Long-term clinical outcome of human immunodeficiency virus-infected patients with discordant immunologic and virologic responses to a protease inhibitor-containing regimen

Within a prospective cohort of 150 human immunodeficiency virus (HIV)-infec ted patients who began first-line protease inhibitor therapy in 1996, the o utcome of 42 patients with discrepant virologic and immunologic responses t o antiretroviral treatment at 12 months was analyzed at 30 months of treatm ent. The incidence of AIDS-defining events and deaths (14%) in the group of patients with immunologic responses in the absence of a virologic response was higher than that in full-responder patients (2%); yet, the incidence i n this group was lower than that in patients with no immunologic response, despite a virologic response (21%), and was lower than that in patients wit hout an immunologic or virologic response (67%;, log-rank test). P < .0001 Differences in outcome were significant (relative risk, 6.9; 95% confidence interval, 1.9-39.3) when factors for progression were compared with those of responder patients. The results support the relevance of the CD4 cell ma rker over plasma HIV load for predicting clinical outcome in patients who d o not achieve full immunologic and virologic responses.