摘要目的:分析浙江省台州市HIV感染者抗病毒治疗（ART）后CD4 +T淋巴细胞（CD4）计数恢复模式，探讨其影响因素及与死亡风险的关联。 方法:基于中国疾病预防控制信息系统艾滋病综合防治数据基本信息系统，纳入台州市2006年1月1日至2024年12月31日接受ART的成年（≥18岁）HIV感染者。采用回顾性队列研究设计和logistic回归分析CD4计数恢复模式；采用Kaplan-Meier法与Cox比例风险回归模型分析不同CD4恢复模式与死亡风险的关联。结果:3 465例HIV感染者纳入本研究，根据CD4计数恢复模式将研究对象分为4组：恢复受限组（43.7%，1 516/3 465）、延迟恢复组（12.6%，435/3 465）、快速恢复组（38.9%，1 347/3 465）和长期稳定组（4.8%，167/3 465）。恢复受限组的CD4计数中位数在基线与随访期间的增幅均低于其他3组。多因素logistic回归分析显示，基线CD4计数较高有利于延迟恢复和快速恢复；在2016年及以后开始ART不利于延迟恢复和快速恢复，有利于长期稳定；WHO临床分期较晚（Ⅲ、Ⅳ期）是快速恢复和长期稳定的独立危险因素；女性更易维持长期稳定。多因素Cox比例风险模型分析结果显示，与恢复受限组相比，延迟恢复组（a HR=0.25，95% CI：0.15~0.42）、快速恢复组（a HR=0.50，95% CI：0.37~0.69）和长期稳定组（a HR=0.30，95% CI：0.10~0.86）的死亡风险均显著降低。在实现免疫恢复（CD4计数>500个/μl）的HIV感染者中，能够长期稳定维持CD4计数>500个/μl是死亡风险的保护因素（a HR=0.46，95% CI：0.25~0.86）。 结论:CD4计数恢复受限的HIV感染者死亡风险更高。ART年份、WHO临床分期较晚和女性是CD4计数恢复模式的独立影响因素。早期干预、关注女性HIV感染者、促进免疫重建并维持其长期稳定，对降低HIV感染者的死亡风险具有重要意义。

abstractsObjective: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 (a HR=0.25, 95% CI:0.15-0.42), the rapid recovery group (a HR=0.50,95% CI: 0.37-0.69), and the long-term stable group (a HR=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 (a HR=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.