JAC Advance Access originally published online on July 19, 2006
Journal of Antimicrobial Chemotherapy 2006 58(3):506-510; doi:10.1093/jac/dkl263
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Discordant immunological and virological responses to antiretroviral therapy
1 Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro Av. Brigadeiro Trompowski s/n, Ilha do Fundão, Rio de Janeiro 21941–590, Brazil 2 Infectious Diseases Epidemiology Research Unit, Graduate School of Public Health and School of Medicine, University of Pittsburgh PA, USA
*Corresponding author. Tel: +55-21-2562-2725; Fax: +55-21-2590-1615; E-mail: maurosch{at}hucff.ufrj.br
In response to antiretroviral therapy, some patients experience what has been termed a discordant response, characterized either by a sustained CD4+ cell count rise despite persistent viraemia or by HIV-1 RNA plasma levels below the limit of detection accompanied by a blunted CD4+ cell count response. In part because of a lack of universally accepted definitions, published estimates of the frequency of discordant responses vary considerably. Little is known about the pathogenesis of discordant responses, which seems to depend on the interaction of a multitude of viral, host and treatment-related factors. Available evidence indicates that discordant responses are associated with an intermediate risk of death or clinical progression. At present, recommendations for the clinical management of patients with discordant responses to antiretroviral therapy are largely based on observational, uncontrolled data. The development of standardized and universally accepted definitions of discordant responses is necessary to allow meaningful comparisons between studies to be made, as well as to help in the design of trials of possible therapeutic interventions.
Keywords: CD4 lymphocyte count , viral load , treatment outcome
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