[Study on the association between the recovery pattern of CD4+T lymphocyte counts and the risk of death among HIV-infected individuals after antiretroviral therapy in Taizhou City, Zhejiang Province from 2006 to 2024].

Objective: To analyze the recovery pattern in CD4+T lymphocyte (CD4) count among HIV-infected individuals after antiretroviral therapy (ART) in Taizhou City, Zhejiang Province, and to explore the influencing factors of these pattern and their association with the risk of death. Methods: Based on the Basic Information System of AIDS Comprehensive Prevention and Control Data of the Chinese Disease Prevention and Control Information System, adult (≥18 years old) HIV-infected individuals who received ART in Taizhou City from January 1, 2006, to December 31, 2024, were included. A retrospective cohort study design and logistic regression analysis were adopted to analyze the pattern of CD4 count recovery. The association between different CD4 change pattern groups and the risk of death was analyzed using the Kaplan-Meier method and the Cox proportional hazards regression model. Results: A total of 3 465 HIV-infected individuals were included. According to the pattern of CD4 counts recovery, the participants were divided into four groups: the recovery-restricted group (43.7%,1 516/3 465), the delayed recovery group (12.6%,435/3 465), the rapid recovery group (38.9%,1 347/3 465), and the long-term stable group (4.8%, 167/3 465). The median increase in CD4 count in the recovery-restricted group during both baseline and follow-up periods was lower than that in the other three groups. Multivariate logistic regression analysis showed that a higher baseline CD4 count was associated with both delayed and rapid recovery. Starting ART in 2016 or later is neither conducive to delayed nor rapid recovery, but is beneficial for long-term stability. A later WHO clinical stage (stage Ⅲ, Ⅳ) was an independent risk factor for rapid recovery and long-term stability, and women were more likely to maintain long-term stability. Multivariate Cox analysis showed that compared with the recovery-restricted group, the delayed recovery group (aHR=0.25, 95%CI:0.15-0.42), the rapid recovery group (aHR=0.50,95%CI: 0.37-0.69), and the long-term stable group (aHR=0.30,95%CI:0.10-0.86) had a significantly reduced risk of death. Furthermore, in patients who achieved immune recovery (CD4>500 cells/μl), the ability to maintain a long-term stable CD4 count >500 cells /μl was a protective factor for the risk of death (aHR=0.46, 95%CI:0.25-0.86). Conclusions: HIV-infected individuals with restricted recovery of CD4 counts had a higher risk of death. The year of starting ART, later WHO clinical stage, and female gender were independent predictors of the recovery pattern of CD4 counts. Early intervention, focusing on female HIV-infected individuals, promoting immune reconstitution and maintaining their long-term stability are of great significance in reducing the mortality risk of HIV-infected individuals.