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Background  Some long-term non-progressors (LTNPs) have decreasing CD4 +  T cell counts and progress to AIDS. Exploring which subsets of CD4 +  T cell decreasing and the determinants associated with the decay in these patients will improve disease progression surveillance and provide further understanding of HIV pathogenesis.    Methods  Twenty-five LTNPs infected with HIV by blood products were classified as decreased (DG) if their CD4 +  cell count dropped to < 400 cells/μL during follow-up or as non-decreased (non-DG) if their CD4 +  cell count was ≥400 cells/μL. Laboratory and clinical assessments were conducted at 6 consecutive visits to identify DG characteristics.    Results  The LTNPs were infected with HIV for 12 (IQR: 11.5–14) years, and 23 were classified as the B′ subtype. Six individuals lost LTNP status 14.5 (IQR: 12.5–17.5) years after infection (DG), and the CD4 +  T cell count decreased to 237 (IQR: 213–320) cells/μL at the latest visit. The naïve CD4 +  T cell count decrease was greater than that of memory CD4 +  T cells [− 128 (IQR: − 196, − 107) vs − 64 (IQR: − 182, − 25) cells/μL)]. Nineteen individuals retained LTNP status (non-DG). At enrolment, the viral load (VL) level ( p  = 0.03) and CD8 + CD38 +  percentage ( p  = 0.03) were higher in DG than non-DG individuals. During follow-up, viral load and CD8 + CD38 +  percentage were significantly increased and negatively associated with CD4 +  cell count [(r = − 0.529,  p  = 0.008), (r = − 0.476,  p  = 0.019), respectively]. However, the CD8 + CD28 +  percentage and B cell count dropped in DG and were positively correlated with CD4 +  T cell count [(r = 0.448,  p  = 0.028), (r = 0.785,  p  < 0.001)].    Conclusion  Immunological progression was mainly characterized by the decrease of naïve CD4 +  T cell in LTNPs infected with HIV by blood products and it may be associated with high HIV RNA levels.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12865-021-00426-8.

bmc immunology

Naïve CD4+ cell counts significantly decay and high HIV RNA levels contribute to immunological progression in long-term non-progressors infected with HIV by blood products: a cohort study