Trends of CD4⁺T cell count among HIV/AIDS patients prior to antiretroviral therapy initiation and its association with immunological recovery and mortality after treatment

Objective To examine the association between the natural trends of CD4⁺T cell prior to antiretroviral therapy (ART) initation and immunological recovery and mortality after ART among HIV/AIDS patients in Yuxi Prefecture, Yunnan. Methods The natural changes of the CD4⁺T cell before ART were divided into four groups among HIV/AIDS patients, the immunologic recovery was described and Kaplan-Meier method were used to describe survival curve among different groups of patients initiated ART. Multivariate logistic regression were used to analyse factors associated with immune non-responses. Results Among 777 HIV/AIDS patients, the natural changes of CD4⁺T cell after ART was significantly lower in gently and rapidly increased groups than rapidly decline groups among ART-naive HIV/AIDS patients. Multivariate logistic regression analysis indicated that patients with natural increase of CD4⁺T cell counts before ART initiation (OR=2.416,95% CI:1.264-4.616,P=0.008;OR=1.997,95% CI:1.067-3.737,P=0.031), with baseline CD4⁺T cell counts more than 500cell/μL (OR=6.550, 95%CI:3.315-12.941, P<0.001) and those older than 50 years old at ART initiaiton (OR=4.276, 95%CI:1.761-10.3865, P=0.001) were more likely to have immune non-responses after ART. The cumulative survival rate was significantly lower in gently increased groups than the gently and rapid decline groups (χ²=8.979,P=0.003;χ²=4.158,P=0.041), further stratified analysis showed that those with baseline CD4 counts less than 200 cell/μl, as well (all P<0.05). Conclusions An association was identified between the natural changes of CD4⁺T cell before ART and the immunologic recovery after ART, INRs and mortality.