Clinical Outcome of HIV-Infected Antiretroviral-Naive Patients With Discordant Immunologic and Virologic Responses to Highly Active Antiretroviral Therapy

Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294-0022, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 05/2008; 47(5):553-8. DOI: 10.1097/QAI.0b013e31816856c5
Source: PubMed


The prognostic significance of a response to highly active antiretroviral therapy (HAART) that is immunologically and virologically discordant is not well understood.
Four hundred four antiretroviral-naive patients initiating HAART at an urban HIV outpatient clinic in 1995 to 2004 were analyzed. The association of treatment responses at 3 to 9 months after HAART initiation with time to development of an opportunistic infection (OI) or death was determined using Cox proportional hazards modeling. Logistic regression modeling was used to examine the association between discordant responses and patient characteristics.
Of 404 patients, 70.5% experienced favorable concordant responses (CD4 cell count [CD4]+/viral load [VL]+: increase in CD4 count of >or=50 cells/microL and achievement of undetectable plasma HIV RNA level), 15.8% an immunologic response only (CD4+/VL(-)), 8.7% a virologic response only (CD4(-)/VL+), and 5.0% a concordant unfavorable response (CD4(-)/VL(-)). Both types of discordant responses (CD4+/VL(-) and CD4(-)/VL+), nonresponse (CD4(-)/VL(-)), and baseline CD4 cell count were significantly associated with earlier development of an OI or death (relative hazard [RH] = 2.81, 95% confidence interval [CI]: 1.31 to 3.97; RH = 4.83, 95% CI: 2.10 to 11.12; and RH = 0.93, 95% CI: 0.88 to 0.99, respectively). CD4+/VL(-) and CD4(-)/VL(-) were associated with nonwhite race in multivariate logistic regression models (adjusted OR = 2.83, 95% CI: 1.46 to 5.47 and adjusted OR = 6.50, 95% CI: 1.65 to 25.69, respectively).
Discordant immunologic and virologic responses at 3 to 9 months after HAART initiation play important roles in predicting long-term clinical outcomes in treatment-naive patients.

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    • "Despite the great progress in treating HIV-1 infection, in some patients starting their first treatment the effectiveness of highly active antiretroviral therapy (HAART) is still not sufficient, with consequent virological failures [1]–[4]. Furthermore, although antiretroviral therapy improves immune response, some patients infected with human immunodeficiency virus type 1 (HIV-1) present unsatisfactory CD4 T cell recovery despite achieving viral suppression, resulting in increased morbidity and mortality [4]–[10]. In this regard, an increase in CD4 cell count in the range of 50 to 150 cells/mm3 per year (generally with an accelerated response in the first 3 months of treatment) is considered an adequate CD4 response for most patients starting their first-line regimen [11]–[12]. "
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