ORIGINAL RESEARCH article

Front. Immunol.

Sec. Viral Immunology

Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1520615

HDL-C as a novel predictor of immune reconstitution in people living with HIV: insights from a baseline-to-dynamic change cohort study in China, 2005-2022

Provisionally accepted
Xiaorui  LiXiaorui Li1LIQIN  SUNLIQIN SUN2Yun  HeYun He2Fang  ZhaoFang Zhao2Yinsong  LuoYinsong Luo1Chenye  LiuChenye Liu1Yiyao  HuYiyao Hu1Yuxin  JiangYuxin Jiang1Hongzhou  LuHongzhou Lu2Jiaye  LiuJiaye Liu1*
  • 1School of Public Health, School of Medicine, Shenzhen University, Shenzhen, China
  • 2Shenzhen Third People’s Hospital, Shenzhen, Guangdong Province, China

The final, formatted version of the article will be published soon.

Background: High-density lipoprotein cholesterol (HDL-C) is a well-established marker of lipid metabolism and increasingly recognized as an indicator of inflammatory status.This study investigates HDL-C's role as a predictor of immune reconstitution in people living with HIV (PLWH).: We performed a prospective cohort study of 15,434 PLWH initiating antiretroviral therapy at the Third People's Hospital of Shenzhen, China, between 2005 and 2022. Baseline quartile grouping and Group-Based Trajectory Modeling (GBTM) explored the relationship between HDL-C and immune reconstitution. Restricted cubic spline plots identified nonlinear association.Results: Over a median follow-up of 17.9 months, 9,609 PLWH achieved the CD4+ T-cell count of 500 cells/μL or higher. Multivariate-adjusted Cox proportional hazards regression model showed that hazard ratios (HR) [95% confidence intervals (CI)] for CD4+ T-cell recovery in Q2, Q3, and Q4 versus Q1 of the HDL-C were 0.94 (95% CI: 0.88-0.99), 0.92 (95% CI: 0.87-0.98), and 0.85 (95% CI: 0.80-0.91), respectively. GBTM identified two HDL-C trajectories: Low-floating and High-floating. Relative to Low-floating, High-floating demonstrated a reduced likelihood of CD4+ T-cell recovery (HR=0.86, 95% CI: 0.82-0.90, p < 0.001). A nonlinear association was observed between HDL-C and the outcome (p for nonlinear association = 0.037, p for overall < 0.001), with a threshold at 1.13 mmol/L. Negative correlations between HDL-C and CD4+ T-cell recovery were observed both below the threshold (HR=0.72, 95% CI: 0.57-0.92) and above the threshold (HR=0.78, 95% CI: 0.69-0.87) (both p < 0.05).Conclusions: Our study highlights HDL-C's role in immune recovery, suggesting its potential in guiding prevention and treatment strategies for PLWH.

Keywords: :high density lipoprotein, HIV, Cd4 + t cell, trajectory, Immune reconstitution

Received: 01 Nov 2024; Accepted: 23 Apr 2025.

Copyright: © 2025 Li, SUN, He, Zhao, Luo, Liu, Hu, Jiang, Lu and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Jiaye Liu, School of Public Health, School of Medicine, Shenzhen University, Shenzhen, 518060, China

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