Analysis of the Influencing Factors of Immunological Nonresponders in Wuhan, China.

Abstract

Objective: CD4⁺ cell recovery is hampered in some human immunodeficiency virus (HIV)-infected patients, despite a successful highly active antiretroviral therapy (HAART) with suppressed viral replication. We investigated the factors that might have hindered the CD4⁺ cell recovery in these patients.

Methods: In this retrospective study, we collected the data of all immune nonresponders (INRs) in Wuhan, China, until the end of 2020. A linear model was constructed based on the data from 220 patients with baseline and follow-up records. The response variables in this study were the CD4⁺ cell count increase. The predictor variables considered in this study were those factors likely to affect the CD4⁺ cell recovery.

Results: Our findings revealed that the plasma HIV-1 viral load of all patients was suppressed and 87.3% patients' CD4⁺ cells was increased after more than one year of the HAART treatment. In addition, their last follow-up showed a significant reduction in complications. In our results, the body mass index (BMI), number of months since HIV diagnosis to HAART start, and nonuse of co-trimoxazole were negatively correlated with the increase in CD4⁺ cells (P < 0.05). However, there were positive associations between serum creatinine levels and CD4⁺ cell recovery (P < 0.05). Further stratified analyses indicated that the associations between HAART replacement or creatinine usage and CD4⁺ cell growth were only observed in those participants with a BMI <18.5 (P < 0.05).

Conclusions: An early initiation of HAART and co-trimoxazole preventive therapy (CPT) can promote immune reconstitution. BMI and serum creatinine can serve as monitoring indicators of immune reconstitution prognosis after the HAART.