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Dr. Adrian Man
Predictive factors of discordant immunologic and virologic response to highly active antiretroviral therapy Marta Andrea Fodor, Minodora Dobreanu, Rodica Pascu
Abstract: The goals of highly active antiretroviral therapy (HAART - administration of 2 INRT/NNRT + 1 - 2IP) are the reduction of plasma HIV - RNA levels, the immune reconstitution - increase the number of CD4 cells and a fa-vorable clinical outcome. On the basis of immunologic and virologic responses, patients have been classified into four groups: complete response (CD4 cell increase and plasma HIV - RNA level decrease –I+V+), complete nonre-sponse (CD4 cell decrease and plasma HIV - RNA increase –I-V-), immunologic response only (CD4 cell increase with plasma HIV - RNA level increase-I+V+) and virologic response only (plasma HIV - RNA level decrease without CD4 cell level increase-I-V+). The objective of this study is to evaluate the frequency and possible predictive factors of discordant immu-nologic and virologic response. This study has been performed in the Infectious Diseases Clinic in Tg. Mures. A lot of study has been formed by 144 HIV infected patients, olden 7-42 years, with HAART (2 INRT + 1 - 2 IP), with CD4 cell count and HIV RNA plasma level determination in the Molecular Biology Laboratory of the Infectious Diseases Clinic in Tg. Mures. CD4 cell count were assessed by flow cytometry (Becton Dickinson), virus load were measured with the use of commercial quantitative PCR technique (LCx HIV-RNA Quantitative –Abbott and COBAS AMPLICOR HIV -1 MONITOR Test, v1.5). Results: we observed a great distribution of CD4 cell/ plasma HIV - RNA levels; 26,38 % of patients had complete response with increase in CD4 cell count and decrease in viral plasma load, 49,99% had discordant re-sponse, the most frequent response (36,8%) the only immunologic response (increase the plasma viral load and both the CD4 cell count). The immunological discordant response has been most frequent in the children with initially elevated CD4 cell counts. We have found a statistically significant difference within the initially CD4 cell count in children with im-munological discordant response (I-V+) and the initially CD4 cell count in the group of children with a treatment failure (I-V-). This difference was found both between the initially CD4 cell count in the group of children with a complete immunologically and virologically response (I+V+) and the group of children with treatment failure (I-V-).
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Fodor MA, Dobreanu M, Pascu R. Predictive factors of discordant immunologic and virologic response to highly active antiretroviral therapy . Rev Romana Med Lab. 2005;1(1):56-62
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