Widespread introduction and early initiation of antiretroviral therapy significantly improves the prognosis in people living with HIV — with an increase in the number of CD4+ T-lymphocytes, the incidence of HIV-related diseases and the mortality rate decreases. Despite suppression of HIV replication, a fraction of ART-treated patients fails to achieve normalization of CD4+ T-cell counts. These patients have an increased risk of clinical progression to AIDS and non-AIDS events. Currently, there are no clear criteria for determining the case of immunological inefficiency of ART. To date, mechanisms of incomplete immune reconstitution in HIV-infected patients have not been fully elucidated. Therefore, in this review, we aim to attract the attention of specialists to this problem — we summarized the results of recent studies and current literature data, described possible mechanisms and risk factors for the development of immunological inefficiency of ART; presented the studied therapeutic strategies aimed at recovering the immunity in HIV-infected patients.

Introduction. Due to the lack of criteria for determining the case of immunological non-response to ART, data on the analysis of deaths in this group of patients are heterogeneous. We analyzed the structure of deaths, clinical and laboratory indicators, and also conducted a survival analysis. Materials and methods. We conducted a retrospective study of HIV-infected patients who had a level of CD4+ T-lymphocytes at the beginning of treatment < 350 cl/mcl and further after that. Two groups were formed: the main one-deceased patients – 357 people; control one-surviving patients – 1846 people. Results. Men and older patients significantly prevailed in the main group of patients. Drug-addicted patients were more likely to have a fatal outcome. When comparing the average indicators of CD4+ T-lymphocytes and viral load at the time of the onset of ART, no statistically significant differences were found. When assessing the frequency of deaths in patients with extremely severe immunodeficiency (CD4 < 50 cells/μl.) at the beginning of ART, the chances of death were significantly higher (OR 1.523; 95 % CI 1,236–1,785). The probability of death increased rapidly by the 5-year period (60 months) from the beginning of ART to 26.9 % ± 1.5, and by the 120-month period (10 years) it reached 43.6 ± 6.8 %. The average development period of a fatal case from the moment of the start of treatment was 82 months (95 % CI: 78.87–85.56 months). Discussion. The question is raised about the predictors of adverse clinical outcomes in patients with immunological inefficiency of ART. A prospective study will provide a complete picture of the course of the disease in this group of patients. Conclusion. The high probability of death in patients with immunological non-response to ART in the first 5 years of follow-up from the beginning of ART requires increased attention from specialists in terms of treatment and dispensary management.