Brian Eka Rachman, Yehuda Tri Nugroho Supranoto, Soraya Isfandiary Iskandar, Tri Pudy Asmarawati, Siti Qamariyah Khairunisa, Muhammad Vitanata Arfijanto, Usman Hadi, Muhammad Miftahussurur, Nasronudin Nasronudin, Masanori Kameoka, Retno Pudji Rahayu, Afif Nurul Hidayati
Immunological non-response (INR) to antiretroviral therapy (ART) is a critical concern for PLHIV, characterized by inadequate CD4+ T-cell recovery despite virological suppression. This retrospective study analyzed medical records of virologically suppressed adult PLHIV on ART (2004–2024) at two hospitals in Surabaya, Indonesia, using four operational categories to identify clinical and demographic determinants of INR. Patients were classified as immunological responders (IRs) or non-responders (INRs) based on four definitions: INR1 (CD4+ gain < 100 cells/mm3), INR2 (CD4+ < 350 cells/mm3), INR3 (meeting of either criterion), and INR4 (meeting of both criteria). Of 464 patients, 382 were analyzed. Baseline CD4+ < 200 cells/mm3 strongly predicted INR2 (aOR = 5.60, 95% CI: 2.95–10.62) and INR3 (aOR = 4.46, 95% CI: 2.39–8.29), while anal sexual transmission was protective against INR2 (aOR = 0.42, 95% CI: 0.19–0.92) and INR3 (aOR = 0.41, 95% CI: 0.19–0.89). By month 12, IR groups had over 350 CD4+ cells/mm3, with faster recovery slopes in months 0–6 (IR: >20 vs. INR: <10 cells/mm3/month). INR1 and INR4 had flat or negative slopes at 12–24 months, while IR groups had positive slopes. Baseline CD4+ was the strongest INR predictor, suggesting the value of early ART and individualized care for Indonesian PLHIV.