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.
BACKGROUND: Whether asymptomatic human immunodeficiency virus (HIV)-infectedpatients 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-infectedpatients can safely discontinue therapy for prolonged periods of time.
Authors: Ellen Van Gulck; Leo Heyndrickx; Lotte Bracke; Sandra Coppens; Eric Florence; Anne Buvé; Paul Lewi; Guido Vanham Journal: AIDS Res Ther Date: 2011-02-11 Impact factor: 2.250
Authors: Ellen Van Gulck; Lotte Bracke; Leo Heyndrickx; Sandra Coppens; Derek Atkinson; Céline Merlin; Alexander Pasternak; Eric Florence; Guido Vanham Journal: PLoS One Date: 2012-05-30 Impact factor: 3.240
Authors: Anne Cori; Helen Ayles; Nulda Beyers; Ab Schaap; Sian Floyd; Kalpana Sabapathy; Jeffrey W Eaton; Katharina Hauck; Peter Smith; Sam Griffith; Ayana Moore; Deborah Donnell; Sten H Vermund; Sarah Fidler; Richard Hayes; Christophe Fraser Journal: PLoS One Date: 2014-01-15 Impact factor: 3.240
Authors: Eva Malatinkova; Ward De Spiegelaere; Pawel Bonczkowski; Maja Kiselinova; Karen Vervisch; Wim Trypsteen; Margaret Johnson; Chris Verhofstede; Danny de Looze; Charles Murray; Sabine Kinloch-de Loes; Linos Vandekerckhove Journal: Elife Date: 2015-10-06 Impact factor: 8.140