Factors Associated with Immunological Discordance in HIV-Infected Patients Receiving Antiretroviral Therapy with Complete Viral Suppression in a Resource-Limited Setting

Abstract

SUMMARY:``Immunological discordance,'' i.e., immunological failure despite complete viral suppression in human immunodeficiency virus (HIV)-infected patients receiving antiretroviral therapy (ART), is associated with increased risk of AIDS or death. To evaluate risk factors for immunological discordance in a resource-limited setting in which patients usually present late with low CD4 cell counts, we conducted a case-control study among HIV-infected patients receiving ART and having undetectable HIV RNA. The study included patients with immunological discordance (cases), which was defined as CD4 cell count ＜ 30z above baseline and absolute CD4 cell count ＜ 200 cells/mm 3 at the first 12 months of undetectable HIV RNA (＜50 copies/mL). Patients without immunological discordance were included as controls. Of 142 patients (44 cases; 98 controls), the mean age was 38.6 ± 9.4 years and 67.6z were men; 65.5z had history of opportunistic infections. In multivariate analysis, only baseline CD4 cell count ＜ 100 cells/mm 3 (odd ratio [OR], 2.53; 95z confidence interval [CI], 1.04-6.14; P ＝ 0.040) and history of lost to follow-up (OR, 11.04; 95z CI,; P ＜ 0.001) were significantly associated with immunological discordance. Early initiation of ART and intervention to improve regular clinic visit compliance and adherence to ART are crucial to prevent immunological discordance among HIV-infected patients.

Immunological and virological discordance among people living with HIV on highly active antiretroviral therapy in Tigray, Northern Ethiopia

“…Immunological discordant responses was also associated with low CD4+ count (< 100 cells/μl) at baseline ( p = 0.026). Association of baseline CD4+ count with immunological discordance was also reported by studies conducted in Nigeria [ 7 ], Oman [ 12 ], Canada [ 27 ], India [ 9 ], Thailand [ 14 ], Italy [ 10 ] and China [ 26 ]. This may be related with diminution of CD4+ cells before initiation of antiretroviral therapy [ 27 ], which may be slow to reconstitute with antiretroviral therapy.…”

“…Immunological discordance among people living with HIV have been reported from 13.59 to 29% [ 5 – 13 ]. Factors such as being younger age [ 6 ], poor HIV treatment adherence, being male gender, lower baseline CD4+ count [ 2 , 7 , 9 , 14 ], not taking treatments from three antiretroviral classes [ 15 ], and Hepatitis C co-infection [ 10 ] have been reported to increase risk of immunological discordant responses. In other hand, virological discordant response has also reported from 5 to 17% [ 5 – 8 ].…”

“…It is reported that people living with HIV with discordant responses were found to be at an increased risk to develop AIDS events such as opportunistic infections and severe non AIDS events such as stroke, liver and kidney failure, meningitis and endocarditis; risk factors for death [ 2 , 8 , 10 , 14 , 16 , 17 ]. As a result, determination of immuno-virological discordant responses and associated risk factors among people living with HIV on HAART could have great role for policy makers and health care providers to end AIDS related epidemics by 2030 [ 18 ].…”

Factors associated with antiretroviral treatment failure among people living with HIV on antiretroviral therapy in resource-poor settings: a systematic review and metaanalysis

“…The results from a previous study have confirmed that low baseline CD4 cell count, particularly < 100 cells/mm 3 , and history of loss to follow-up are risk factors for immunological discordance [ 18 ]. Independent risk factors associated with virological failure were being followed-up at the semirural center, having experienced unstructured treatment interruptions, and having low CD4 counts at enrolment [ 19 ].…”