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

Corresponding author: KE Ran, keranran@163.com

DOI: 10.12201/bmr.202610.00049

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  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

  Submit time: 22 October 2026

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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