Mortality patterns and survival rates in HIV-infected patients with immunological ineffectiveness of antiretroviral therapy

Abstract

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.