title: Clinical outcome of HIV-infected patients with discordant virological and immunological response to antiretroviral therapy.
abstract: BACKGROUND
  A subgroup of human immunodeficiency virus type 1 (HIV-1)-infected patients with severe immunodeficiency show persistently low CD4+ cell counts despite sustained viral suppression. It is unclear whether this immuno-virological discordance translates into an increased risk for clinical events.
  
  
  METHODS
  Data analysis from a large multicenter cohort incorporating 14,433 HIV-1-infected patients in Germany. Treatment-naive patients beginning antiretroviral therapy (ART) with CD4+ cell counts <200 cells/μL who achieved complete and sustained viral suppression <50 copies/mL (n = 1318) were stratified according to the duration of immuno-virological discordance (failure to achieve a CD4+ cell count ≥200 cells/μL). Groups were compared by descriptive and Poisson statistics. The time-varying discordance status was analyzed in a multivariable Cox model.
  
  
  RESULTS
  During a total of 5038 person years of follow-up, 42 new AIDS events occurred. The incidence rate of new AIDS events was highest in the initial 6 months of complete viral suppression (immuno-virological discordance group, 55.06; 95% confidence interval [CI], 30.82-90.82; and immune responder group, 24.54; 95% CI, 10.59-48.35) and decreased significantly by 65% per year in patients with immuno-virological discordance (incidence risk ratio, 0.35; 95% CI, 0.14-0.92; P = .03). Immuno-virological discordance and prior AIDS diagnosis were independently associated with new AIDS events (hazard ratio, 3.10; 95% CI, 1.09-8.82; P = .03).
  
  
  CONCLUSIONS
  Compared with immune responders, patients with immuno-virological discordance seem to remain at increased risk for AIDS. Absolute risk is greatly reduced after the first 6 months of complete viral suppression.
authors.affiliation: Infectious Diseases Unit/Department of Medicine 1, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Zoufaly
authors.forename: M
authors.initials: M
authors.lastname: an der Heiden
authors.forename: C
authors.initials: C
authors.lastname: Kollan
authors.forename: J R
authors.initials: JR
authors.lastname: Bogner
authors.forename: G
authors.initials: G
authors.lastname: Fätkenheuer
authors.forename: J C
authors.initials: JC
authors.lastname: Wasmuth
authors.forename: M
authors.initials: M
authors.lastname: Stoll
authors.forename: O
authors.initials: O
authors.lastname: Hamouda
authors.forename: J
authors.initials: J
authors.lastname: van Lunzen
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology* / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models
chemical_list: D019380:Anti-HIV Agents