Longitudinal analysis of immune reconstitution and metabolic changes in women living with HIV:A real-world observational study

作     者：Xiaolei Wang Jiang Xiao Leidan Zhang Ying Liu Na Chen Meiju Deng Chuan Song Tingting Liu Yuanyuan Zhang Hongxin Zhao 

作者机构：Clinical and Research Center of Infectious DiseasesBeijing Ditan HospitalCapital Medical UniversityBeijing 100015China Institute of Infectious DiseasesBeijing Ditan HospitalCapital Medical UniversityBeijing 100015China Beijing Key Laboratory of Emerging Infectious DiseasesInstitute of Infectious DiseasesBeijing Ditan HospitalCapital Medical UniversityBeijing 100015China National Center for Infectious DiseasesBeijing Ditan HospitalCapital Medical UniversityBeijing 100015China Department of InfectionBeijing Ditan HospitalPeking UniversityBeijing 100015China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2023年第136卷第18期

页      面：2168-2177页

核心收录：

学科分类：1004[医学-公共卫生与预防医学(可授医学、理学学位)] 1002[医学-临床医学] 100401[医学-流行病与卫生统计学] 10[医学] 

基　　金：Beijing Municipal Administration of Hospitals’Ascent Plan(No.DFL20191802) Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support(No.ZYLX202126) 

主　　题：Women Human immunodeficiency virus Immune reconstitution CD4/CD8 ratio HIV 

摘      要：Background:Women comprise more than half of people living with human immunodeficiency virus/acquired immune deficiency syndrome(HIV/AIDS)worldwide and incomplete immune recovery and metabolic abnormalities affect them deeply.Studies of HIV antiretroviral therapy(ART)have a low female representation in China.We aimed to investigate immune reconstitution and metabolic changes of female HIV-positive cohort in China longitudinally.Methods:HIV-positive women who initiated ART from January 2005 to June 2021 and were followed up regularly at least once a year were included in this study.Immunological indicators(cluster of differentiation 4[CD4]counts and CD8 counts),viral load(VL),and metabolic indicators were collected at follow-up.All data were collected from the China Disease Prevention and Control Information System(CDPCIS).VL was tested half a year,1 year after receiving ART,and every other year subsequently according to local policy.CD4/CD8 ratio normalization was considered as the primary outcome and defined as a value≥1.Incidence rate and probability of CD4/CD8 ratio normalization were estimated through per 100 person-years follow-up(PYFU)and Kaplan-Meier curve,respectively.Multivariate Cox regression was used to identify independent risk factors associated with CD4/CD8 ratio normalization.We further studied the rate of dyslipidemia,hyperuricemia,diabetes,liver injury,and renal injury after ART initiation with the chi-squared tests or Fisher’s exact probability tests,and a generalized estimating equation model was used to analyze factors of dyslipidemia and hyperuricemia.Results:A total of 494 female patients with HIV/AIDS started ART within 16 years from January 2005 to June 2021,out of which 301 women were enrolled with a median duration of ART for 4.1 years(interquartile range,2.3-7.0 years).The overall incidence rate of CD4/CD8 ratio normalization was 8.9(95%confidence interval[CI],7.4-10.6)per 100 PYFU,and probabilities of CD4/CD8 normalization after initiating ART at 1 year,2 years,5 years,and 10 years follow-up were 11.7%,23.2%,44.0%,and 59.0%,respectively.Independent risk factors associated with CD4/CD8 normalization were baseline CD4 cell counts1000 cells/μL,and more than 6 months from the start of combined ART(cART)to first virological suppression.Longitudinally,the rate of hypercholesterolemia(total cholesterol[TC])and high triglyceride(TG)showed an increasing trend,while the rate of low high-density lipoprotein cholesterol(HDL)showed a decreasing trend.The rate of hyperuricemia presented a downtrend at follow-up.Although liver and renal injury and diabetes persisted during ART,the rate was not statistically significant.Older age and protease inhibitors were independent risk factors for increase of TC and TG,and ART duration was an independent factor for elevation of TC and recovery of HDL-C.Conclusions:This study showed that women were more likely to normalize CD4/CD8 ratio in comparison with findings reported in the literature even though immune reconstruction was incomplete.