Ethnicity as predictor of immune reconstitution among Malaysian HIV‐positive patients treated with highly active antiretroviral therapy

Abstract

The impact of sociodemographic and clinical factors on immune recovery and viral load suppression among HIV-1 positive patients treated with HAART particularly in Malaysia is largely unknown. This cross-sectional study enrolled 170 HIV-1-infected individuals of three major ethnicities who attended three HIV outpatient clinics in Malaysia. Questionnaire was used to obtain sociodemographic data while CD4 count and viral load data were gathered from hospital's record. Multiple factors were assessed for their predictive effects on CD4 count recovery (≥500 cells/mm3 ) and viral load suppression (≤50 copies/mL) using binary logistic regression. Most of the subjects were male (149/87.6%), in the age group 30 to 39 years old (78/45.9%) and got infected via homosexual contact (82/48.2%). Indians were associated with 11 times higher chance for CD4 recovery as compared to Malays at 8 to 12 months of HAART (adjusted OR: 10.948, 95% CI: 1.873, 64.001, P = .008). Viral load suppression was positively influenced by intravenous drug use (IVDU) status (adjusted OR: 35.224, 95% CI: 1.234, 1000.489, P = .037) at 4 to 6 months of HAART. Higher pretreatment CD4 count was a positive predictor for both initial immunological and virological responses while higher pretreatment viral load was a negative predictor for virological suppression only. In conclusion, ethnicity plays a significant role in determining early immune reconstitution in Malaysia, besides pretreatment CD4 count. Further studies are needed to identify possible biological factors underlying this association.

Trends in the burden and determinants of HIV in the Asia‐Pacific region (1990−2019): An age‐period‐cohort analysis of the 2019 Global Burden of Disease Study

“…Morbidity among the females of Malaysia peaked in young adults and was significantly lower than that among men, possibly because more than two-thirds of new cases in the country were among men aged 20−39 years old who had sex with other men; worryingly, this age group is the most productive. 37 From 1990 to 2019, the major risk factor for HIV/AIDS in Malaysia changed from drug use to unsafe sex, possibly due to the country's previous efforts to address HIV transmission among intravenous drug users through its Needle and Syringe Programme. 38 There is significant diversity across the Asia-Pacific region, and as such, the response to the AIDS epidemic must be tailored to individuals from nations with a wide range of conditions.…”

Development and Evaluation of a Nomogram for Predicting the Outcome of Immune Reconstitution Among HIV/AIDS Patients Receiving Antiretroviral Therapy in China

“…[ 11–13 ] Some demographic characteristics (age, gender, and ethnicity) may also be associated with the immune recovery in some studies. [ 14,15 ] Moreover, available studies have revealed the immune proliferation, senescence, exhaustion, and percentages of regulatory T cells (Tregs) may also reflect the immune recovery. [ 16,17 ] The nutritional status, [ 18 ] such as body mass index (BMI), [ 19 ] hemoglobin (HB), [ 20 ] and other parameters, [ 18 ] has been widely used for the assessment of prognosis of HIV‐infected patients, but their roles in the assessment of immune recovery are still controversial.…”