RESEARCH PAPER
Factors associated with discordant immuno-viral response in HIV-positive Peruvian adult people treated between 2005 and 2017
1
School of Medicine, Universidad Continental, Huancayo, Junín, Peru
2
Universidad Nacional del Centro del Perú, Huancayo, Junín, Peru
3
Chief of Department, Department of Tropical and Dermatological Infectious Diseases, Hospital Daniel Alcides Carrión-Huancayo, Junín, Peru
Submission date: 2020-04-08
Final revision date: 2021-08-11
Acceptance date: 2021-08-11
Publication date: 2022-04-22
HIV & AIDS Review 2022;21(2):164-168
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Discordant immuno-viral response, defined as a failure in increasing more than 100 CD4+ cells/μl T lymphocytes with an undetectable viral load at one year after initiation of a highly active antiretroviral therapy (HAART), is associated with an increase in mortality in people living with HIV (PLWH). This study explored a cohort of HIV-positive patients in a Peruvian hospital to determine factors associated with discordant immuno-viral response.
Material and methods:
A retrospective, analytical, cross-sectional single-site study was conducted, including PLWH receiving HAART with regular follow-up visits. In total, 310 PLWH, out of which 47 with a discordant response (DIR) and 263 with concordant immune response (CIR) fulfilled inclusion criteria for the study.
Results:
Main characteristics of our population were: age of onset of HAART around 35 years, male and heterosexual. Moreover, age over 65 years, from different hospital, co-infection, opportunistic infections, and baseline CD4+ > 250 cells/μl were significantly associated with DIR. Multivariate regression analysis showed basal CD4+ > 250 cells/μl and opportunistic infections associated with DIR.
Conclusions:
In our cohort, factors associated with the development of DIR are baseline CD4+ over 250 cells/μl and opportunistic infections.
Discordant immuno-viral response, defined as a failure in increasing more than 100 CD4+ cells/μl T lymphocytes with an undetectable viral load at one year after initiation of a highly active antiretroviral therapy (HAART), is associated with an increase in mortality in people living with HIV (PLWH). This study explored a cohort of HIV-positive patients in a Peruvian hospital to determine factors associated with discordant immuno-viral response.
Material and methods:
A retrospective, analytical, cross-sectional single-site study was conducted, including PLWH receiving HAART with regular follow-up visits. In total, 310 PLWH, out of which 47 with a discordant response (DIR) and 263 with concordant immune response (CIR) fulfilled inclusion criteria for the study.
Results:
Main characteristics of our population were: age of onset of HAART around 35 years, male and heterosexual. Moreover, age over 65 years, from different hospital, co-infection, opportunistic infections, and baseline CD4+ > 250 cells/μl were significantly associated with DIR. Multivariate regression analysis showed basal CD4+ > 250 cells/μl and opportunistic infections associated with DIR.
Conclusions:
In our cohort, factors associated with the development of DIR are baseline CD4+ over 250 cells/μl and opportunistic infections.
REFERENCES (33)
1.
Engsig FN, Zangerle R, Katsarou O, et al. Long-term mortality in HIV-positive individuals virally suppressed for >3 years with incomplete CD4 recovery. Clin Infect Dis 2014; 58: 1312-1321.
2.
Monroe AK, Rowe TL, Moore RD, Chander G. Medication adherence in HIV-positive patients with diabetes or hypertension: a focus group study. BMC Health Serv Res 2013; 13: 488.
3.
Grabar S, Le Moing V, Goujard C, et al. Clinical outcome of patients with HIV-1 infection according to immunologic and virologic response after 6 months of highly active antiretroviral therapy. Ann Intern Med 2000; 133: 401-410.
4.
Merchante N, Girón-González JA, González-Serrano M, et al. Survival and prognostic factors of HIV-infected patients with HCV-related end-stage liver disease. AIDS 2006; 20: 49-57.
5.
Fokam J, Santoro MM, Takou D, et al. Evaluation of treatment response, drug resistance and HIV-1 variability among adolescents on first- and second-line antiretroviral therapy: a study protocol for a prospective observational study in the centre region of Cameroon (EDCTP READY-study). BMC Pediatr 2019; 19: 226.
6.
López de Castilla D, Verdonck K, et al. Predictors of CD4+ cell count response and of adverse outcome among HIV-infected patients receiving highly active antiretroviral therapy in a public hospital in Peru. Int J Infect Dis 2008; 12: 325-331.
7.
Alave J, Paz J, Gonzalez E, et al. Risk factors associated with virologic failure in HIV-infected patients receiving antiretroviral therapy at a public hospital in Peru. Rev Chilena Infectol 2013; 30: 42-48.
8.
Bazán-Ruiz S, Chanamé Pinedo LE, Maguiña Vargas C. Adherence to HAART on HIV/AIDS. A public health problem. Acta Médica Peruana 2013; 30: 101-102 [Article in Spanish].
9.
Hiromi Tuboi S, Guilherme Pacheco A, Harrison LH, et al. Mortality associated with discordant responses to antiretroviral therapy in resource-constrained settings. J Acquir Immune Defic Syndr 2010; 53: 70-77.
10.
Cáceres CF, Mendoza W. The national response to the HIV/AIDS epidemic in Peru: accomplishments and gaps – a review. J Acquir Immune Defic Syndr 2009; 51 Suppl 1: S60-66.
11.
