The prognosis of patients with dissociated virological and immunological responses to HAART.
BACKGROUND
While HAART allows for the reconstitution of immune functions in most treated HIV patients, failure to achieve a significant increase in circulating CD4+ T cells despite undetectable viremia occurs.


METHODS
A retrospective study was conducted to evaluate the treatment outcome in a subgroup of 232 patients who after 3.1 years of treatment had not achieved desirable immune reconstitution despite a good virological response to HAART.


RESULTS
After a further 3.6 ± 2.4 years of HAART, 82 (35.3%) patients achieved immune reconstitution (565.2 ± 174.6 CD4 cells/μl), while 149 (64.2%) patients did not (268.8 ± 91.1 cells/μl); the difference in the achieved CD4 counts between these subgroups was significant (P<0.01). One patient experienced treatment failure. Eleven patients died to the end of follow-up, of which 10 with a continuously dissociated response. Factors associated with immune recovery included clinical AIDS at HAART initiation (OR: 0.4, 95% CI: 0.24-0.81, P<0.01), usage of PIs and of drugs from all three classes (OR: 1.7, 95% CI: 1.0-3.0, P=0.046 and OR: 4.5, 95% CI: 1.15-18.19, P=0.03, respectively), and a rise in CD4 count to over 200 cells/μl after the first 3.1 years of treatment (OR: 5.3 95% CI: 2.6-11.0, P<0.01). Achievement of a rise in CD4 count to over 200 cells/μl after the first 3.1 years of treatment was an independent predictor of immune reconstitution in the following period.


CONCLUSIONS
If patients on HAART reach CD4 cell counts of above 200 cells/μl in the first 3 years, immune recovery is possible after at least 6 years of treatment.
Jevtović
D
D
Institute for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade University School of Medicine, Bulevar Oslobodjenja 16, 11000 Belgrade, Serbia.
Salemović
D
D
Ranin
J
J
Pešić-Pavlović
I
I
Korać
M
M
Djurković-Djaković
O
O
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects / Q000276:immunology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology* / Q000821:virology; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome