Immunological Discordance in Virologically Suppressed Patients Pre-integrase Inhibitor Era

Objective:The majority of HIV-infected patients commencing antiretroviral therapy typically experience a rapid reduction in plasma HIV-RNA levels and an increase in CD4+ T lymphocyte count.Nevertheless, in certain cases, the suppression of viral replication does not coincide with a notable rise in CD4+ T lymphocyte count-a phenomenon referred to as a "discordant response."This study aims to investigate the frequency of immunological discordant responses and the associated factors in HIV-infected patients. Materials and Methods:We retrospectively analyzed the records of 216 HIV-infected patients who were monitored at our outpatient clinic between 2002 and 2014.We identified patients over 18 years old and previously drug-nave who were under treatment.Viral suppression was defined as a plasma viral load below 200 copies/mL during therapy.Patients achieving virological suppression were assessed for immunologic responses at the 6 th and 12 th months of the antiretroviral therapy (ART) regimen.A discordant response was considered if there was an increase of less than 50 cells/mm in CD4+ T lymphocyte count compared to baseline levels at the 6 th month, and this threshold was set at 100 cells/mm at the 12 th month of therapy.We examined the relationship between immunological discordance and parameters such as age, gender, baseline CD4+ T lymphocyte count, baseline HIV-RNA level, and treatment regimen. Results:Of the 93 patients who met the inclusion criteria, the majority were male (81%), with a mean age of 37 years.The median baseline viral load was 5.35 log10 copies/mL, and the median baseline CD4+ T lymphocyte count was 272 cells/mm.The most common treatment regimen among the patients (68.6%) consisted of Efavirenz (EFV) + Tenofovir/Emtricitabine (TDF/FTC).At the 6 th month, 10 patients (10.7%) exhibited discordant responses, while at the 12 th month, 14 patients (17.5%) showed discordant responses. Conclusion:No significant relationship was found between the discordant response and age, gender, baseline CD4+ T lymphocyte counts, baseline HIV-RNA levels, or treatment regimens during both the 6 th and 12 th months of the treatment.