Virologic–Immunologic Failure and Discordance in HIV–infected Adults on Antiretroviral Therapy in Sakon Nakhon Hospital

Abstract

          CD4+ T lymphocyte count (CD4) and HIV viral load were applied for monitoring and assessing the treatment outcome of antiretroviral therapy (ART) in HIV–infected individuals and AIDS patients. This retrospective descriptive research aimed to study the situation of virologic and immunologic failure and virologic and immunologic discordance and to study the association between sex, age, CD4 count and virologic and immunologic failure in naïve HIV–infected adults on ART in Sakon Nakhon hospital. They were treated with first–line ART for at least 6 months from year 2015 to 2017. The CD4 count and HIV viral load retrieved from the National AIDS Program (NAP) were analyzed using these statistics; frequency, percentage, mean, median, Pearson Chi–square test, Odds ratio, and 95%CI.

          The results revealed that there were 353 naïve HIV–infected individuals and AIDS patients. The average age was 34.7 years old. Their median CD4 count before ART initiation was 211 cell/mm3. Among these, 35 had virologic failure, 58 had immunologic failure, 12 had virologic and immunologic failure, 23 had virologic discordance and 46 had immunologic discordance. The CD4 count < 200 cell/mm3 before ART initiation was statistically associated with virologic failure (Odds ratio = 4.13, 95% CI 1.820–9.371, p < 0.01). These situations of virologic–immunologic failure and discordance were in the low rate. Therefore, other cofactors should be studied to gain the treatment success, for instance, the host factors during HIV infection and the accessibility of service system while the CD4 count is still high.

          Keywords: HIV, Antiretroviral therapy (ART), Virologic failure, Immunologic failure, Virologic and immunologic discordance