Performance of immunological response in predicting virological failure

Area of Science:

• Infectious Diseases
• Immunology
• Clinical Medicine

Background:

• Antiretroviral therapy (ART) is standard for HIV management.
• Treatment failure necessitates switching from first- to second-line therapy.
• Treatment failure is assessed clinically, immunologically (CD4 count), and virologically (viral load).

Purpose of the Study:

• To determine immunological and virological responses to ART.
• To evaluate the predictive utility of immunological response for virological failure.

Main Methods:

• Study included treatment-naive HIV-positive adults (>18 years).
• Assessed patients at baseline, 6, and 12 months for clinical status, CD4 count, and viral load.
• Categorized responses as concordant favorable (CF), immunological only (IO), virological only (VO), and concordant unfavorable (CU).

Main Results:

• At 12 months, 69.3% had CF, 10.2% IO, 18.2% VO, and 2.3% CU responses.
• Immunological failure criteria showed low sensitivity (11.1-40%) and positive predictive value (8.3-25%) for predicting virological failure.
• Significant misclassification of therapeutic responses occurred when relying solely on immunological criteria.

Conclusions:

• Immunological criteria alone are insufficient for accurately predicting virological failure in HIV patients on ART.
• Viral load testing is essential for accurate monitoring and management of ART.
• Urgent need to incorporate viral load testing in ART initiation and monitoring protocols.