THE INFLUENCE OF HIV INFECTION DURATION BEFORE ANTIRETROVIRAL THERAPY ON IMMUNOLOGICAL TREATMENT FAILURE.

Abstract

Some patients with HIV infection receiving virologically effective antiretroviral therapy (ART) did not show any growth in CD4 cell count during treatment. Despite the long-term treatment of patients, immunodeficiency persisted. In the observational cohort retro/prospective study we investigated the effect of the duration of HIV infection before starting the antiretroviral therapy on the development of immunological treatment failure. In a group of 140 HIV-infected patients a moderate inverse correlation was found between the duration of HIV infection and CD4 cell gain after 6 months, 1, 2 and 3 years of ART (r = -0.33, p < 0.01; r = -0.3, p < 0.01; r = -0.3, p < 0.01; r = -0.29, p < 0.01, respectively). In the case of ART starting at CD4 count of 200-350 cells/mcl statistically significant differences were revealed in the levels of relative CD4 count at 6 months, 1, 2 and 3 years of ART in sub-groups with durations of HIV infection prior to initiating therapy of 1-8 years and > 8 years (p = 0.035; p = 0.015; p = 0.05; p = 0.05, respectively). In patients who started ART with CD4 levels > 200 cells/mcl after 8 years of HIV infection, the risk of immunological treatment failure is 4 times higher as compared to patients with the same CD4 level, but lesser duration of HIV infection. The shorter the duration of HIV infection, the greater the increase in CD4 cell count. When starting ART at CD4 level of 200-350 cells/mcl, restoration of CD4 count is more intense in the group with lesser period of HIV infection. A negative effect of the >8-year infection duration before the start of ART on the development of the immunological treatment failure was observed in a subgroup with a starting level of CD4 > 200 cells /mcl.