Table 4. Effect of DIR on rate of clinical outcomes, according to DIR definitions, for 20 studies reporting clinical outcomes.
| Definition of discordant immune response | First Author | HIV viral load cut off | Number virologically suppressed | Number virologically suppressed with DIR | Effect of DIR on risk of Mortality | Effect of DIR on risk of AIDS | Effect of DIR on risk of AIDS or mortality | ||||||
| DIR number of participants (%) | IR number of participants (%) | Risk ratio (min CI–max CI) | DIR number of participants (%) | IR number of participants (%) | Risk ratio (min CI–max CI) | DIR number of participants (%) | IR number of participants (%) | Risk ratio (min CI–max CI) | |||||
| Failure to achieve rise in CD4 count of > = 50 cells/mm3 at 6 months after ART initiation | MOORE [7] | <500 at 6 months | 1084 | 235 | 53 (22.6) | 61 (7.2) | 3.14 (2.24–4.40) | NR | NR | NR | NR | NR | NR |
| TAN [8] | Undetected at 6 months | 320 | 35 | 4 (11.4) | 11 (3.9) | 2.96 (1.00–8.80) | 6 (17.1) | 30 (10.5) | 1.63 (0.73–3.54) | NR | NR | NR | |
| TUBOI [9] | <500 at 6 months | 6234 | 1260 | 23 (4.5) | 51 (1.0) | 1.78 (1.09–2.90) | NR | NR | NR | NR | NR | NR | |
| Failure to achieve rise in CD4 count of > = 50 cells/mm3 at 8 months after ART initiation | BAKER [50] | <400 at 8 months | 850 | 149 | 7 (4.7) | 19 (2.7) | 1.73 (0.74–4.03) | 16 (10.7) | 33 (4.7) | 2.28 (1.29–4.02) | NR | NR | NR |
| Failure to achieve rise in CD4 count of > = 50 cells/mm3 at 12 months after ART initiation | GRABAR [54] | <1000 at 6 months | 1486 | 387 | NR | NR | NR | NR | NR | NR | 37 (9.6) | 51 (4.8) | 1.99 (1.33–2.99) |
| GUTERRIEZ [55] | <500 throughout follow-up | 650 | 108 | 8 (7.4) | 10 (1.8) | 4.01 (1.62–9.94) | 3 (2.8) | 15 (2.8) | 1.00 (0.30 -–3.41) | NR | NR | NR | |
| Failure to achieve rise in CD4 count of > = 100 cells/mm3 at 12 months after ART initiation | DRONDA [51] | <50 quarterly for 2 years | 288 | 76 | NR | NR | NR | NR | NR | NR | 7 (9.2) | 40 (18.9) | 0.86 (0.41–1.80) |
| NAKANJAKO [58] | <400 quarterly for 2 years | 339 | 151 | NR | NR | NR | 14 (9.3) | 9 (4.8) | 1.94 (0.86–4.35) | NR | NR | NR | |
| Failure to achieve rise in CD4 count of > = 100 cells/mm3 at 12 months after ART | NICASTRI [61] | <500 at 12 months | 1117 | 336 | NR | NR | NR | NR | NR | NR | Not reported | Not reported | Odds ratio 2.32 (1.36–3.95) |
| Failure to achieve rise in CD4 count of > = 100 cells/mm3 at 8 months after ART initiation | GILSON [6] | <50 twice over one year | 2584 | 571 | 26 (4.6) | 24 (2.0) | 2.29 (1.33–3.97) | 15 (2.6) | 33 (2.8) | 0.96 (0.53–1.76) | NR | NR | NR |
| Failure to achieve an absolute CD4 count of > = 174cells/mm3 at 6 months after ART initiation1 | HUNT [4] | <1000 throughout follow-up | 451 | 107 | 3 (2.8) | 6 (1.7) | 1.00 (0.26–3.92) | NR | NR | NR | NR | NR | NR |
| Failure to achieve an absolute CD4 count of > = 350 cells/mm3 at 9 months after ART initiation | FALSTER [53] | <400 twice over one year | 292 | 83 | NR | NR | NR | NR | NR | NR | 14 (3.5) | 35 (2.2) | 2.06 (0.89–4.79) |
| Failure to achieve an absolute CD4 count of > = 200 cells/mm3 at 12 months after ART | ZOUFALY [10] | <50 throughout follow-up | 1085 | 248 | NR | NR | NR | 18 (7.3) | 11 (1.3) | 2.70 (1.29–5.66) | NR | NR | NR |
| LOUTFY [57] | <50 throughout | 2028 | 404 | NR | NR | NR | NR | NR | NR | 14 (3.5) | 35 (2.2) | 1.61 (0.87–2.96) | |
| Failure to achieve an absolute CD4 count of > = 250 cells/mm3 at 22 months after ART initiation | PACHECO [59] | <1000 quarterly for 2 years | 147 | 40 | 5 (12.5) | 4 (3.7) | 3.23 (0.89–11.77) | NR | NR | NR | NR | NR | NR |
| Failure to achieve an absolute CD4 count of > = 200 cells/mm3 at 36 months after ART initiation | ENGSIG [52] | <50 over 3 years | 291 | 55 | 11 (20) | 11 (4.7) | 4.29 (1.96–9.38) | NR | NR | NR | NR | NR | NR |
| Failure to achieve an absolute CD4 count of > = 500 cells/mm3 at 60 months after ART | KAUFMANN [56] | <1000 over 5 years | 293 | 105 | 22 (21.0) | 18 (9.6) | 2.19 (1.23–3.89) | NR | NR | NR | NR | NR | NR |
NR not reported. DIR discordant immune response IR concordant immune response. VL viral load.