecutive CD4+ T cell counts > 500 cells/µL after cART initiation.). Multivariable logistic regression identified risk factors for immune non-responsiveness.

Results

Median CD4+ T cell counts increased from 346 to 700 cells/µL in the HET group and from 404 to 778 cells/µL in the MSM group. However, CD4+ T cells declined during the first year among HET, and counts remained below 500 cells/µL after four years, while MSM surpassed this threshold earlier. Those with baseline CD4+ T cell counts < 150 cells/µL failed to achieve complete immune reconstitution even after six years. The risk of immune non-response among those with CD4+ T cell percentage ≤ 20%, 20%-30%, and 30%-40% were 10.82 (95% confidential interval (CI): 7.54–15.64, P < 0.001), 0.68 (95%CI: 0.49–0.94, P < 0.023), and 0.06 (95%CI: 0.02–0.12, P < 0.0001) times higher than other groups. Longer cART duration was correlated with improved recovery. Key factors associated with lower probability of immune recovery included being age ≥ 50 years, absence of cotrimoxazole prophylaxis (SMZ), heterosexual transmission, baseline CD4+ T cell < 350 cells/µL, and CD4+ T cell percentage ≤ 20%. Those who were divorced and those with shorter cART duration also exhibited reduced immune reconstitution rates.

Conclusions

Immune recovery after cART was slower and less complete in HET individuals and those with low baseline CD4+ T cell counts and low baseline CD4+ T cell percentage. Early diagnosis, prompt initiation of cART, long-term treatment adherence, and SMZ prophylaxis were critical to optimize immune reconstitution, particularly in high-risk subgroups.