# Negative influence of age and low baseline CD4 on T helper cell recovery among HIV-infected individuals with fixed-dose combination of tenofovir disoproxil, lamivudine and dolutegravir

## TL;DR

Some HIV patients on TLD treatment don't recover their CD4+ T cells well, especially if they're older or have low CD4 counts at the start.

## Contribution

The study identifies baseline CD4 and age as significant predictors of poor CD4 recovery despite effective antiretroviral therapy.

## Key findings

- 55% of patients showed inadequate CD4+ T cell recovery despite viral suppression.
- Lower baseline CD4 counts were strongly associated with poor immune recovery.
- Age and treatment duration also significantly influenced CD4 recovery outcomes.

## Abstract

A discordant immune response (DIR) refers to inadequate CD4+ T cell recovery despite virological suppression after antiretroviral therapy (ART).

This study evaluated DIR in HIV-positive patients receiving a first-line regimen of tenofovir disoproxil fumarate, lamivudine and dolutegravir (TLD) at the ART Centre, Saveetha Medical College and Hospital, Chennai, India. DIR was defined as virological suppression to <150 copies/mL and a CD4+ T cell count of <500 cells/μL after at least 12 months of ART. Patients with DIR were further categorized as DIR350 (CD4+ T-cell count <350 cells/μL) and DIR500 (CD4+ T-cell count between 350 and <500 cells/μL). Patients with a CD4+ T-cell count >500 cells/μL were classified as responders. Descriptive and ordinal regression analyses were performed, with suitable measures of central trends, and a p-value of 0.05 indicating the confirmation of a relationship between the variables.

Out of the 112 patients screened, 40 were enrolled in the study. Of the 40 participants 55% (22/40) showed DIR, with equal proportions in DIR350 (27.5%) and DIR500 (27.5%), while 45% (18/40) achieved immune reconstitution. By using ordinal regression analysis, the study found that the baseline CD4 counts were significantly associated with DIR. Univariate analysis indicated that age, baseline CD4 and treatment duration were significantly associated with CD4 recovery.

The study highlights that, despite viral suppression with TLD, a substantial proportion of patients fail to achieve adequate immune restoration. Lower baseline CD4 was observed to be a key predictor of DIR. These findings underscore the need for early ART initiation, targeted adherence support, and counselling to optimize outcomes and progress toward the UNAIDS 95 target.