Baseline conditions
Sixty-one treatment-naive HIV infected male patients in the Public and Health Clinic Centre of Chengdu from October 1, 2012 to Decmenber 31, 2017, were divided into three groups according to the baseline CD4 + T cell count (26, 12, 23 cases in < 200, from 200 to 350, > 350 cell/ul three groups, respectively).There were 42 cases of homosexual infection, 13 cases of heterosexual infection and 5 cases of two types of homosexual and heterosexual infection. The general information, baseline immunity and virological indicators, lipid metabolism parameters of 61 cases were shown in Table 1.
Table 1
Baseline information and of HIV infected male patients (n = 61)
variable | χ± SD or cases(%) | range |
age(years) | 32.05 ± 8.38 | 20ཞ58 |
gender(male,%) | 61(100%) | |
infection duration(months) | 11.16 ± 1.19 | 1ཞ86 |
T lymphocyte subsets | | |
CD3 + count (cells/ul) | 1433.98 ± 595.35 | 470 ~ 3074 |
CD3 + CD4 + count (cells/ul) | 313.87 ± 118.473 | 54 ~ 499 |
CD3 + CD4 + percentage (%) | 19.78 ± 6.83 | 1.40 ~ 43.40 |
CD3 + CD8 + count (cells/ul) | 1119.70 ± 605.0 | 360 ~ 2456 |
CD3 + CD8 + percentage (%) | 69.97 ± 13.80 | 36.13 ~ 97.20 |
*Virus load of HIVRNA | 41772.77 ± 10.38 | 895.00 ~ 505987.00 |
metabolic parameters | | |
TG (mmol/L) | 1.68 ± 1.23 | 0.39 ~ 16.81 |
TC (mmol/L) | 4.20 ± 0.72 | 2.38 ~ 6.09 |
LDL-c (mmol/L) | 2.61 ± 0.68 | 0.92 ~ 4.71 |
HDL-c (mmol/L) | 1.12 ± 0.24 | 0.57 ~ 1.77 |
UA (µmol/L) | 310.72 ± 68.65 | 143 ~ 506 |
Note: Abbreviation: TG, triglyceride.TC, total cholesterol. LDL-c, low density lipoprotein cholesterol. HDL-c, high density lipoprotein cholesterol. UA, uric acid. *refers to logarithmic transformation before statistical analysis for non-normally distributed data. |
Effectiveness of HAARTwith TDF plus 3TC plus EFV regimen
In 61 patients the average CD4 + T cell count (Fig. 1A) gradually increase from 319.80cell/ul at baseline to 464.85cell/ul at 96 weeks after HAART, and the average viral load (Fig. 1B) decreased rapidly from 49846.32 IU/ml at baseline to reaching undetectable levels by the high-precision detection method at 72 weeks, and the percentage of viral load reaching undetectable levels (Fig. 1C) was from 21.31% at 12 weeks to100.00% at 72 weeks.
Long-term dynamic changes of lipid and purine metabolism parameters after after treatment with TDF + 3TC + EFV
TC level, LDL-c level, HDL-c level, TG level and UA level (Fig. 2A, 2B, 2C, 2D and 4A) all gradually increased along with prolonged HAART, but the increasing amplitude was small, only statistical significance of TC level (Fig. 2A) and HDL-c level (Fig. 2C) (0, 24, 48, 96, 120, 144 weeks: 4.20vs. 4.13, 4.43, 4.60, 4.44, 4.67 mmol/L; 1.12vs.1.19, 1.32, 1.36, 1.23, 1.30 mmol/L; F = 4.382, 6.033, P = 0.0007, 0.000, respectively) was found. Compared with baseline, there were significant differences of TC level at 96 and 144 weeks (Fig. 2A), HDL-c level at 48, 96 and 144 weeks (Fig. 2C) (4.20vs.4.60 mmol/L, 4.20vs. 4.67 mmol/L; 1.12vs. 1.32 mmol/L, 1.12vs. 1.36 mmol/L, 1.12vs. 1.30 mmol/L; t = 3.155, 2.175, 3.610, 5.189, 2.473, P = 0.002, 0.0329, 0.0004, 0.0001, 0.0157, respectively). Comparison between different time points and compared with baseline, no significant difference of LDL-c level (Fig. 2B), TG level (Fig. 2D) and UA level (Fig. 4A) was found ( all P > 0.05).
Simultaneously the percentage of hypercholesterolemia (Fig. 3A), hyper low density lipoprotein cholesterolemia (Fig. 3B) and hypertriglyceridemia (Fig. 3D) all gradually increased, but there was no obvious difference (24.59vs. 29.51, 24.59, 21.31, 25.00, 50.00%; 9.84vs. 8.20, 8.20, 18.03, 25.00, 21.43%; 8.20vs. 8.20, 9.84, 18.05, 10.00, 21.43%, χ2 = 5.351, 7.966, 5.408, P = 0.375, 0.158, 0.368, respectively). On the countrary, the percentage of low high density lipoprotein cholesterolemia (Fig. 3C) gradually decreased along with prolonged HAART, significant difference was found from baseline to 144 weeks (Fig. 3C) (36.07vs. 18.03, 16.39, 9.84, 20.00, 7.14%, χ2 = 16.105, P = 0.0007), and at 24, 48, 96, 144 weeks compared with at baseline (Fig. 3C) (36.07vs. 18.03, 16.39, 9.84, 20.00, 7.14%, 36.07vs. 18.03%, 36.07vs. 16.39%, 36.07vs.9.84%, 36.07vs.7.14%; Z=-2.233, -2.460, -3.431, -2.102, P = 0.026, 0.014, 0.001, 0.036, respectively). The percentage of hyperucicemia (Fig. 4B) slightly decreased with the extension of the treatment time of HAART, no obvious difference was found ( P > 0.05).
Effect of baseline CD4 + T cell count on lipid and purinemetabolic parameters after treatment with TDF + 3TC + EFV
The lower the CD4 + T cell count at baseline, the higher the TG level (Fig. 5D), and the lower the TC level (Fig. 5A), LDL-c level (Fig. 5B), HDL-c level (Fig. 5C) and UA level (Fig. 6), and the changes were maintained throughout the follow-up period after HAART treatment. However, there was no statistical significance from baseline to 96 weeks between three different CD4 + T cell count groups ( all P > 0.05). Only the difference of LDL-c level (Fig. 5B) at baseline between three different CD4 + T cell count groups was found (2.22vs.2.70, 2.67 mmol/L, F = 3.256, P = 0.0457). TC level (Fig. 5A) and HDL-c level (Fig. 5C) all gradually increased along with prolonged HAART regardless of the CD4 + T cell count at baseline.