Background Restoring the impaired immune function of infected people through timely and effective antiretroviral therapy (ART) is the current fundamental treatment measure. How to accurately evaluate the immune recovery of patients early is an urgent clinical problem to be discussed.

Objective  To investigate the changes of CD4 and CD8 cells and their ratio in HIV-infected patients who accept initial antiviral treatment (ART) for 72 weeks, and explore the relevant influencing factors of immune reconstitution.

Methods  The real-world data of the HIV infected patients from January 2011 to December 2018, who received antiretroviral therapy (ART) with “2NRTs + NNRTIs” regimen during that period in our medical center, were collected; and the changes of CD4/ CD8 at different time points of ART were observed. These data were used for analyses of contributing factors.

Results A total of 1 796 HIV-infected patients were enrolled, including 1 710 males (95.21%) and 86 females (4.79%), who were (35.47 ± 11.68) years old on average. In terms of the transmission route, homosexual sexual transmission (MSM) accounted for 80.12%, and heterosexual transmission accounted for 13.31%. The CD4 and CD8 cells before ART was (264 ± 166)/μL and (935 ± 473)/μL respectively, and the CD4/CD8 ratio was 0.28 ± 0.18, with 82.79% of infected patients being less than 0.5. After 24 weeks, 48 weeks, and 72 weeks of ART with tenofovir, lamivudine, and eafavirenz, the patients’ CD4 cells rose to (374 ± 187)/μL, (589 ± 207)/μL, (726 ± 377)/μL, respectively, and CD8 cells fell to (779 ± 350)/μL, (734 ± 284)/μL, (708 ± 299)/μL, respectively. Meanwhile, the CD4/CD8 ratio rose to 0.55 ± 0.33, 0.84 ± 0.20, 1.03 ± 0.38, respectively. The differences were statistically significant compared to baseline levels (all P <0.05). However, after 48 weeks, the growth rate of all indicators was significantly slower, and the difference was not statistically significant when comparing CD4 cells of 72 weeks with those of 48 weeks (P>0.05). Multivariate analysis showed that higher baseline CD8 level, lower baseline CD4 level and CD4/CD8 ratio, were closely related to longer recovery of CD4/CD8 ratio at 72 weeks' antiviral therapy.

Conclusion  The CD4 cell count and CD4/CD8 ratio of the HIV-infected patients are generally low before ART. After 72 weeks of ART, the CD4 cells of most patients are recovered and CD4/CD8 ratio improves significantly, but some patients still show poor immune reconstruction. Baseline CD4, CD8 levels and CD4/CD8 ratio are important associated-factors affecting the immune recovery of the HIV-infected patients with ART.