Evaluation of Virologic–Immunologic Responses in HIV-1 Perinatally Infected Children at Public Sector Clinics in South Africa

Abstract

Background Despite achieving HIV viral suppression following start of combination antiretroviral therapy (cART), a significant proportion of HIV infected adults fail to restore CD4 Tcell counts to expected levels, a phenomenon known as a virologic-immunologic discordance. There is however paucity of data on the prevalence rate of virologic-immunologic discordance in HIV infected children. The study therefore aims to determine the prevalence and associated risk factors of virologic-immunolgic discordance in perinatally HIV-1 infected children after initiation of a antiretroviral regimen. Methods The study is a retrospective longitudinal design that set out to describe the prevalence and risk factors of virologic-immunologic discordant responses in a large HIV paediatric public sector cohort of 1747 children initiated on cART from the January 1st 2004 to December 30th 2022. Data Analysis For data analysis, Chi-square and the Mann-Whitney U test were used. To explore factors associated with virologic- immunologic discordance, univariate and multivariate logistic regression analysis was used. Results Of the 1747 HIV-infected children included in the analysis, 895 (51.2%) were female and 852 (49.0%) male. One thousand two hundred and ninety-seven children on cART had HIV viral loads below the limit of detection and 72 (6%) displayed virologic- immunologic discordance. WHO stage III/IV, older age (10 – 17 yrs), CD4 T cell count <50 cells/μl and AZT or d4T based NRTI regimen, were factors associated with virologic-immunologic discordance. Conclusion HIV infected children who fail to achieve viral suppression and a resulting increase in CD4 T cell count, are at high risk of disease progression and death from AIDS and non-AIDS events and should be monitored closely, without effecting a regimen change.