The predictive role of CD4+ cell count and CD4/CD8 ratio in immune reconstitution outcome among HIV/AIDS patients receiving antiretroviral therapy: an eight-year observation in China
The predictive role of CD4+ cell count and CD4/CD8 ratio in immune reconstitution outcome among HIV/AIDS patients receiving antiretroviral therapy: an eight-year observation in China
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DOI：
10.1186/s12865-019-0311-2
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发表时间：
2019-08-28
期刊：
影响因子：
3
通讯作者：
Kuang, Yi-Qun
中科院分区：
文献类型：
--
作者：
Li, Chong-Xi;Li, Yu-Ye;Kuang, Yi-Qun
背景 HIV 感染者开始高效抗逆转录病毒治疗 (HAART) 后的免疫重建显着影响患者的预后。然而，重建结果的动态特征和预测因素仍不清楚。方法本研究纳入HAART后病毒学持续抑制（病毒载量<50拷贝/ml）的HIV/AIDS患者。根据两年HAART后CD4细胞计数，将患者分为免疫无反应者(INRs)(<200个细胞/μl)、免疫反应不足者(IIRs)(200 500个细胞/μl)和免疫反应者(IRs)(>500个细胞/μl)。收集基于8年随访的CD4(+)和CD8(+)细胞计数的免疫重建数据进行分析。结果 免疫应答者（IR）的CD4（+）细胞计数显着高于免疫无应答者（INR）和免疫不充分应答者（IIR）（P < 0.001）。 IR 中的总体 CD4(+) 细胞计数和 CD4/CD8 比率比 IIR 和 INR 增加得更快。 IRs中HAART后0.5年和1年的CD4(+)细胞计数增长显着高于IIRs和INRs。 ROC曲线显示，1年CD4(+)细胞计数预测值最高，最佳截断值为188个细胞/μl，预测灵敏度为81.0%，预测特异度为85.2%，假阳性率为14.8%，假阴性率为19.0%，阳性预测值(IR)为63.0%，阴性预测值(INR)为93.5%。结论 综上所述，我们的研究结果表明，早期开始 HAART 可以减少免疫重建失败。基线CD4(+)细胞计数和基线CD4/CD8比率的组合可以作为HAART后免疫重建预后的有效预测因子。
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.