Abstract
Background. The therapeutic goal of antiretroviral therapy (ART) is sustained immune recovery and viral suppression. However, some patients experience poor CD4 cell count responses despite achieving viral suppression. Such discordant immune responses have been associated with poor clinical outcomes. 
 
 Objective. We aimed to determine the prevalence of discordant immune response and explore associated factors in a retrospective cohort of patients attending 2 large public sector clinics, during the 6 months following ART initiation. 
 
 Methods. Data were analysed from 810 HIV-infected adults initiated on first-line ART at 2 clinics in Johannesburg, between 1 November 2008 and 31 December 2009. Multivariate logistic regression models were used to estimate adjusted odds ratios (AORs) to determine associations between discordant immune response and clinical and demographic factors. 
 
 Results. At ART initiation, 65% (n=592) of participants were female, with a mean age of 38.5 years. Median baseline CD4 cell count was 155 cells/mm3, 70% (n=645) of patients had a haemoglobin level >11 g/dl and 88% (n=803) were initiated on stavudine-lamivudine-efavirenz/nevirapine (D4T-3TC-EFV/NVP). Six months after ART initiation, 24% (n=220) of patients had a discordant immune response and 7% (n=67) a discordant virological response. On multivariate analysis, baseline CD cell count ≥200 cells/mm3 (AOR 3.02; 95% confidence interval (CI) 2.08 - 4.38; p
Highlights
The therapeutic goal of antiretroviral therapy (ART) is sustained immune recovery and viral suppression
The lack of knowledge about this subgroup may contribute to inadequate clinical management, as current HIV treatment guidelines do not provide specific applicable guidance. In this retrospective study we describe the prevalence of, and factors associated with, discordant immune response in a cohort of patients from 2 large public sector clinics in South Africa (SA) in the first 6 months after ART initiation
A total of 6 460 adults enrolled in the ART programme at the 2 clinics; 4 581 (80%) were excluded due to an absent baseline/6month follow-up CD4 cell count and/or plasma HIV viral load (PVL), and a further 962 were excluded due to a lack of additional information (e.g. ART regimen or baseline laboratory values)
Summary
The therapeutic goal of antiretroviral therapy (ART) is sustained immune recovery and viral suppression. Some patients experience poor CD4 cell count responses despite achieving viral suppression. Such discordant immune responses have been associated with poor clinical outcomes. We aimed to determine the prevalence of discordant immune response and explore associated factors in a retrospective cohort of patients attending 2 large public sector clinics, during the 6 months following ART initiation. Baseline CD cell count ≥200 cells/mm[3] (AOR 3.02; 95% confidence interval (CI) 2.08 - 4.38; p
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