Factors Affecting Changes in CD4+ T-cell Count Among People Living with HIV (PLWH): A Retrospective Cohort Study in Kermanshah, Iran.

BACKGROUND AND OBJECTIVE: Considering the crucial role of CD4+ T-cell counts in disease control and management, the present study aimed to investigate changes in CD4+ T-cell counts among People Living with HIV (PLWH) at the Behavioral Diseases Counseling Center in Kermanshah Province. The study also assessed the impact of demographic and clinical factors, including age, gender, duration of infection, duration of antiretroviral therapy (ART), and CD4+ T-cell count, on changes in CD4+ T-cell counts during ART among PLWH. METHODS: In this retrospective study, the medical records of 2909 PLWH who had attended the Kermanshah Behavioral Diseases Counseling Center between 2012 and 2023 were reviewed. Demographic, behavioral, and clinical data were extracted from the records. Ultimately, 728 individuals whose CD4+ T-cell counts were documented both at diagnosis and after treatment were included in the analysis. Data were analyzed using SPSS version 21. As CD4+ T- cell count changes were not normally distributed, robust linear regression was employed. Collinearity among independent variables and autocorrelation of errors were assessed and confirmed. The assumption of homoscedasticity of errors was also evaluated and satisfied. RESULTS: Among the 728 PLWH, 519 (71.3%) were male and 209 (28.7%) were female. The mean age of the PLWH was 37.2 ± 11.5 years. The mean CD4+ T-cell count at diagnosis was 336.4 cells/µL, which increased to 526.4 cells/µL after treatment. The average duration of treatment was 57.8 months (SD = 34.5), and the average number of follow-up visits was 48.6 (SD = 36.9). Robust linear regression, with ART duration entered as a four-level category, showed that longer ART duration (1-5 years: B=111.9; 5-10 years: B=267.5; >10 years: B=527.3, all vs <1 year, p<0.001), higher education (B=302.6, 95% CI: 171.5-433.7), older age (B=5.3, 95% CI: 2.4-8.3), and sexual transmission (B=101.6, 95% CI: 18.0-185.2) were significantly associated with improved CD4+ T-cell recovery (p<0.05). Female sex, more advanced clinical stage (III-IV), and certain occupational categories were also significantly associated with CD4+ T-cell recovery, while a longer duration of infection was associated with lower CD4+ T-cell recovery (all p<0.05). CONCLUSION: Consistent with the well-established effect of antiretroviral therapy on CD4+ T-cell recovery, this study suggests that immune recovery is influenced by both treatment duration and patients' demographic and clinical characteristics. These findings emphasize the importance of individualized HIV care, with closer monitoring and adherence support for patients at risk of poorer immune recovery.