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JAC Advance Access published online on July 19, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl263
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Leading article

Discordant immunological and virological responses to antiretroviral therapy

Mauro Schechter 1 * and Suely Hiromi Tuboi 2

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

* To whom correspondence should be addressed.
Mauro Schechter, E-mail: maurosch{at}hucff.ufrj.br


  Abstract

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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