Defining and Predicting HIV Immunological Non-Response: A Multi-Definition Analysis from an Indonesian Cohort

Area of Science:

• Immunology
• Infectious Diseases
• Public Health

Background:

• Immunological non-response (INR) to antiretroviral therapy (ART) is a significant challenge for people living with HIV (PLHIV).
• INR is defined as inadequate CD4+ T-cell recovery despite successful viral suppression.
• Understanding determinants of INR is crucial for improving treatment outcomes in PLHIV.

Purpose of the Study:

• To identify clinical and demographic factors associated with INR in virologically suppressed adult PLHIV in Indonesia.
• To analyze CD4+ T-cell recovery patterns in responders versus non-responders.

Main Methods:

• Retrospective analysis of medical records of 382 virologically suppressed adult PLHIV on ART (2004-2024).
• Patients classified as immunological responders (IRs) or non-responders (INRs) using four distinct definitions.
• Statistical analysis to determine predictors of INR and compare CD4+ T-cell recovery slopes.

Main Results:

• Low baseline CD4+ T-cell count (<200 cells/mm3) was a strong predictor of INR.
• Anal sexual transmission was found to be protective against certain INR definitions.
• Immunological responders showed significantly faster CD4+ T-cell recovery compared to non-responders.

Conclusions:

• Baseline CD4+ T-cell count is the most critical predictor of immunological non-response to ART.
• Early initiation of ART and individualized patient care are essential for optimizing treatment outcomes in Indonesian PLHIV.
• Further research into specific transmission routes and INR mechanisms is warranted.