Human Immunodeficiency Virus (HIV) is a virus that weakens an individual’s immune system by attacking CD4 T cells. If HIV is left untreated, it can lead to acquired immunodeficiency syndrome (AIDS). Antiretroviral therapy (ART) controls HIV infection and prevents AIDS. Despite being on effective ART, some people with HIV fail to restore their immune system to normal function. This is termed immune non-response [to ART], and can be diagnosed by a low CD4:CD8 ratio (Yang et al, J Leuk Biol 2020). Risk factors for immune non-response include older age, male sex, a history of injecting drug use, and lower nadir CD4 T-cell counts. HIV can affect all groups of people; however, it disproportionately affects those in marginalized groups who are experiencing social exclusion. Statistics reveal higher rates of infection among gay and bisexual men of all ethnicities, those of lower SES, African Americans, Latinos, injection drug users and transgender folks (CDC, 2020, para. 1). Conversely, HIV can also lead to social exclusion (Terrence Higgins Trust, 2001), further exacerbating recovery outcomes. Due to the continued stigma of the disease, people living with HIV (PLWHIV) may face obstacles with employment, tension within families and restrictions on access to health care (Terrence Higgins Trust, 2001).
We hypothesise that immune non-response may occur more frequently in PLWHIV who are socially excluded compared to PLWHIV who are not socially excluded. We will collect and analyse data on approximately 4000 PLWHIV attending St James’s Hospital including CD4:CD8 ratios and demographic and clinical information.
