Determinants of immune recovery and survival in HIV late presenters: a retrospective cohort study from Southwest China

Late presentation (LP) of HIV infection, defined as diagnosis at an advanced stage with a low CD4⁺ T cell count or the presence of AIDS-defining illnesses, remains a major global challenge. Late presenters often experience higher morbidity, poorer immune recovery, and increased mortality, highlighting the importance of early diagnosis and timely initiation of antiretroviral therapy (ART). A retrospective analysis was conducted among HIV-infected patients who initiated ART at Yunnan Provincial Infectious Disease Hospital between 2004 and 2024. Late presenters were defined as patients with a baseline CD4⁺ T cell count < 350/µL or the presence of AIDS-defining illnesses, regardless of CD4⁺ T cell count. Clinical data were collected, survival rates were analyzed using the Kaplan–Meier method, and Cox regression and logistic regression were applied to identify associated factors. A total of 7,549 patients were included, with a median follow-up time of 10.0 years (IQR 5.7–13.6). Among them, 73.3% were late presenters. Compared with non-late presenters, late presenters had a higher risk of mortality and poorer immune recovery. Key factors influencing immune recovery included sex, baseline CD4⁺ T cell count, and baseline viral load, with baseline CD4⁺ T cell count being particularly important. Late presentation of HIV infection significantly affects survival and immune reconstitution. This study highlights the importance of early diagnosis and intervention and provides evidence for identifying high-risk populations.