Abstract
Background: Despite sustained viral control by antiretroviral therapy (ART), some HIV-infected patients do not recover normal CD4+ T cell counts. This Discordant Immune Response (DIR) increases the risk of opportunistic infections. Objective: To evaluate the factors associated with DIR in HIV-infected Omani patients attending public sector clinics. Methods: All HIV-infected patients receiving ART with regular follow-up visits were eligible for this study. The DIR group comprised patients on ART for at least two years with plasma HIV viral load < 50 copies/mL and helper CD4+ T cell counts below 350 cells/μl. The Concordant Immune Responses (CIR) group was similar to DIR but with CD4+ T cell counts above 350 cells/μl. Univariate and multivariate analyses using logistic regression models were used to assess the impact of demographic characteristics, clinical, immunological and virological parameters, type of ART regimens, tuberculosis and other opportunistic co-infections on DIR. Results: Among 153 enrolled participants, 28 and 76 patients were identified as having DIR and CIR, respectively. The multivariate analysis revealed that the only factors independently associated with DIR after adjustment were age (odds ratio [OR] 1.13; 95% confidence interval [CI] 1.04-1.23), baseline CD4+ T cell count (OR: 0.98; CI: 0.97-0.99) and baseline CD56+ cell count (OR: 0.97; CI: 0.96-0.99). Conclusion: Collectively, these findings suggest that a significant proportion of HIV-infected Omani patients develop DIR totaling 27%, and efforts should be made to improve early identification of these patients who tend to experience poor clinical outcomes.
Highlights
Antiretroviral therapy (ART) is one of the greatest discoveries of the last century that decelerated the global epidemic of Human Immunodeficiency Virus (HIV)
Collectively, these findings suggest that a significant proportion of HIV-infected Omani patients develop Discordant Immune Response (DIR) totaling 27%, and efforts should be made to improve early identification of these patients who tend to experience poor clinical outcomes
Changing or intensifying antiretroviral therapy (ART) regimen has not shown any effect on the CD4+ T cell response, except in some patients whose regimen contains antiretroviral drugs that are associated with leucopenia [6]
Summary
Antiretroviral therapy (ART) is one of the greatest discoveries of the last century that decelerated the global epidemic of Human Immunodeficiency Virus (HIV). Ali and Boulassel few studies have explored the risk factors for HIV-infected patients with discordant immune response and showed that older age and low baseline CD4+ T cell count are important factors, which may delay the immunological recovery [3]. The latter is the key in the prevention of opportunistic infections, the increasing survival of HIV-infected patients. Despite sustained viral control by antiretroviral therapy (ART), some HIV-infected patients do not recover normal CD4+ T cell counts This Discordant Immune Response (DIR) increases the risk of opportunistic infections
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