Plateaued CD4+ T count and its influencing factors in HIV infected patients after long-term antiviral treatment

Abstract

Objective To investigate the plateaued count of CD4+ T cells in human immunodeficiency virus (HIV)-infected patients after long-term antiretroviral therapy (ART) and its influencing factors. Methods All HIV-infected patients receiving continuous ART for >8 years till December 2021 and with HIV RNA < 200 copies/mL in the Infection Department of Chongqing Public Health Medical Treatment Center were recruited and subjected as research object. Their age, ART scheme and CD4+ T count at each time point were collected retrospectively, the growth of CD4+ T count was counted, and the factors affecting CD4+ T count in the plateau stage were analyzed. Results A total of 766 patients who receiving ART for longer than 8 years were included in this study. The median plateaued count of CD4+ T cells was 394.0 (292.0, 507.0)/μL. There were 66 (8.6%) patients of suboptimal immune responders (SIR) with CD4+ T count < 200/μL, 458 (59.8%) with the count ≥350/μL, and 198 (25.8%) ≥500/μL. Based on baseline CD4+ T count (< 200, 200~349, 350~499, and ≥500/μL), the patients were divided into 4 groups and significant differences were seen in CD4+ T count and its increase from baseline in each group (P < 0.05). The teenager group had obviously higher plateaued count of CD4+T cells [403 (306, 519)/μL] than the middle-aged and elderly group (P < 0.05). Univariate analysis showed that the proportion of patients older than 44 years was notably larger (P < 0.01), and that of patients with baseline CD4+ T count < 100/μL was also higher (54.5% vs 17.6%, P < 0.05) in the severe SIR group than the non-severe SIR group. Multivariate analysis indicated that age over 44 years old (OR=2.061, 95%CI: 1.157~3.672) and baseline CD4+ T count < 100/μL (OR=4.803, 95%CI: 2.767~8.340) were associated with severe SIR in plateau stage (P < 0.05). Conclusion The plateaued count of CD4+ T cells in HIV-infected patients is generally low in plateau stage. In middle-aged and elderly patients, those with baseline CD4+ T count < 100/μL at initiation of ART is at higher risk for severe SIR in plateau stage. Early screening and early treatment are the key points to prevent and control the occurrence of severe SIR.

Keywords

• human immunodeficiency virus
• cd4+t cells
• severe suboptimal immune responders
• age
• baseline