Background:Among HlV-infected patients initiating antiretroviral therapy (ART),early changes in CD4+ T-cell subsets are well described.However,HIV-infected late presenters initiating treatment present with a subop...Background:Among HlV-infected patients initiating antiretroviral therapy (ART),early changes in CD4+ T-cell subsets are well described.However,HIV-infected late presenters initiating treatment present with a suboptimal CD4+ T-cell reconstitution and remain at a higher risk for AIDS and non-AIDS events.Therefore,factors associated with CD4+ T-cell reconstitution need to be determined in this population,which will allow designing effective immunotherapeutic strategies.Methods:Thirty-one adult patients with baseline CD4+ T-cell count 〈350 cells/mm^3 exhibiting viral suppression after ART initiation were followed in the HIV/AIDS research center of Peking Union Medical College Hospital in Beijing,China,from October 2002 to September 2013.Changes in T-cell subsets and associated determinants were measured.Results:Median baseline CD4+ T-cell count was 70 cells/mm3.We found a biphasic reconstitution ofT-cell subsets and immune activation:a rapid change during the first 6 months followed by a more gradual change over the subsequent 8 years.Baseline CD4+ T-cell count 〉200 cells/ mm3 in comparison to CD4+ T-cell count ≤200 cells/mm3 was associated with more complete immune Reconstitution (77.8% vs.27.3% respectively;P =0.017) and normalized CD4/CD8 ratio.We showed that the baseline percentage of naive CD4+ T-cell was a predictive marker for complete immune reconstitution (area under receiver operating characteristic curve 0.907),and 12.4% as cutoffvalue had a sensitivity of 84.6% and a specificity of 88.2%.Conclusions:Baseline naive CD4+ T-cell percentage may serve as a predictive marker for optimal immune reconstitution during long-term therapy.Such study findings suggest that increasing thymic output should represent an avenue to improve patients who are diagnosed late in the course of infection.展开更多
基金This study was supported by the National Natural Science Foundation of China (No. 81071372), the National Key Technologies R and D Program for the 11th Five-year Plan (No. 2008ZX10001-006), the National Key Technologies R and D Program for the 12th Five-year Plan (No. 2012ZX10001003-001), and the Key Clinical Program of the Ministry of Health (2010-2012).
文摘Background:Among HlV-infected patients initiating antiretroviral therapy (ART),early changes in CD4+ T-cell subsets are well described.However,HIV-infected late presenters initiating treatment present with a suboptimal CD4+ T-cell reconstitution and remain at a higher risk for AIDS and non-AIDS events.Therefore,factors associated with CD4+ T-cell reconstitution need to be determined in this population,which will allow designing effective immunotherapeutic strategies.Methods:Thirty-one adult patients with baseline CD4+ T-cell count 〈350 cells/mm^3 exhibiting viral suppression after ART initiation were followed in the HIV/AIDS research center of Peking Union Medical College Hospital in Beijing,China,from October 2002 to September 2013.Changes in T-cell subsets and associated determinants were measured.Results:Median baseline CD4+ T-cell count was 70 cells/mm3.We found a biphasic reconstitution ofT-cell subsets and immune activation:a rapid change during the first 6 months followed by a more gradual change over the subsequent 8 years.Baseline CD4+ T-cell count 〉200 cells/ mm3 in comparison to CD4+ T-cell count ≤200 cells/mm3 was associated with more complete immune Reconstitution (77.8% vs.27.3% respectively;P =0.017) and normalized CD4/CD8 ratio.We showed that the baseline percentage of naive CD4+ T-cell was a predictive marker for complete immune reconstitution (area under receiver operating characteristic curve 0.907),and 12.4% as cutoffvalue had a sensitivity of 84.6% and a specificity of 88.2%.Conclusions:Baseline naive CD4+ T-cell percentage may serve as a predictive marker for optimal immune reconstitution during long-term therapy.Such study findings suggest that increasing thymic output should represent an avenue to improve patients who are diagnosed late in the course of infection.