Journal Article

Long-Term Follow-Up of Asymptomatic HIV-Infected Patients Who Discontinued Antiretroviral Therapy

Manuel L. Fernández Guerrero, Pablo Rivas, Mercedes Molina, Rosa Garcia and Miguel De Górgolas

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 41, issue 3, pages 390-394
Published in print August 2005 | ISSN: 1058-4838
Published online August 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/431487
Long-Term Follow-Up of Asymptomatic HIV-Infected Patients Who Discontinued Antiretroviral Therapy

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Background. Whether asymptomatic human immunodeficiency virus (HIV)–infected patients can interrupt treatment remains unknown.

Methods. We performed a prospective, observational study of 46 patients who started therapy with >300 CD4+ cells/mm3 and/or <70,0000 HIV-1 RNA copies/mL. Patients had been receiving highly active antiretroviral therapy (HAART) for at least 6 months. HAART was discontinued, and plasma HIV-1 RNA loads and CD4+ cell counts were determined at 4-month intervals.

Results. At the time of HAART discontinuation, the median CD4+ cell count was 793 cells/mm3, and all patients had undetectable viral loads. A rapid decrease of 173 cells/mm3 in the median CD4+ cell count was observed during the first 4 months after HAART was stopped, followed by a slower decrease of 234 cells/mm3 between months 5 and 20. The decrease in the median CD4+ cell count early after HAART discontinuation was inversely correlated with the increase that occurred during receipt of therapy (r = -0.653) and with the count at the time of HAART discontinuation (r = -0.589). The decrease in the median CD4+ cell count after the fourth month without HAART was correlated with the nadir count before HAART initiation (r = -0.349) and the increase during treatment (r = -0.322). The median follow-up duration was 20 months. After 12, 24, and 36 months of observation, 33 patients (71.7%), 22 patients (47.8%), and 16 patients (34.7%), respectively, remained free of therapy. Adverse clinical events were not seen, and all patients who reinitiated HAART responded rapidly.

Conclusion. Selected asymptomatic HIV-infected patients can safely discontinue therapy for prolonged periods of time.

Journal Article.  3185 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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