When Viral Suppresion Is Not Enough: Clinical Characteristics of HIV Infected Patients with Poor Immune Recovery

Abstract

Background The use of combination antiretroviral therapy (ARVT) has made it possible to halt HIV replication, achieve CD4+ recovery and immune reconstitution. Some patients with long-term viral suppression never adequately recover their CD4+ count and manifest increased mortality. Age, CD4+ nadir, Hepatitis C infection have been associated with incomplete immune recovery. By matching for age, gender, and CD4 nadir, we aim to elucidate the role of clinical factors in virally suppressed patients with suboptimal CD4 recovery.Methods Retrospective record review of patients with CD4 <200 (Cases) and CD4 >500 (Controls) with over 2 years of viral supression (viral load <200) on ARVT for the same duration, was conducted. One case was matched to 2 controls by age, gender and CD4 nadir. Associations between variables were assessed using univariable exact conditional logistic regressions.ResultsOf the 1265 charts reviewed, 13 cases were identified. A unit higher BMI was significantly associated with a 13% lower odds of having low CD4 (P = 0.04). Higher hemoglobin A1c (A1c) was associated with 82% lower odds of having low CD4 (P = 0.02). Other non-significant comparisons include ethnicity; 33% cases were Hispanic vs. 16% controls. Gastrointestinal (GI) symptoms were more common in the cases (83% vs. 50%), as was lymphadenopathy (LAD) (36.4% vs. 25%). Mean years since diagnosis was longer in cases (19.2 vs. 16.7) despite the duration of ARVT being longer in controls. Mean number of comorbidities was higher in cases (3.17 vs. 2.75). Controls had more statin use (45.8% vs. 25%).Conclusion Incomplete CD4 recovery was significantly associated with lower BMI, suggesting that despite viral suppression, these patients are vulnerable to metabolic issues that affect uncontrolled HIV patients. We hypothesize that rapid control of HIV in this suburban population was associated with weight gain and note that the BMI in controls was in the obesity range. Statin use may play a protective role in the controls, perhaps due to its anti-inflammatory properties. Trends in GI symptoms, LAD, number of comorbidities, albeit not statistically significant, seem to be important. Due to small sample size, this study was underpowered to fully assess the effect of these factors. Thus this study should be considered exploratory.Disclosures All authors: No reported disclosures.

Analysis of different levels of viral suppression in HIV-1 patients after antiviral treatment

“…In our study, CD4 cell counts baseline under 500 n/µL and co-infected with HBV were independent risk factors for high HIV-1 replication. These were consistent with previous studies [19][20] . Young age and test & treat were independent protective factors for viral suppression.…”