Psychosocial trajectories and CD4+/CD8+ ratio normalization among adults with HIV in Changsha, China: a 9-year longitudinal cohort study

Long-term patterns of psychosocial characteristics may be associated with immune recovery after antiretroviral therapy (ART), but evidence based on repeated psychosocial assessments remains limited. This nine-year longitudinal cohort study described psychosocial trajectories among adults with HIV in Changsha, China, and examined their associations with CD4 + /CD8 + ratio normalization. Adults newly diagnosed with HIV in Changsha, China, during 2013 to 2014 were assessed at baseline and approximately 1, 5, and 9 years after diagnosis. The primary analysis included 338 participants who completed at least three of the four psychosocial assessments and met the clinical eligibility criteria. CD4 + /CD8 + ratio normalization was defined as the first recorded ratio ≥ 1.0 after ART initiation. Latent growth mixture models identified psychosocial trajectories, and Cox proportional hazards regression examined their associations with time to normalization. A five-year landmark sensitivity analysis was also conducted. Among 338 participants, 88 (26.0%) had a first recorded CD4 + /CD8 + ratio ≥​1.0 after ART initiation. Mean depression and anxiety scores were lowest at the five-year follow-up and increased at the nine-year follow-up. Mean total HIV-related stress scores were lowest at the one-year follow-up and increased thereafter. Mean total social support scores were highest at the five-year follow-up and lowest at the nine-year follow-up. Two or three trajectory groups were identified for each psychosocial characteristic; persistently low trajectories were the most common for depression, anxiety, and total HIV-related stress, while a persistently high trajectory was the most common for total social support. In the fully adjusted Cox model, a persistently high social stress trajectory was associated with a lower hazard of normalization than a persistently low trajectory (aHR = 0.562, 95% CI: 0.321, 0.985), while a U-shaped emotional stress trajectory was associated with a higher hazard of normalization than a persistently low trajectory (aHR = 2.135, 95% CI: 1.064, 4.283). In the landmark analysis, the association for social stress remained, while the 95% CI for emotional stress included 1. CD4 + /CD8 + ratio normalization was associated with social and emotional stress trajectories. These findings suggest that repeated assessment of HIV-related stress may complement routine monitoring of immune recovery during long-term ART.