HIV感染者初始抗病毒治疗72周CD4/CD8变化及关联因素分析  

Changes of CD4/CD8 ratio in HIV-infected patients undergoing initial antiretroviral therapy for 72 weeks and analysis of its influencing factors

作　　者：郭佳佳 程娟 张春捷 方海霞 宋兵 孙咏冰 索绪海 黄辉煌 姜天俊 GUO Jiajia;CHENG Juan;ZHANG Chunjie;FANG Haixia;SONG Bing;SUN Yongbing;SUO Xuhai;HUANG Huihuang;JIANG Tianjun(Department of Infectious Diseases,the Fifth Medical Center,Chinese PLA General Hospital,National Clinical Research Center for Infectious Diseases,Beijing 100039,China)

机构地区：[1]解放军总医院第五医学中心感染病医学部,国家感染病临床医学研究中心,北京100039

出　　处：《解放军医学院学报》2023年第10期1068-1073,共6页Academic Journal of Chinese PLA Medical School

基　　金：国家重点研发计划(2022YFC2305004)。

摘　　要：背景及时有效的抗逆转录病毒治疗(antiretroviral therapy,ART)恢复HIV感染者受损的免疫功能是根本治疗措施,如何在早期精准评估患者免疫恢复状况是亟需探讨的临床问题。目的分析HIV感染者初始抗病毒治疗72周CD4、CD8细胞及其比值的变化规律,探讨免疫重建的相关因素。方法采集2011年1月-2018年12月在解放军总医院第五医学中心就诊入组并启动“2种核苷类逆转录酶抑制剂+1种非核苷类逆转录酶抑制剂”方案抗病毒治疗、服药依从性良好、长期随访的HIV感染者临床数据;观察CD4细胞与CD8细胞比值在ART不同时间节点的变化规律,并进行关联因素分析。结果(1)研究设定时间内共1796例HIV感染者入组,其中男性1710例(95.21%)、女性86例(4.79%),平均(35.47±11.68)岁。同性性传播占80.12%,异性性传播占13.31%。(2)ART前CD4细胞(/μL)、CD8细胞(/μL)分别为264±166、935±473;CD4/CD8比值为0.28±0.18,82.79%的感染者比值低于0.5。替诺福韦、拉米夫定、依非韦伦三联抗病毒治疗24周、48周、72周后,CD4细胞(/μL)分别升至374±187、589±207、726±377,CD8细胞(/μL)分别降至779±350、734±284、708±299,CD4/CD8比值分别升至0.55±0.33、0.84±0.20、1.03±0.38;与基线水平相比,三个指标的差异均有统计学意义(P<0.05)。但ART 48周之后,各指标增幅均明显放缓。(3)多因素分析显示,基线CD4低(<200/μL)、基线CD8高(≥800/μL)和基线CD4/CD8比值低(<0.5)者抗病毒治疗72周CD4/CD8比值恢复更差(P<0.05,OR>1)。结论HIV感染者开始ART前CD4细胞水平普遍较低、CD4/CD8比值倒置严重,ART 72周后多数HIV感染者CD4细胞得以恢复,CD4/CD8比值明显改善,但仍有部分感染者免疫重建不良。基线CD4、CD8水平以及CD4/CD8比值是影响感染者免疫恢复的重要关联因素。Background Restoring the impaired immune function of infected people through timely and effective antiretroviral therapy(ART)is the current fundamental treatment measure.How to accurately evaluate the immune recovery of patients early is an urgent clinical problem to be discussed.Objective To investigate the changes of CD4 and CD8 cells and their ratio in HIV-infected patients who accept initial antiviral treatment(ART)for 72 weeks,and explore the relevant influencing factors of immune reconstitution.Methods The real-world data of the HIV infected patients from January 2011 to December 2018,who received antiretroviral therapy(ART)with“2NRTs+NNRTIs”regimen during that period in our medical center,were collected;and the changes of CD4/CD8 at different time points of ART were observed.These data were used for analyses of contributing factors.Results A total of 1796 HIV-infected patients were enrolled,including 1710 males(95.21%)and 86 females(4.79%),who were(35.47±11.68)years old on average.In terms of the transmission route,homosexual sexual transmission(MSM)accounted for 80.12%,and heterosexual transmission accounted for 13.31%.The CD4 and CD8 cells before ART was(264±166)/μL and(935±473)/μL respectively,and the CD4/CD8 ratio was 0.28±0.18,with 82.79%of infected patients being less than 0.5.After 24 weeks,48 weeks,and 72 weeks of ART with tenofovir,lamivudine,and eafavirenz,the patients’CD4 cells rose to(374±187)/μL,(589±207)/μL,(726±377)/μL,respectively,and CD8 cells fell to(779±350)/μL,(734±284)/μL,(708±299)/μL,respectively.Meanwhile,the CD4/CD8 ratio rose to 0.55±0.33,0.84±0.20,1.03±0.38,respectively.The differences were statistically significant compared to baseline levels(all P<0.05).However,after 48 weeks,the growth rate of all indicators was significantly slower,and the difference was not statistically significant when comparing CD4 cells of 72 weeks with those of 48 weeks(P>0.05).Multivariate analysis showed that higher baseline CD8 level,lower baseline CD4 level and CD4/CD8 rati

关 键 词：人类免疫缺陷病毒感染者 抗病毒治疗 免疫重建 CD4/CD8比值 国家免费抗病毒治疗方案 

分 类 号：R512.91[医药卫生—内科学]