Treatment Interruptions Guided by CD4+ Cell Count Do Not Reduce the Efficacy of HAART in HIV Patients with Good Initial HAART Responses

The use of treatment interruptions in HIV positive patients continues to be studied and the results debated. Italian researchers report the results of treatment interruption guided by CD4 cell count in a group of 71 individuals.

The objective of this study was to evaluate the safety of treatment interruption guided by CD4+ cell count in HIV-infected patients followed up prospectively.

Patients on HAART with CD4+ cell counts > 500 x 10⁶ cells/l discontinued therapy with instructions to start therapy again before their CD4+ count dropped below 200 x 10⁶ cells/l. Any patients who resumed therapy would be eligible to interrupt treatment again once their CD4+ cell count increased above 500 x 10⁶ cells/l.

Results

Data on 71 HIV infected patients is reported. Their median nadir CD4+ cell count before antiretroviral treatment was 352 x 10⁶ cells/l. The median CD4+ cell count at the time of first interruption was 790 x 10⁶ cells/l. The median follow-up after starting the first treatment interruption was 28.3 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

The authors conclude, “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.”

01/05/05

Reference
A Boschi and others. CD4+ cell-count-guided treatment interruptions in chronic HIV-infected patients with good response to highly active antiretroviral therapy. AIDS 18(18): 2381-2389, December 3, 2004.