Objective To explore the association between the levels of soluble differentiation antigen 14 (sCD14), CD4⁺T cells and helper T cell 17 (Th17) in peripheral blood and therapeutic effect and prognosis of patients, and provide a reference for the early clinical identification of high-risk patients and optimization of treatment strategies.

Methods A total of 102 patients with AIDS complicated with tuberculosis (TB) were selected, and divided into the effective-treatment group (71 cases) and ineffective-treatment group (31 cases) based on the efficacy of their antiretroviral therapy (ART). All patients were followed up for 2 years. Among the 102 patients, 22 cases had a poor prognosis and 80 cases had a good prognosis. The general information of the patients was collected, The peripheral blood sCD14 levels were measured by enzyme-linked immunosorbent assay (ELISA), The peripheral blood CD4⁺T cell count and Th17 cell proportion were determined by flow cytometry, and the plasma HIV viral load was detected by real-time quantitative PCR. Logistic regression was used to analyze the influencing factors of the therapeutic effect of ART treatment in AIDS patients complicated with TB. COX regression analysis was used to analyze the influencing factors of poor prognosis in AIDS patients complicated with TB. The receiver operating characteristic curve (ROC) was used to analyze the value of these indicators in evaluating poor prognosis of patients.

Results The levels of CD4⁺T cells and Th17 cells in the ineffective-treatment group were lower than those in the effective treatment group, while the HIV load and sCD14 levels were higher than those in the effective treatment group (P ＜ 0.05). High sCD14 levels and low CD4⁺T cell levels were the risk factors of poor treatment efficacy in AIDS patients complicated with TB (P ＜ 0.05). The results of univariate analysis showed that the low levels of CD4⁺T cells and Th17 cells, HIV viral load and sCD14 were associated with poor prognosis in AIDS patients complicated with TB (P ＜ 0.01). The AUCs of the CD4⁺T cells, sCD14 and combination of the two indicators for evaluating the poor prognosis of AIDS patients complicated with TB were 0.799, 0.850 and 0.891, respectively, and the Youden indices were 0.468, 0.693 and 0.701, respectively.

Conclusions High baseline levels of sCD14 and low levels of CD4⁺T cells are the independent risk factors of poor antiviral treatment efficacy and prognosis in patients with AIDS complicated with TB disease. The combined detection of these two indicators has potential clinical value for identifying high-risk patients.