Factors associated with immunological and virological discordant responses to highly active antiretroviral therapy among adult HIV positive individuals in Ethiopia

Abstract

In clinical practice, not all human immune deficiency virus (HIV) positive individuals who received highly active antiretroviral therapy (HAART) achieve the desired concordant response characterized by a sustained viral suppression or immune recovery. The expected success of HAART doesn't occur in all treated patients and a discordant response between CD4 count and the viral load (VL) has been a major concern in the treatment of HIV patients. Thus, this study is designed to describe the factors associated with immunological and virological discordant responses to HAART among adult HIV positive individuals.A hospital-based cross-sectional study with secondary data review was conducted on 423 HIV positive individuals on HAART from February 1 to April 30, 2017. Socio-demographic characteristics, clinical data and about 10 mL of blood specimen for HIV VL, and CD4 count measurement were collected. The data was entered into SPSS version 20 and descriptive, bivariate, and multivariate logistic regression analysis was employed.The mean age of the patients at study time was 39 (±9.8). The average follow-up duration of patients on antiretroviral therapy (ART) was 7 (±3) years. The prevalence of immunological discordance and virological discordance to HAART were 13.2% and 47%, respectively. With multivariate logistic regression analysis duration of follow-up on ART 6 years (adjusted odds ratio [AOR] = 3.29 (1.80-6.03), P.001) and VL ≥20 copies/mm 3 (AOR = 3.08 [1.70-5.61], P .001) were significant factors for immunological discordance conversely the patients who switched drug as a result of TB (AOR = 3.33 [1.10-10.08], P = .03) was significant factors for virological discordance.The prevalence of immunological discordance and virological discordance to HAART among HIV patients is high. Patients with the duration of follow-up on ART 6 years, VL ≥ 20 copies/mm 3 and patients who switched drugs as a result of TB were significant factors for discordance. Hence, intensive adherence support and counseling should be provided to achieve the UNAIDS 90 target. HIV positive individuals co-infected with TB, who have had VL ≥ 20 copies/mm 3 and who are 6 years duration of follow-up on ART need to be carefully monitored. In addition, national based study of discordant groups is recommended.

Immunovirological discordance among people living with human immunodeficiency virus at a center in Western India

“…The incidence of TB co-infection among immunological nonresponders was 16.6% which was in concurrence with studies in Ethiopia[ 10 25 ] and Korea. [ 26 ] A possible explanation would be that TB infection impairs cellular immune responses through Mycobacterium tuberculosis -induced apoptosis of CD4 + cells which subsequently leads to the depletion of CD4 + cells and results in poor immunological recovery despite viral suppression.…”

“…In a study in Ethiopia, TB co-infection was also associated with virological discordant responses. [ 25 ] In another study in Northern Ethiopia, age at or below 35 years at highly active ART initiation, male gender, type of regimen given, and good treatment adherence were associated risk factors for virological discordant response. [ 10 ]…”

The Prognosis for Delayed Immune Recovery in HIV-Infected Children might be Associated with Pre-cART CD4 + T cell Count Irrespective of Co-Infection with Tuberculosis

“…Whereas cART treated individuals with suboptimal immune recovery are referred to as "discordant immune responders" 24 , the underlying mechanisms for this discrepant post-cART developments are still ill-de ned, with discordant immune recovery being associated with a number of factors such as ageing, lower nadir CD4 + T cell count, residual viral replication, increase T cell death, immune hyperactivation, altered ratio of regulatory T cells to Th17 cells, tissue brosis and speci c metabolic pro les [25][26][27] . TB coinfection has also been proposed as a potential factor that can affect the long-term chances of immune recovery through increased apoptosis of CD4 + T cells 1,28,29 .…”