Factors associated with immunological non-response in HIV patients receiving antiretroviral therapy in Southeast Asia: A systematic review
Clinical Snapshot
PICO Framework
| P — Population | People with HIV receiving antiretroviral therapy in Southeast Asia |
| I — Intervention | Antiretroviral therapy (ART) |
| C — Comparator | Various baseline characteristics and clinical factors |
| O — Outcomes | Immunological non-response (INR) - failure to achieve adequate CD4+ T-cell recovery despite ART |
Bottom Line
This systematic review of 10 studies involving nearly 7,000 HIV patients in Southeast Asia identifies baseline CD4 count as the most consistent predictor of immunological non-response to antiretroviral therapy. While substantial heterogeneity between studies limits the ability to provide precise effect estimates, the findings reinforce the critical importance of early HIV diagnosis and prompt ART initiation before significant immune damage occurs. The results support current Australian practice guidelines that recommend immediate ART initiation regardless of CD4 count, and highlight the need for enhanced HIV testing strategies to identify patients earlier in their disease course. Clinicians should be aware that patients presenting with very low baseline CD4 counts may experience suboptimal immune recovery despite achieving viral suppression, requiring closer monitoring and potentially adjunctive interventions. The regional focus makes these findings particularly relevant for Australian practitioners caring for patients from Southeast Asian backgrounds.
Key Findings
P Value: Not reported
Effect Size: Not quantified due to heterogeneity - harvest plot synthesis used
Primary Outcome: Immunological non-response to antiretroviral therapy
Nnt Or Sensitivity: Baseline CD4 count identified as most consistent predictor of immunological non-response
Confidence Interval: Not reported
Clinical Application
Findings support current Australian HIV guidelines emphasizing early diagnosis and treatment initiation Relevant to Australian practice given significant Southeast Asian migrant populations and similar ART regimens. Supports PBS-subsidized early ART initiation and aligns with ASHM guidelines for HIV management People with HIV initiating or receiving ART, particularly those from Southeast Asian backgrounds
Abstract
ObjectiveThis systematic review summarizes factors associated with immunological non-response (INR) among people with HIV on antiretroviral therapy (ART) in Southeast Asia.MethodsWe conducted a systematic search of PubMed, ScienceDirect, DOAJ, and Lens.org for studies published between 2010 and 2025. Observational studies examining immunological outcomes following ART initiation and related factors were included. Study quality was assessed using the Newcastle-Ottawa Scale, and results were synthesized using a harvest plot.ResultTen eligible studies were included in the synthesis, comprising a total of 6,988 participants with substantial heterogeneity observed across studies. Factors associated with INR included age, sex, baseline CD4 cell count, HIV RNA levels, and co-infections. Among these factors, baseline CD4 cell count at the initiation of ART emerged as the most consistently associated determinant; lower baseline CD4 levels were linked to a higher risk of INR even with virological suppression.ConclusionThis review highlights baseline immunological status at ART initiation as a key predictor of immunological non-response in Southeast Asia. These findings underscore the critical importance of early HIV diagnosis and timely initiation of ART to prevent advanced immune damage and optimize immunological recovery.
References
- 1.Efrida, Yuza, & Aziizah. (2026). Factors associated with immunological non-response in HIV patients receiving antiretroviral therapy in Southeast Asia: A systematic review. Antiviral Therapy. https://doi.org/10.1177/13596535261450699
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