Clinical Outcomes of Immune Nonresponse Among Virally Suppressed Adults Living With HIV in Thailand

A minority of people living with HIV/AIDS (PLWHA) experience poor CD4 + T-cell recovery while achieving virological suppression (VS), known as immune nonresponse (INR). The clinical outcomes of serious non-AIDS-related events (SNAE) in INR population remain poorly understood. This study assessed INR clinical outcomes, focusing on SNAE in PLWHA on antiretroviral therapy with VS.

Multicenter, retrospective cohort study.

PLWHA aged ≥ 20 years, who received antiretroviral therapy, had at least 2 consecutive HIV-1 viral load tests, and were followed for at least 24 months between January 1997 and March 2023 were included. The primary outcome was the incidence of SNAE between the INR group [CD4 < 350 cells/µL after sustained VS of < 50 copies/mL for ≥ 2 years] and a non-INR group with adequate immune recovery.

Total of 1457 PLWHA were included. The prevalence of INR was 433 (29.7%). Male sex, older age, lower body mass index, lower CD4 count at diagnosis, earlier treatment era, and the presence of comorbidities were significantly more common in the INR group than in the non-INR group. After 2 years of sustained VS, the median follow-up time was 7.9 (4.4-12.2) years. The incidence of SNAE during follow-up was 1.06/100 person-year in the INR group compared with 0.85/100 in the non-INR group (hazard ratios 1.20, 95% confidence intervals: 0.79-1.82, P = 0.406). INR was not significantly associated with SNAE (aHR 1.05, 95% confidence intervals: 0.68-1.63, P = 0.822).

INR was not associated with increased SNAE incidence, suggesting it may not independently predict SNAE in PLWHA with sustained VS.