The Red Blood Cell Counts before HAART Treatment may be Related to the Long-Term Immune Reconstitution in HIV Patients.

Abstract

Introduction: While HIV infection damages red blood cells and rapid hemoglobin drops are strongly associated with disease progression, it is unclear whether red blood cells can have an impact on immune reconstitution following long-term highly active antiretroviral therapy (HAART).

Methods: We collected and analyzed data on 75 confirmed HIV cases in Wenzhou between January 2 and October 31, 2017. The sample size of 75 patients was determined by the total number of eligible ART-naïve individuals available at our center during the enrollment period, reflecting a realistic recruitment scenario for this preliminary single-center study. HIV patients were classified as the immune-reconstitution-successful group (IRSG) or the immune-reconstitution-failed group (IRFG) based on their CD4+ T cell count at two years on HAART. The parameters of red blood cells were determined and compared between the two groups previously described. Dynamic monitoring of lymphocytic subsets was conducted in HIV-positive patients receiving HAART.

Results: When compared to patients with IRSG, patients with IRFG have lower hemoglobin, red blood cell count, and hematocrit levels (all P values <0.01). After adjusting for gender and age, the odds ratio for long-term HAART efficacy was 10.971 (p=0.001). There was a positive correlation between red blood cell counts and CD4+ T cell counts in male HIV patients (r=0.496, p<0.001). The area under the curve of red blood cell count in male HIV patients was 0.791 (p values<0.001). The cut-off value of red blood cell count on male HIV patients was 5.03×1012/L.

Discussion: These findings suggest that pre-treatment red blood cell count may serve as a simple and accessible predictor of long-term immune reconstitution in HIV patients, particularly in males. The association aligns with previous reports linking anemia to poorer HIV outcomes, and supports the potential role of red blood cells in immune regulation. However, validation in larger, more diverse cohorts and with contemporary antiretroviral regimens is warranted.

Conclusions: Patients with a low red blood cell count before treatment had a lower CD4+ T cell count and a higher level of immune activation than those with a high red blood cell count. The red blood cell count before treatment may be associated with long-term HAART efficacy.