Prevalence, risk factors and the clinical outcomes of HIV-1 infected patients with immune discordance - A retrospective case-control study

<h2>Abstract</h2><h3>Background</h3> The study aims to assess the prevalence, risk factors and clinical outcomes among immune discordant HIV patients at an HIV care hospital located in southern India as the prognosis of immune discordant subjects is poorly comprehended and only a handful of studies have been conducted in this region. <h3>Methods</h3> A retrospective case-control study was conducted among 1270 patients enrolled at the HIV care hospital between the period of March 2016 and July 2023. The study protocol was endorsed by the institutional ethics Committee. 1249 patients met the study criteria and 71 were found to be immune discordant. The data collection form was designed to capture patients' demographic and clinical details. Univariate and multivariate logistic regressions were utilized to quantify the relationships. <h3>Results</h3> The prevalence of discordant immune responders and non-immune discordant responders among people living with HIV (PLHIV) was found to be 5.6 % and 94.4 % respectively. The risk factors independently influencing the immune discordance along with their adjusted odds ratio (AOR) were baseline CD4 cell count less than 200 cells/mm3 (AOR 1.49; 95 % CI: 1.270–1.816, P = 0.00), presence of concomitant tuberculosis (AOR 1.58; 95 % CI: 1.344–1.996, P = 0.04) and heterosexually transmitted HIV (AOR 12.31; 95 % CI: 3.223–47.053, P = 0.00). Clinical outcomes observed in immune discordant subjects were classified as non-communicable disease (22.45 %), Opportunistic infection (8.45 %) and mortality (8.45 %). <h3>Conclusion</h3> Discordant immune response was seen primarily in patients with Tuberculosis coinfection, heterosexually transmission and baseline CD4 cell count ≤200 cell/mm3 the probable mechanism behind this could be a prior modification of the immune system.