CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS OF HIV-INFECTED PATIENTS WITH DISCORDANT IMMUNE RESPONSE TO ART IN THE SVERDLOVSK REGION
The aim of the study - to analyze clinical and epidemiological indicators, the chances of death in patients with a discordant immune response in the Sverdlovsk region; to identify the range of values of CD4+ lymphocytes at the beginning of treatment, in which the development of DIR is probably. Materials and methods. We conducted a cohort retrospective study of HIV-infected patients who were observed in the Sverdlovsk region and had a level of CD4+lymphocytes at the beginning of treatment <350 cl/mcl. Two groups were formed: the main one (DIR) - patients, who had CD4 <350 cl/mcl 1 year after the start of ART and then it never has risen higher; control one - patients, who had CD4 >350 cl /mcl 1 year after the start of ART and then it never has fallen below. Results. According to the results of the study, we revealed the influence of the following factors on the recovery of CD4+ T-lymphocytes: age - older age prevailed in the group of patients with DIR (Me 39 (Q1-Q3: 35-44)) in relation to patients of the control group (Me 35 (Q1-Q3:31-40)); male sex had a higher chance of DIR (OR 2,058; 95% CI 1,864-2,272); HIV transmission pathway - drug-addicted patients had DIR more often. The risks of death were significantly higher in the group of patients with DIR: from all causes (OR 3,522; 95% CI 3,041-4,079), from HIV-related causes (OR 5,445; 95% CI 4,317-6,867), from non-HIV-related causes (OR 2,426; 95% CI 2,011-2,927). The baseline level of CD4+ lymphocytes before ART in the DIR group was significantly lower (Me 91 (Q1-Q3: 39-154)) in relation to patients of the control group (Me 240 (Q1-Q3: 160-295)). We obtained the threshold value of CD4+ lymphocytes using ROC analysis - 165 cl/µl.It can be used to predict the recovery of CD4+ lymphocytes above 350 cl/µl. Conclusion. A discordant immune response to ART can be caused by many factors. The level of CD4+lymphocytes before the start of ART strongly affects the immune response and can be used to predict the recovery of CD4+ above 350 cl/µl.