Study On Influencing Factors And Establishment Of Multivariate Logistic Model Of Incomplete Immune Reconstitution After HAART

Objective:To explore the influencing factors of immune reconstitution in AIDS patients after HAART,and to establish a model of incomplete immune reconstitution,to predict the possibility of incomplete immune reconstitution in AIDS patients,so as to provide reference for clinical diagnosis and treatment.Methods:Collect the clinical data of 155 patients who were confirmed AIDS and follow-up in Wuming Hospital Affiliated to Guangxi Medical University and People’s Hospital of Mashan County,from May 2007 to December2019.According to the recovery of immune function after HAART,the patients were divided into two groups:complete immune reconstruction group and incomplete immune reconstruction group.Through univariate analysis between the two groups of age,gender,disease status,AIDS indicative diseases,baseline levels of CD4+T/CD8+T cells,white blood-cells,hemoglobin,platelet,liver function,serum creatinine and other indicators,select the factors with statistical significance and establish multivariate logistic model for prognosis.Result:1.A total of 155 patients were included in the study.66 patients in the complete immune reconstitution group includes 50 male patients（75.8%）,16female patients（24.2%）,aged 45±18 years;89 patients in the incomplete immune reconstitution group includes 66 male patients（74.2%）,23 female patients（25.8%）,aged 50±13 years.There was no significant difference in gender between the two groups.The proportion of people with age≥60 years old in the incomplete immune reconstitution group was significantly higher,and the difference was statistically significant.2.The number of patients with WHO clinical classification IV in the incomplete immune reconstitution group is significantly increased compared with the complete immune reconstitution group,and the difference is statistically significant.3.The probability of AIDS indicative diseases in the incomplete immune reconstitution group is higher than that in the complete immune reconstitution group,and the difference is statistically significant.4.From the perspective of special pathogens infection with HBV and HCV,about 11～15%of AIDS patients co-infection with HBV,and the difference between the two groups co-infection with HBV/HCV is not statistically significant.5.The number of patients who began to receive treatment within the first year in the complete immune reconstitution group was significantly higher,the difference is statistically significant.6.About 10～20%of the patients changed the therapy within one year from the beginning of treatment.The main reasons for the change were myelosuppression,rash and other adverse drug reactions.In the incomplete immune reconstitution group,the initial treatment using EFV+3TC+TDF was more than that in the complete immune reconstitution group,and the difference was statistically significant.7.The proportion of baseline CD4+T cells<50/μl in the incomplete immune reconstitution group was significantly higher than that in the complete immune reconstitution group.8.The proportion of baseline CD8+T cells<600/μl was significantly higher in the incomplete immune reconstitution group,the difference was statistically significant.9.The level of hemoglobin,leukocyte in the incomplete immune reconstitution group was lower than that in the complete immune reconstitution group,the difference was statistically significant.There was no statistical significance in the differences of platelet,creatinine,ALT,AST,total cholesterol,triglyceride and blood glucose between the two groups.10.Multivariate logistic analysis showed that age,baseline CD4+T,CD8+T cell level,AIDS indicative diseases and initial treatment had significant effects on incomplete immune reconstitution.To establish the regression equation,the probability of incomplete immune reconstitution was P=1/(1+e^-Y),Y=-5.748+1.303×age+2.124×baseline CD4 cell+1.433×baseline CD8 cell+1.781×AIDS indicative diseases+1.224×initial treatment.The area under ROC curve of the model was 0.868,the lower limit of progressive 95%confidence interval was 0.810,the upper limit was 0.925,the sensitivity was 84.4%,and the specificity was 77.6%.Conclusion:1.The independent risk factors of incomplete immune reconstitution in AIDS patients after HAART are Age,baseline CD4+T,CD8+T cell level,AIDS indicative diseases and initial treatment.2.The effect of WHO clinical classification,leukocyte and hemoglobin levels on incomplete immune reconstruction is less and the predictive is of little value.3.The predictive model of incomplete immune reconstitution established in this study had a certain value of discrimination for incomplete reconstruction of AIDS patients after HAART.