• R J C Gilson, S-L Man, A Copas, A Rider, S Forsyth, T Hill, L Bansi, K Porter, B Gazzard, C Orkin, D Pillay, A Schwenk, M Johnson, P Easterbook, J Walsh, M Fisher, C Leen, J Anderson, C A Sabin, and UK Collaborative HIV Cohort Study Group.
• Centre for Sexual Health and HIV Research, Research Department of Infection & Population Health, University College London, The Mortimer Market Centre, Camden Primary Care Trust, London, UK. rgilson@gum.ucl.ac.uk
• HIV Med. 2010 Feb 1; 11 (2): 152-60.

ObjectivesPatients starting highly active antiretroviral therapy (HAART) may have a suboptimal CD4 increase despite rapid virological suppression. The frequency and the significance for patient care of this discordant response are uncertain. This study was designed to determine the incidence of a discordant response at two time-points, soon after 6 months and at 12 months, and to determine the relationship with clinical outcomes.MethodsData obtained in the UK Collaborative HIV Cohort Study were analysed. A total of 2584 treatment-naïve patients starting HAART with HIV viral load (VL) > 1000 HIV-1 RNA copies/mL at baseline and < 50 copies/mL within 6 months were included in the analysis. Patients were classified at either 6-10 (midpoint 8) months or 10-14 (midpoint 12) months as having a discordant (CD4 count increase < 100 cells/microL from baseline) or concordant response (CD4 count increase >or= 100 cells/microL).ResultsDiscordant responses occurred in 32.1% of patients at 8 months and in 24.2% at 12 months; 35% of those discordant at 8 months were concordant at 12 months. A discordant response was associated with older age, lower baseline VL, and (at 12 months) higher baseline CD4 cell count. In a multivariate analysis it was associated with an increased risk of death, more strongly at 12 months [incidence rate ratio (IRR) 3.35, 95% confidence interval (CI) 1.73-6.47, P < 0.001] than at 8 months (IRR 2.08, 95% CI 1.19-3.64, P = 0.010), but not with new AIDS events.ConclusionsDiscordant responders have a worse outcome, but assessment at 12 months may be preferred, given the number of 'slow' responders. Management strategies to improve outcomes for discordant responders need to be investigated.

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