Inferior Clinical Outcome of the CD4+ Cell Count–Guided Antiretroviral Treatment Interruption Strategy in the SMART Study: Role of CD4+ Cell Counts and HIV RNA Levels during Follow-up

• Published in: The Journal of infectious diseases Vol. 197; no. 8; pp. 1145 - 1155
• Main Authors: Lundgren, Jens D, Babiker, Abdel, El-Sadr, Wafaa, Emery, Sean, Grund, Birgit, Neaton, James D, Neuhaus, Jacquie, Phillips, Andrew N
• Format: Journal Article Web Resource
• Language: English
• Published: Chicago, IL The University of Chicago Press 15.04.2008; University of Chicago Press
• Subjects: AIDS; AIDS-Related Opportunistic Infections - epidemiology; AIDS-Related Opportunistic Infections - mortality; AIDS-Related Opportunistic Infections/epidemiology/mortality; Anti-HIV Agents - administration & dosage; Antiretrovirals; Art periods; Biological and medical sciences; CD4 Lymphocyte Count; Disease risk; Drug Administration Schedule; Fundamental and applied biological sciences. Psychology; Health outcomes; HIV; HIV - genetics; HIV - immunology; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - mortality; HIV Infections - virology; HIV Infections/drug therapy/immunology/mortality/virology; HIV/AIDS; HIV/genetics/immunology; Human health sciences; Humans; Immunologie & maladie infectieuse; Immunology & infectious disease; Infectious diseases; Medical sciences; Microbiology; Miscellaneous; Mortality; Opportunistic behavior; Proportional Hazards Models; RNA; RNA, Viral - blood; Sciences de la santé humaine; Treatment Outcome; Virology; Virus; Infection; Antiretroviral agent; Prognosis; Treatment; Microbiology; Retroviridae; Antiviral; Human immunodeficiency virus; Lentivirus
• ISSN: 0022-1899; 1537-6613; 1537-6613
• DOI: 10.1086/529523

Background and methodsThe SMART study compared 2 strategies for using antiretroviral therapy—drug conservation (DC) and viral suppression (VS)—in 5472 human immunodeficiency virus (HIV)–infected patients with CD4+ cell counts >350 cells/μL. Rates and predictors of opportunistic disease or death (OD/death) and the relative risk (RR) in DC versus VS groups according to the latest CD4+ cell count and HIV RNA level are reported ResultsDuring a mean of 16 months of follow-up, DC patients spent more time with a latest CD4+ cell count <350 cells/μL (for DC vs. VS, 31% vs. 8%) and with a latest HIV RNA level >400 copies/mL (71% vs. 28%) and had a higher rate of OD/death (3.4 vs. 1.3/100 person-years) than VS patients. For periods of follow-up with a CD4+ cell count <350 cells/μL, rates of OD/death were increased but similar in the 2 groups (5.7 vs. 4.6/100 person-years), whereas the rates were higher in DC versus VS patients (2.3 vs. 1.0/100 person-years; RR, 2.3 [95% confidence interval, 1.5–3.4]) for periods with the latest CD4+ cell count ⩾350 cells/μL—an increase explained by the higher HIV RNA levels in the DC group ConclusionsThe higher risk of OD/death in DC patients was associated with (1) spending more follow-up time with relative immunodeficiency and (2) living longer with uncontrolled HIV replication even at higher CD4+ cell counts. Ongoing HIV replication at a given CD4+ cell count places patients at an excess risk of OD/death Trial registrationClinicalTrials.gov identifier: NCT00027352