CD4+ cell-count-guided treatment interruptions in chronic HIV-infected patients with good response to highly active antiretroviral therapy

Andrea Boschi, Carmine Tinelli, Patrizia Ortolani, Gianluigi Moscatelli, Giorgio Morigi, Massimo Arlotti

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To evaluate the safety of treatment interruption guided by CD4+ cell count in HIV-infected patients followed up prospectively. Methods: Patients on highly active antiretroviral therapy with CD4+ cell counts > 500 × 10 6 cells/l discontinued therapy with instructions to start therapy again before their CD4+ count dropped below 200 × 10 6 cells/l. Any patients who resumed therapy would be eligible to interrupt treatment again once their CD4+ cell count increased above 500 × 10 6 cells/l. Results: Data on 71 HIV infected patients is reported. Their median nadir CD4+ cell count before antiretroviral treatment was 352 × 10 6 cells/l [interquartile range (IQR), 294-445 × 10 6 cells/l]. The median CD4+ cell count at the time of first interruption was 790 × 10 6cells/l (IQR, 657-1041 × 10 6 cells/l). The median follow-up after starting the first treatment interruption was 28.3 months (IQR, 21.4-37.0 months). During the follow-up 49 patients restarted therapy and 22 patients remain off therapy; 24 patients have interrupted therapy twice, nine patients have interrupted therapy three times and six patients four times. No AIDS-defining illnesses occurred during the follow-up. The median duration of the first interruption was 15 months (IQR, 6-26 months). The overall reduction of time on therapy was 71.1 %. The duration of the first interruption and the reduction of time on therapy were related to nadir CD4+ cell count. The patients who resumed HAART rapidly regained CD4+ cells and achieved viral suppression. Conclusion: If carefully monitored, treatment interruptions guided by CD4+ cell count in patients with an initially high CD4+ cell counts are clinically safe, decrease exposure to the drugs and do not reduce the efficacy of therapy when this is re-started.

Original languageEnglish
Pages (from-to)2381-2389
Number of pages9
JournalAIDS (London, England)
Volume18
Issue number18
Publication statusPublished - Dec 3 2004

Keywords

  • Chronic infection
  • Highly active antiretroviral therapy
  • HIV
  • Nadir CD4+ cell count
  • Treatment interruptions
  • Treatment strategy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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