Factors associated with paradoxical immune response to antiretroviral therapy in HIV infected patients: a case control study

BMC Infectious Diseases

Research Article

Janaina AS Casotti¹  Luciana N Passos¹  Fabiano JP Oliveira²  Crispim Cerutti³ 

[1] Infectious Diseases Outpatient Clinic of the Hospital Universitário Cassiano Antonio Moraes of Universidade Federal do Espírito Santo, Vitória, Espírito Santo State, Brazil;Secretary of Health of the Municipality of Vitória, Vitória, Espírito Santo State, Brazil;Tropical Medicine Unit and Program of Post Graduation in Collective Health of the Universidade Federal do Espírito Santo, Vitória, Espírito Santo State, Brazil;

关键词: Viral Suppression;    Nucleoside Analogue Reverse Transcriptase Inhibitor;    Hierarchical Logistic Regression Model;    Discordant Response;    Immune Response Elevation;   

DOI  :  10.1186/1471-2334-11-306

 received in 2011-06-19, accepted in 2011-11-02,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundA 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.MethodsA case-control study (1:4) matched by gender was conducted among 934 HIV infected patients on HAART in Brazil. Cases: patients with PIR, defined as CD4 < 350 cells/mm3 (hazard ratio for AIDS or death of at least 8.5) and undetectable HIV viral load on HAART for at least one year. Controls: similar to cases, but with CD4 counts ≥ 350 cells/mm3. 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.ResultsAmong 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).ConclusionsPIR 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.

【 授权许可】

Unknown   
© Casotti et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.