Immunologic nonresponse in HIV after ART initiation tied to male sex, older age

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Male sex, older age, and hepatitis B and hepatitis C coinfection were associated with immunologic nonresponse among patients with HIV on antiretroviral therapy.

Among patients with HIV infection, factors associated with immunologic nonresponse following antiretroviral therapy (ART) initiation include male sex, older age, hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection, low CD4+ T-cell count, and low CD4/CD8 ratio. These findings were published in BMC Infectious Diseases.

To identity factors associated with immunologic nonresponse after ART initiation, researchers conducted a retrospective observational cohort study using data sourced from 3900 HIV-positive adult patients in China. The researchers grouped patients by immunologic response following 24 months of consecutive ART, including those who were responders (CD4+ count, ≥350 cells/μL), incomplete responders (CD4+ count, 200-350 cells/μL), and nonresponders (CD4+ count, <200 cells/μL). Multivariable logistic regression was used examine risk factors for immunologic nonresponse.

Among patients included in the final analysis, 2309 (59.2%) were responders, 1206 (30.9%) were incomplete responders, and 385 (9.9%) were nonresponders. Overall, the median age was 34 (IQR, 27-43) years, most patients were men (83.1%), the median BMI was 20.8 (19.0-22.9) kg/m2, 48.2% were married, 12.7% had HBV coinfection, 4.8% had HCV coinfection.

Further analysis of the population showed that the median time since ART initiation was 1.0 (IQR, 0.5-6.4) month. In addition, most patients (96.6%) acquired HIV infection via sexual exposure (homosexual transmission, 50.3%; heterosexual transmission, 46.3%), and 3.3% acquired infection via intravenous drug use.

Understanding factors associated with immunological non-response is critical to the improvement of immunological response among PLHIV.

Compared with younger patients (age range, 18-29 years), immunologic nonresponse was more likely to occur among those who were older, including those aged 40 to 49 years (adjusted odds ratio [aOR], 2.05; 95% CI, 1.29-3.25; P =.002), 50 to 59 years (aOR, 4.04; 95% CI, 2.33-7.00; P <.001), and 60 years and older (aOR, 5.51; 95% CI, 2.84-10.67; P <.001).

Other factors significantly associated with immunologic nonresponse were as follows:

  • Male sex (aOR, 2.07; 95% CI, 1.39-3.09; P <.001);
  • HBV coinfection (aOR, 1.63; 95% CI, 1.14-2.34; P =.008);
  • HCV coinfection (aOR, 2.01; 95% CI, 1.01-4.02; P =.047);
  • Low baseline CD4+ count (50-200 cells/μL; aOR, 40.20; 95% CI, 16.83-96.01; P <.001);
  • Very low CD4+ count (<50 cells/μL; aOR, 2.15.67; 95% CI, 85.62-543.26; P <.001); and
  • Low baseline CD4/CD8 ratio (<.02; aOR, 2.93; 95% CI, 1.98-4.34; P <.001).

Stratified by ART type, the risk for immunologic nonresponse was significantly lower among patients receiving protease inhibitor-based regimens (aOR, 0.47; 95% CI, 0.26-0.82) when compared with those receiving non-nucleoside reverse transcriptase inhibitor-based regimens.

Study limitations include the short follow-up period and the inability to differentiate between subsets of CD4+ T cells.

According to the researchers, “Understanding factors associated with immunological non-response is critical to the improvement of immunological response among [people living with HIV].”


Zhao H, Feng A, Luo D, et al. Factors associated with immunological non-response after ART initiation: a retrospective observational cohort study. BMC Infect Dis. 2024;24(1):138. doi: 10.1186/s12879-024-09021-9


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