Abstract:

Back ground: The impact of ART is measured by CD4 rise and HVL suppression through regular CD4 and viral load monitoring. There are groups of patients where viral replication is suppressed appropriately with immunologic recovery (concordant immunological responders). Conversely, there are patients with no immunologic recovery but with sustained viral load suppression (discordant immunological non responders (INR)). This type of discordance is associated with poor clinical outcomes and is unstable group. The purpose of this study was to determine the cumulative incidence and associated factors for immunological non responders among adults HIV infected patients on first line cART.

Methods: This was a retrospective follow up study which involved all HIV infected patients who were initiated on cART between January 2016 to June 2018 at Bugando Medical Center CTC Mwanza using first line cART for at least 6months. Face to face interview were conducted by using pre tested structured questionnaire to obtain social demographic informations and adherence by using Morisky adherence score. Blood sample for viral hepatitis B and C, HVL and CD4 cell count were drawn from the patient with no recent results, and were sent to BMC laboratory for processing. Patient’s record was used to retrieve complementary information on baseline investigations at different period of time. Then data were entered to excel spread sheet and analyzed by STATA version 13 to obtain cumulative incidence of immunological non responders and its associated factors, an outcome of interest.

Results: A total of 380 participants were enrolled in study of which, 101(26.58%) of clients full filled criteria for immunological non response (INR) at any time of interest. The cumulative incidence at 6 months, 12 months and 24 months were 27 (7.11%), 41 (23.30%) and 57 (42.22%) respectively. The odds of becoming INR were dependently associated with baseline CD4 count >200cells/µl (OR 3.2, p=<0.001), age >60years (OR=3.5, P=0.006), and being on ART treatment longer >12months (OR 3.5, P=<0.001).

Conclusion: The cumulative incidence of INR in this study is relatively higher compared to other studies in East Africa. The baseline CD4 count >200cell/µl, age >60years, and being on cART more than 12months were dependently associated factors. Predictors of INR from this study can potentially be useful in identification of patients at high risk of being INR when categorizing patients for HIV differentiated care.