Kelly C, Gaskell KM, Richardson M, Klein N, Garner P, Macpherson P. Discordant immune response with antiretroviral therapy in HIV-1: a systematic review of clinical outcomes. PLoS One 2016; 11: e0156099.
12.
Gesesew HA, Ward P, Woldemichael K, Mwanri L. Immunological failure in HIV-infected adults from 2003 to 2015 in Southwest Ethiopia: a retrospective cohort study. BMJ Open 2018; 8: 17413.
13.
Gebrehiwet Hailu G, Gebreyesus Wasihun A. Immunological and virological discordance among people living with HIV on highly active antiretroviral therapy in Tigray, Northern Ethiopia. BMC Infect Dis 2021; 21: 561.
14.
Muzah BP, Takuva S, Maskew M, Delany-Moretlwe S. Risk factors for discordant immune response among HIV-infected patients initiating antiretroviral therapy: a retrospective cohort study. South Afr J HIV Med 2012; 13: 168-172.
15.
Kayigamba FR, Franke MF, Bakker MI, et al. Discordant treatment responses to combination antiretroviral therapy in Rwanda: a prospective cohort study. PLoS One 2016; 11: e0159446.
16.
Baker Z, Javanbakht M, Mierzwa S, et al. Predictors of over-reporting HIV pre-exposure prophylaxis (PrEP) adherence among young men who have sex with men (YMSM) in self-reported versus biomarker data. AIDS Behav 2018; 22: 1174-1183.
17.
Greenbaum AH, Wilson LE, Keruly JC, Moore RD, Gebo KA. Effect of age and HAART regimen on clinical response in an urban cohort of HIV-infected individuals. AIDS 2008; 22: 2331-2339.
18.
Julg B, Poole D, Ghebremichael M, et al. Factors predicting discordant virological and immunological responses to antiretroviral therapy in HIV-1 clade C infected zulu/xhosa in South Africa. PLoS One 2012; 7: e31161.
19.
Krogstad P, Patel K, Karalius B, et al. Incomplete immune reconstitution despite virologic suppression in HIV-1 infected children and adolescents. AIDS 2015; 29: 683-693.
20.
Kà D, Manga NM, Ngom-Guéye NF, et al. Factors associated with immunovirologic dissociation in HIV-1-infected patients under highly active antiretroviral therapy in the Ambulatory Treatment Center (ATC) in Dakar. Pan Afr Med J 2017; 27: 16 [Article in French].
21.
Sharma M, Ying R, Tarr G, Barnabas R. Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature 2015; 528: S77-85.
22.
Zoufaly A, An Der Heiden M, Kollan C, et al. Clinical outcome of HIV-infected patients with discordant virological and immunological response to antiretroviral therapy. J Infect Dis 2011; 203: 364-371.
23.
Tuboi SH, Brinkhof MWG, Egger M, et al. Discordant responses to potent antiretroviral treatment in previously naive HIV-1-infected adults initiating treatment in resource-constrained countries: the antiretroviral therapy in low-income countries (ART-LINC) collaboration. J Acquir Immune Defic Syndr 2007; 45: 52-59.
24.
Moore DM, Hogg RS, Chan K, Tyndall M, Yip B, Montaner JS. Disease progression in patients with virological suppression in response to HAART is associated with the degree of immunological response. AIDS 2006; 20: 371-377.
25.
Saison J, Ferry T, Demaret J, et al. Relationship between discordant response to HAART, Tregs, immune activation and low-level viraemia. J Int AIDS Soc 2014; 17: 19672.
26.
Torti C, Quiros-Roldan E, Scudeller L, et al. Characterization of viro-immunological responses in a closely followed cohort of heavily pretreated patients: evidence from the GenPheRex Study. HIV Med 2003; 4: 263-270.
27.
Ingole N, Mehta P, Pazare A, Paranjpe S, Sarkate P. Performance of immunological response in predicting virological failure. AIDS Res Hum Retroviruses 2013; 29: 541-546.
28.
Karo B, Krause GG, Castell S, Kollan C, Hamouda O, Haas W. Immunological recovery in tuberculosis/HIV co-infected patients on antiretroviral therapy: implication for tuberculosis preventive therapy. BMC Infect Dis 2017; 17: 517.
29.
Kupin WL. Viral-associated GN: hepatitis C and HIV. Clin J Am Soc Nephrol 2017; 12: 1337-1342.
30.
Ruiz L, Maya MA, Rueda ZV, López L, Vélez LA. Características actuales de la coinfección con tuberculosis y el virus de la inmunodeficiencia humana en. Biomedica 2018; 38: 59-67 [Article in Spanish].
31.
Saita NM, de Paula Andrade RL, Bossonário PA, et al. Determinants of coinfection tuberculosis and HIV in prisons in Brazil. J Infect Dev Ctries 2021; 15: 263-269.
32.
Romano-Mazzotti L, Sifuentes-Vela C, Villalobos-Acosta P, Santos-Preciado JI, Pavía-Ruz N. Discordant response to highly active antiretroviral therapy in Mexican pediatric patients infected with HIV/AIDS. Bol Med Hosp Infant Mex 2009; 66: 335-342 [Article in Spanish]. Available from: http://www.scielo.org.mx/sciel....
33.
Massanella M, Negredo E, Clotet B, Blanco J. Immunodiscordant responses to HAART – mechanisms and consequences. Expert Rev Clin Immunol 2013; 9: 1135-1149.
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