Na?ve CD4 cell counts significantly decay and high HIV RNA levels contribute to immunological progression in long-term non-progressors infected with HIV by blood products: a cohort study

摘要

Some long-term non-progressors (LTNPs) have decreasing CD4 T cell counts and progress to AIDS. Exploring which subsets of CD4 T cell decreasing and the determinants associated with the decay in these patients will improve disease progression surveillance and provide further understanding of HIV pathogenesis. Twenty-five LTNPs infected with HIV by blood products were classified as decreased (DG) if their CD4 cell count dropped to ?400 cells/μL during follow-up or as non-decreased (non-DG) if their CD4 cell count was ≥400 cells/μL. Laboratory and clinical assessments were conducted at 6 consecutive visits to identify DG characteristics. The LTNPs were infected with HIV for 12 (IQR: 11.5–14) years, and 23 were classified as the B′ subtype. Six individuals lost LTNP status 14.5 (IQR: 12.5–17.5) years after infection (DG), and the CD4 T cell count decreased to 237 (IQR: 213–320) cells/μL at the latest visit. The na?ve CD4 T cell count decrease was greater than that of memory CD4 T cells [??128 (IQR: ??196, ??107) vs ??64 (IQR: ??182, ??25) cells/μL)]. Nineteen individuals retained LTNP status (non-DG). At enrolment, the viral load (VL) level (p?=?0.03) and CD8 CD38 percentage (p?=?0.03) were higher in DG than non-DG individuals. During follow-up, viral load and CD8 CD38 percentage were significantly increased and negatively associated with CD4 cell count [(r?=???0.529, p?=?0.008), (r?=???0.476, p?=?0.019), respectively]. However, the CD8 CD28 percentage and B cell count dropped in DG and were positively correlated with CD4 T cell count [(r?=?0.448, p?=?0.028), (r?=?0.785, p??0.001)]. Immunological progression was mainly characterized by the decrease of na?ve CD4 T cell in LTNPs infected with HIV by blood products and it may be associated with high HIV RNA levels.