通讯作者: 柯然, keranran@163.com

DOI：10.12201/bmr.202610.00049

Analysis of Immune Reconstitution and Its Influencing Factors in Late-Presenting HIV/AIDS Patients Receiving Antiretroviral Therapy in Xiamen City

• 摘要：摘要 目的 分析厦门市晚发现HIV/AIDS患者长期接受ART后免疫重建的状况及其影响因素。方法 采用回顾性队列研究。资料来源于“艾滋病综合防治信息系统”，研究对象为2006年1月至2025年12月期间确诊、现住址在厦门市、符合晚发现标准且规律随访≥4年的HIV/AIDS患者，共1642例。以最近一次随访CD4+T细胞计数判定免疫重建结局：≥350个/μL为良好，<350个/μL为不全。组间比较采用χ²检验或Mann-Whitney U检验；二元Logistic回归（Enter法）用于影响因素分析。结果 免疫重建不全413例（25.15%），良好1229例（74.85%）。初始CD4+T细胞计数较高是保护因素（OR=0.993, 95%CI: 0.991~0.994, P<0.001）。年龄≥50岁（相较于15~24岁，OR=2.205, 95%CI: 1.361~3.572, P=0.001）与曾发生失访或停药（OR=1.578, 95%CI: 1.234~2.017, P<0.001）则为独立危险因素；婚姻状况与感染途径未见独立影响。限定于病毒学抑制者（n=1493）重新分析，初始CD4+T细胞计数与年龄的关联基本不变，失访或停药的关联则减弱，未再有统计学意义（OR=1.217, 95%CI: 0.935~1.584）。结论 该人群免疫重建不全的比例较高，其发生与初始CD4水平、年龄及治疗连续性独立相关；失访或停药的不利影响，可能部分是通过病毒学失败实现的。应推进早发现、早治疗，并加强对老年及治疗中断风险患者的随访管理。关键词 艾滋病；免疫重建；晚发现；影响因素中图分类号 R512.91

  关键词： 艾滋病；免疫重建；晚发现；影响因素; ; ; 

   

  Abstract: Abstract Objective To analyze the status of immune reconstitution and its influencing factors in late-presenting HIV/AIDS patients in Xiamen City, Fujian Province, after receiving long-term ART. Methods This was a retrospective cohort study. Patients were identified from the “AIDS Comprehensive Prevention and Treatment Information System”. They were diagnosed between January 2006 and December 2025, had a current registered address in Xiamen City, met the criteria for late presentation, and had been receiving ART with regular follow-up for at least 4 years. A total of 1642 patients were included. Good immune reconstitution was defined as a CD4+T cell count ≥350 cells/μL at the most recent follow-up; incomplete reconstitution as a count <350 cells/μL. Inter-group comparisons used the chi-square test or the Mann-Whitney U test; influencing factors were analyzed with multivariate binary logistic regression (enter method). Results Among the 1642 late-presenting patients, 413 (25.15%) had incomplete immune reconstitution, and 1229 (74.85%) had good immune reconstitution. In univariate analysis, immune reconstitution was associated with age, marital status, transmission route, treatment interruption or loss to follow-up, initial CD4+T cell count, and initial viral load (all P<0.05). Multivariate logistic regression identified a higher initial CD4+T cell count as a protective factor against incomplete immune reconstitution (OR=0.993, 95%CI: 0.991~0.994, P<0.001). Age ≥50 years (versus 15-24 years, OR=2.205, 95%CI: 1.361~3.572, P=0.001) and any treatment interruption or loss to follow-up (OR=1.578, 95%CI: 1.234~2.017, P<0.001) were independent risk factors for incomplete immune reconstitution. Marital status and transmission route were not independently associated with incomplete immune reconstitution. In a sensitivity analysis restricted to virologically suppressed participants (most recent VL <50 copies/mL, n=1493), the associations with initial CD4+T cell count and age ≥50 years were essentially unchanged, whereas the association with treatment interruption or loss to follow-up was attenuated and no longer statistically significant (OR=1.217, 95%CI: 0.935~1.584). Conclusion The proportion of incomplete immune reconstitution is high among late-presenting HIV/AIDS patients in Xiamen City after long-term ART. A higher initial CD4 level was protective against incomplete immune reconstitution, whereas age ≥50 years and treatment interruption or loss to follow-up were independent risk factors for it. The adverse effect of the latter may be partly explained by virological failure. Early detection and treatment should be promoted, and follow-up management should focus on older patients and those at risk of treatment interruption.Key words AIDS; Immune Reconstitution; Late Presentation; Influencing Factors

  Key words: AIDS; Immune Reconstitution; Late Presentation; Influencing Factors

  提交时间：2026-10-22

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• 序号	提交日期	编号	操作
  1	2026-06-05	10.12201/bmr.202610.00049V1	下载

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