Interruption of antiretroviral therapy in chronically HIV-infected patients

• Published in: Medicina clínica Vol. 125; no. 2; p. 41
• Main Authors: Amador, Concepción, Pasquau, Francisco, Ena, Javier, Benito, Concepción, Ruiz de Apodaca, Rosa F
• Format: Journal Article
• Language: Spanish
• Published: Spain 11.06.2005
• Subjects: Adult; Anti-Retroviral Agents - adverse effects; Anti-Retroviral Agents - therapeutic use; CD4 Antigens - drug effects; CD4 Antigens - immunology; Cell Count; Chronic Disease; Female; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - immunology; HIV Infections - virology; Humans; Male; Retrospective Studies; Retroviridae Infections - epidemiology; Retroviridae Infections - immunology; RNA, Viral - drug effects; RNA, Viral - immunology; Withholding Treatment - statistics & numerical data
• DOI: 10.1157/13076461
• ISSN: 0025-7753

To describe the immunological, virological and clinical outcomes of HIV-infected patients who stop antiretroviral therapy (ART) and to identify the factors related to durability. Retrospective study of patients who interrupt therapy after six months without clinical events, level of CD4+ > or = 500 cells/microl and HIV RNA > or = 5,000 copies/ml (3.7 log10). In October 2004, 44 patients were included, 32 (72%) of them were stables after one year of ART cessation (group A) and 12 (28%) patients had to restart therapy due to a decreased CD4+ count < 300 cells/microl (group B). Both groups were compared. CD4 cell count nadir (414 cells/microl [199] versus 171 cells/microl [107]; p = 0.000) and CD4+ count level at time of ART stop (920 [302] cells/microl versus 633 cells/microl [177] p = 0.004) showed differences with statistical significance. The most important CD4+ count fall was observed at third month after stopping ART; 588 cells/microl (288) on group A and 382 cells/microl (167) on group B. The mean time without ART was 27 months on group A and 7 months on group B. Two patients had acute retroviral syndrome, and one had Pneumocystis jiroveci pneumonia. Cholesterol levels were 199 mg/dl (42) and triglycerides 257 mg/dl (271) on ART and during interruption decreased to 155 (38) and 165 (122) mg/dl respectively. After multivariate analysis, a CD4+ count nadir > 200 cells/microl (p = 0,0005; OR = 0,12; 95% CI, 0.036-0,398) and a CD4+ count at time of ART stop > 800 cells/microl (p = 0,04; OR: 0,11; CI 95%: 0,015-0,936) were independently related to durability of therapy interruption. Prolonged discontinuation of ART guided by CD4+ response causes a low morbi-mortality. The cell count CD4+ nadir and the CD4+ count at time of ART cessation are protective factors of durability. An improvement of metabolic parameters is observed during the discontinuation of ART.