Objective To explore the dynamic change characteristics and influencing factors of immune reconstitution and abnormal immune activation in human immunodeficiency virus (HIV)-infected individuals/acquired immunodeficiency syndrome (AIDS) patients undergoing long-term highly active antiretroviral therapy (HAART). Methods The clinical data of 153 HIV-infected individuals/AIDS patients who received long-term standardized HAART and completed 7-year follow-up in a tertiary grade A hospital in Nanning were collected. According to the baseline CD4+ T lymphocyte count, the patients were divided into three groups: low baseline CD4 group (≤200 cells/μL, n=56), medium baseline CD4 group (201-349 cells/μL, n=58), and high baseline CD4 group (≥350 cells/μL, n=39). The dynamic changes of CD4+ T lymphocyte count, CD8+ T lymphocyte count, and CD4/CD8 ratio before treatment (at baseline) and each time point after treatment were observed in the three groups; the recovery rate of CD4+ T lymphocyte count (≥500 cells/μL) and the rate of abnormal immune activation (CD4/CD8 ratio<1.0) at each time point after treatment were compared among the three groups; generalized estimating equation (GEE) was used to analyze the influencing factors for the normalization of CD4/CD8 ratio (≥1.0) in HIV-infected individuals/AIDS patients after HAART. Results (1) After HAART, the CD4+ T lymphocyte count and CD4/CD8 ratio of HIV-infected individuals/AIDS patients showed an overall continuous upward trend with a slowing growth rate, the CD8+ T lymphocyte count presented a fluctuating trend of decline in the first 4 years and rebound in the subsequent 3 years, and the change trends of each group were basically consistent with the overall trend. (2) At the 7th year of treatment, the low baseline CD4 group had the maximum absolute increment and relative growth rate of CD4+ T lymphocyte count, but the minimum absolute decline and relative reduction rate of CD8+ T lymphocyte count; the high baseline CD4 group showed the minimum absolute increment and relative growth rate of CD4+ T lymphocyte count, but the maximum absolute decline and relative reduction rate of CD8+ T lymphocyte count; the aforementioned indexes in the medium baseline CD4 group were between those in the high and low baseline CD4 groups. (3) At 0.5, 1, 2, 4, 5, and 6 years of treatment, the CD4+ T lymphocyte recovery rates in the medium and high baseline CD4 groups were higher than those in the low baseline CD4 group, and those in the high baseline CD4 group were higher than those in the medium baseline CD4 group (all P<0.05); at the 3rd and 7th year of treatment, the CD4+ T lymphocyte recovery rates in the medium and high baseline CD4 groups were higher than those in the low baseline CD4 group (all P<0.05). (4) At 0.5, 1, and 6 years of treatment, the rates of abnormal immune activation in the medium and high baseline CD4 groups were lower than those in the low baseline CD4 group (all P<0.05); at 2, 5, and 7 years of treatment, the rate of abnormal immune activation in the high baseline CD4 group was lower than that in the low baseline CD4 group (all P<0.05); at the 4th year of treatment, the medium and high baseline CD4 groups had lower rates of abnormal immune activation than the low baseline CD4 group, and the high baseline CD4 group's was lower than the moderate baseline CD4 group's (all P<0.05).; at the 3rd year of treatment, there was no statistically significant difference in the overall rate of abnormal immune activation among the three groups (P>0.05). (5) GEE analysis indicated that HIV-infected individuals/AIDS patients with higher baseline CD4+ T lymphocyte count and longer HAART duration were more likely to achieve CD4/CD8 ratio normalization (recovery from abnormal immune activation) after HAART, while baseline CD8+ T lymphocyte count ≥ 800 cells/μL was an adverse factor (all P<0.05); age at initial HAART, gender, World Health Organization clinical staging of HIV infection, interval from HIV diagnosis to HAART initiation, initial treatment regimen, complicated anemia before HAART, and complicated viral hepatitis before HAART had no statistically significant effects on the normalization of CD4/CD8 ratio after HAART (all P>0.05). Conclusion Long-term HAART can significantly improve the status of immune reconstitution and abnormal immune activation in HIV-infected individuals/AIDS patients, although the recovery trajectories differ based on baseline CD4+ T lymphocyte counts. A higher baseline CD4+ T lymphocyte count and a longer HAART duration are favorable factors for promoting CD4/CD8 ratio normalization (recovery from abnormal immune activation) in HIV-infected individuals/AIDS patients, while baseline CD8+ T lymphocyte count ≥ 800 cells/μL is an adverse factor.

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