The immunological failure, not evaluated in routine, may represent a long-term persistent failure in the same way as renal failure in some patients.
These patients also fulfilled the WHO criteria for immunological failure more often.
When transmitted, immunological failure occurs earlier than in children infected with HIV-1 of R5narrow phenotype.
The presence of viruses with R5broad phenotype in the infected newborns was accompanied by a faster progression to immunological failure.
Multivariable logistic regression analysis was performed to investigate the effect of incident TB on immunological failure adjusting for the same factors.
Conversely these viral variants are significantly linked with severe immunological failure within the first years of age of the infected children.
Of utmost relevance are our data, which show that the R5broad phenotype detected in the newborn shortly after birth was predictive of a fast and severe immunological failure.
In many Southeast Asian countries, treatment failure is often realized due to clinical symptoms rather than the presence of mutations or virological or immunological failure.
This effect was confirmed by multivariable logistic regression analysis which showed a significantly increased likelihood of immunological failure (odds ratio [OR]; 2.02 [1.13–3.59], P = 0.02) with incident TB, independent of baseline CD4 count, male sex, older age and the use of AZT (Table 3).
In our study, patients with incident TB during ART were twice as likely to be classified as having immunological failure after 2 years on ART than those without, a finding which was confirmed in multivariable logistic regression to be independent of other associated factors.
Immunological failure at 24 months was defined by fulfilment of one or more of the World Health Organization (WHO) criteria: decrease in CD4 count to pre-ART level or below, decrease in CD4 count from on-treatment peak value by more than 50% or persistent CD4 count <100 cells/mm3 [22].
