Title : Characterization of virologic-immunologic failure and discordance among new HIV-infected adults in the Upper Southern Region of Thailand
Abstract:
Virologic-immunologic failure and virologic-immunologic discordance are vital for predicting clinical outcomes. In HIV-infected people, the CD4+ T lymphocyte count (CD4) and HIV viral load were used to track and assess the treatment response of antiretroviral therapy (ART). The objectives of this retrospective descriptive study were to examine the situation of virologic-immunologic failure and virologic-immunologic discordance, along with the study of factors, including sex, age, CD4 count before ART initiation, symptom, occupation, marriage status, pregnancy status, previous infection, opportunistic infection while receiving ARV drugs, viral load >1,000 copies/ml after receiving ARV drugs, and changing ARV drug regimen during treatment to virologic and immunologic failure among new HIV-infected adults in the upper southern region of Thailand. They were treated with first-line ART for at least 6 months from 2021 to 2023. Data were analyzed using percentage, mean, median, chi-square, and odds ratio. Of the 492 new HIV-infected adults, 68.3% were male and 31.7% were female, with an average age of 37.3 years. The median CD4 count before ART started was 250 cells/μl. Most participants (44.7% and 42.3%) received TDF+FTC+EFV and TLD for the first ARV drug. 31.5% of the participants worked as general employees. 54.9% of participants were single, and 70.7% were asymptomatic. Among these, 23 had virologic failure, 41 had immunologic failure, 2 had virologic and immunologic failure, 32 had virologic discordance, and 21 had immunologic discordance. Factors of age <30 years, viral load >1,000 copies/ml after receiving ARV drugs, changing ARV drug regimen during treatment, and pregnant participants were statistically associated with virologic failure (odds ratio 3.5, 29.8, 0.4, 5.4, respectively). While the CD4 count <200 cells/μl before ART initiation was statistically associated with immunologic failure.
The percentage of new HIV-infected adults in this study was 2.2% of all new HIV-infected adult cases in Thailand, indicating that our measures for managing people with HIV were used well. Although the CD4 count before ART initiation in this study was higher than in the previous research in the eastern part of Thailand, most of the participants (43.9%) had a CD4 count of less than 200 cells/μl, reflecting the delay in HIV diagnosis, leading to a high chance of opportunistic infection. The proportion of virologic-immunologic failure and discordance in this study was low, which may be related to the high efficiency of current ARV drugs. Moreover, the proportion of immunologic discordance was higher than virologic discordance 2 times, indicating that only the CD4 count for monitoring the treatment may cause failure to diagnose. Therefore, to prevent a misdiagnosis, viral load is crucial for testing. Several factors were statistically associated with virologic failure, but only a CD4 count <200 cells/μl before ART initiation was statistically related to immunologic failure. Interestingly, pregnant participants and participants aged <30 years were more likely to develop a virologic failure than those who were not pregnant 5.4 times and those who were aged ≥30 years 3.5 times.
