{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T15:54:15Z","timestamp":1790610855859,"version":"4.1.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Swedish Council Project","award":["2021-02703"],"award-info":[{"award-number":["2021-02703"]}]},{"name":"Xiamen University Malaysia Research Fund","award":["XMUMRF\/2024-C14\/ILAB\/0006"],"award-info":[{"award-number":["XMUMRF\/2024-C14\/ILAB\/0006"]}]},{"name":"Emory National Primate Research Center, NIH","award":["ORIP\/OD P51OD011132"],"award-info":[{"award-number":["ORIP\/OD P51OD011132"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      A discordant immune response (DIR) refers to inadequate CD4\n                      <jats:sup>+<\/jats:sup>\n                      T cell recovery despite virological suppression after antiretroviral therapy (ART).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study evaluated DIR in HIV-positive patients receiving a first-line regimen of tenofovir disoproxil fumarate, lamivudine and dolutegravir (TLD) at the ART Centre, Saveetha Medical College and Hospital, Chennai, India. DIR was defined as virological suppression to &amp;lt;150 copies\/mL and a CD4\n                      <jats:sup>+<\/jats:sup>\n                      T cell count of &amp;lt;500 cells\/\u03bcL after at least 12\u202fmonths of ART. Patients with DIR were further categorized as DIR350 (CD4\n                      <jats:sup>+<\/jats:sup>\n                      T-cell count &amp;lt;350 cells\/\u03bcL) and DIR500 (CD4\n                      <jats:sup>+<\/jats:sup>\n                      T-cell count between 350 and &amp;lt;500 cells\/\u03bcL). Patients with a CD4\n                      <jats:sup>+<\/jats:sup>\n                      T-cell count &amp;gt;500 cells\/\u03bcL were classified as responders. Descriptive and ordinal regression analyses were performed, with suitable measures of central trends, and a\n                      <jats:italic>p<\/jats:italic>\n                      -value of 0.05 indicating the confirmation of a relationship between the variables.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of the 112 patients screened, 40 were enrolled in the study. Of the 40 participants 55% (22\/40) showed DIR, with equal proportions in DIR350 (27.5%) and DIR500 (27.5%), while 45% (18\/40) achieved immune reconstitution. By using ordinal regression analysis, the study found that the baseline CD4 counts were significantly associated with DIR. Univariate analysis indicated that age, baseline CD4 and treatment duration were significantly associated with CD4 recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study highlights that, despite viral suppression with TLD, a substantial proportion of patients fail to achieve adequate immune restoration. Lower baseline CD4 was observed to be a key predictor of DIR. These findings underscore the need for early ART initiation, targeted adherence support, and counselling to optimize outcomes and progress toward the UNAIDS 95 target.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1729238","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T07:36:52Z","timestamp":1772091412000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Negative influence of age and low baseline CD4 on T helper cell recovery among HIV-infected individuals with fixed-dose combination of tenofovir disoproxil, lamivudine and dolutegravir"],"prefix":"10.3389","volume":"14","author":[{"given":"Shanmugam","family":"Saravanan","sequence":"first","affiliation":[{"name":"Saveetha Medical College and Hospitals (SMCH), Saveetha Institute of Medical and Technical Sciences (SIMATS)","place":["Chennai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramachandran","family":"Vignesh","sequence":"additional","affiliation":[{"name":"Pre-Clinical Department, Faculty of Medicine, Royal College of Medicine Perak, Universiti Kuala Lumpur","place":["Ipoh, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakthi","family":"Rengarajan","sequence":"additional","affiliation":[{"name":"Saveetha Medical College and Hospitals (SMCH), Saveetha Institute of Medical and Technical Sciences (SIMATS)","place":["Chennai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiyagarajan","family":"Vivekanandan","sequence":"additional","affiliation":[{"name":"Saveetha Medical College and Hospitals (SMCH), Saveetha Institute of Medical and Technical Sciences (SIMATS)","place":["Chennai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yean Kong","family":"Yong","sequence":"additional","affiliation":[{"name":"Laboratory Centre, Xiamen University Malaysia","place":["Sepang, Selangor, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkatesan","family":"Varsha","sequence":"additional","affiliation":[{"name":"Saveetha Medical College and Hospitals (SMCH), Saveetha Institute of Medical and Technical Sciences (SIMATS)","place":["Chennai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Princy","family":"Mounika","sequence":"additional","affiliation":[{"name":"Saveetha College of Allied Health Sciences, Saveetha Institute of Medical and Technical Sciences (SIMATS)","place":["Chennai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sathasivam","family":"Sivamalar","sequence":"additional","affiliation":[{"name":"Department of Research, Meenakshi Academy of Higher Education and Research","place":["Chennai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhavan","family":"Vidya","sequence":"additional","affiliation":[{"name":"Aevum BioLabs Pvt. Ltd.","place":["Hyderabad, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esaki M.","family":"Shankar","sequence":"additional","affiliation":[{"name":"Infection and Inflammation, Department of Biotechnology, Central University of Tamil Nadu","place":["Thiruvarur, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Larsson","sequence":"additional","affiliation":[{"name":"Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Link\u00f6ping University","place":["Link\u00f6ping, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijayakumar","family":"Velu","sequence":"additional","affiliation":[{"name":"Division of Microbiology and Immunology, Emory National Primate Research Center, Emory Vaccine Center, Department of Pathology and Laboratory Medicine, Emory University School of Medicine","place":["Atlanta, GA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sivadoss","family":"Raju","sequence":"additional","affiliation":[{"name":"State Public Health Laboratory, Directorate of Public Health and Preventive Medicine","place":["Chennai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pachamuthu","family":"Balakrishnan","sequence":"additional","affiliation":[{"name":"Department of Research, Meenakshi Academy of Higher Education and Research","place":["Chennai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boopathy","family":"Nisha","sequence":"additional","affiliation":[{"name":"Saveetha Medical College and Hospitals (SMCH), Saveetha Institute of Medical and Technical Sciences (SIMATS)","place":["Chennai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arcot R.","family":"Venkateswaran","sequence":"additional","affiliation":[{"name":"Saveetha Medical College and Hospitals (SMCH), Saveetha Institute of Medical and Technical Sciences (SIMATS)","place":["Chennai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajendran","family":"Kannan","sequence":"additional","affiliation":[{"name":"Saveetha Medical College and Hospitals (SMCH), Saveetha Institute of Medical and Technical Sciences (SIMATS)","place":["Chennai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.35248\/2572-0805-24.9.415","article-title":"Antiretroviral therapy: revolutionizing HIV management","volume":"9","author":"Grace","year":"2024","journal-title":"HIV Curr Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"5582","DOI":"10.1182\/blood-2010-12-322453","article-title":"Review article immune reconstitution under antiretroviral therapy: the new challenge in HIV-1 infection","volume":"117","author":"Corbeau","year":"2011","journal-title":"Therapy"},{"key":"ref3","first-page":"44","article-title":"Thymic function in HIV-infection","volume":"60","author":"Kolte","year":"2013","journal-title":"Dan Med J"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1535565","DOI":"10.3389\/fimmu.2025.1535565","article-title":"How to properly define immunological nonresponse to antiretroviral therapy in people living with HIV? 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