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 3.5±2.7 years of HAART, 41 (17.7%) patients achieved immune reconstitution (681.4±172.7 CD4 cells/µL), while 191 (82.3%) patients did not (306.6±109.16 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 ten with a continuously dissociated response. Factors associated with immune recovery included, usage of PIs and of drugs from all three classes (OR 2.1, 95% CI 1.0-4.2, P=0.037 and OR 5.1, 95% CI 1.4-18.7, P=0.013, respectively), and a rise in CD4 count to over 200 cell/µL after the first 3.1 years of treatment (OR 2.8, 95% CI 1.1-6.6, P=0.019). Achievement of a rise in CD4 count to over 200 cell/µL after the first 3.1 years of treatment, and usage of all three drug classes were 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 three years, immune recovery is possible after at least six years of treatment, particularly if treated with drugs from all three classes.