title: Factors associated with paradoxical immune response to antiretroviral therapy in HIV infected patients: a case control study.
abstract: BACKGROUND
  A paradoxical immunologic response (PIR) to Highly Active Antiretroviral Therapy (HAART), defined as viral suppression without CD4 cell-count improvement, has been reported in the literature as 8 to 42%, around 15% in most instances. The present study aims to determine, in a cohort of HIV infected patients in Brazil, what factors were independently associated with such a discordant response to HAART.
  
  
  METHODS
  A case-control study (1:4) matched by gender was conducted among 934 HIV infected patients on HAART in Brazil.
  
  
  METHODS
  patients with PIR, defined as CD4 < 350 cells/mm(3) (hazard ratio for AIDS or death of at least 8.5) and undetectable HIV viral load on HAART for at least one year.
  
  
  METHODS
  similar to cases, but with CD4 counts ≥ 350 cells/mm(3). Eligibility criteria were applied. Data were collected from medical records using a standardized form. Variables were introduced in a hierarchical logistic regression model if a p-value < 0.1 was determined in a bivariate analysis.
  
  
  RESULTS
  Among 934 patients, 39 cases and 160 controls were consecutively selected. Factors associated with PIR in the logistic regression model were: total time in use of HAART (OR 0.981; CI 95%: 0.96-0.99), nadir CD4-count (OR 0.985; CI 95%: 0.97-0.99), and time of undetectable HIV viral load (OR 0.969; CI 95%: 0.94-0.99).
  
  
  CONCLUSIONS
  PIR seems to be related to a delay in the management of immunodeficient patients, as shown by its negative association with nadir CD4-count. Strategies should be implemented to avoid such a delay and improve the adherence to HAART as a way to implement concordant responses.
authors: Infectious Diseases Outpatient Clinic of the Hospital Universitário Cassiano Antonio Moraes of Universidade Federal do Espírito Santo, Vitória, Brazil.
authors: Janaina A S
authors: JA
authors: Casotti
authors: Luciana N
authors: LN
authors: Passos
authors: Fabiano J P
authors: FJ
authors: Oliveira
authors: Crispim
authors: C
authors: Cerutti
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D001938:Brazil; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents