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• W1593196040 abstract "Antiretroviral therapy (ART) use has led to a decline in morbidity and mortality in HIV-infected patients but adverse events, adherence problems and resistance development continue to occur. High costs are also an issue, especially in low- and middle-income countries. Hence ART discontinuation is still of interest, in spite of the disappointing results of the SMART, DART and TRIVACAN studies [1-3]. Indeed, an earlier study from Switzerland found that treatment interruptions could be a safe option for people who started ART with high CD4 cell counts [4], and in everyday clinical practice it is not uncommon to encounter HIV-infected patients who wish to take time off their antiretrovirals. In 2007 we reported preliminary results of a prospective observational study in a group of 46 HIV-infected patients who had interrupted treatment while having CD4 counts >500 cells/μL and undetectable HIV RNA for at least 3 years, and had been followed for a mean period of 18 months [5]. Here we report findings in the same cohort after a median follow-up period of 59 months. All 46 patients, who were enrolled in the Outpatient Clinic of the Infectious Diseases Unit, G. B. Rossi University Hospital, Verona between April 2004 and February 2006, had been informed that treatment interruption was not a therapeutic strategy recommended by guidelines. Nevertheless, they gave written informed consent to a treatment interruption in an attempt to try to reduce drug toxicity and improve their quality of life. Seventy-six similar patients preferred to continue their therapeutic regimens. The criteria for restarting therapy were: patient's choice at any CD4 cell count, pregnancy, HIV-related systemic symptoms (acute retroviral syndrome), any opportunistic infections or CD4 count <200 cells/μL. In February 2010, after a median follow-up time of 59 months (range 48–72 months), seven patients were still on a treatment interruption and reported good general health and an improvement in quality of life. All these seven patients continued to have CD4 counts >400 cells/μL. The reasons for restarting ART in the remaining 39 patients were: pregnancy (one patient), liver cancer superimposed on alcohol and hepatitis C virus-related cirrhosis (one patient), herpetic encephalitis (one patient), peripheral neuropathy (one patient), individual choice (two patients), acute retroviral syndrome (four patients), severe reduction in blood platelets (three patients) and a decrease in CD4 count to <200 cells/μL (26 patients). These 26 patients resumed the same therapy as was received before the interruption and all achieved complete viral suppression within 10 weeks and a good immunological response [median CD4 count 621 cells/μL (range 432–1127 cells/μL) after a median of 30 months since restarting treatment]. No patients presented with cardiovascular diseases, opportunistic infections or cancers during the follow-up period. Importantly, the metabolic pattern improved during treatment interruption: all 16 patients with high levels of cholesterol experienced a reduction to normal values (from a median of 5.9 to 4.4 mmol/L), as did all eight patients with hypertriglyceridaemia (from a median of 5.0 to 2.2 mmol/L). The only factor predictive of a poor outcome during treatment interruption in our series was a low CD4 cell count before starting ART. Indeed, the median period of interruption was longer in patients with a CD4 nadir >200 cells/μL. Our results, although obtained in a small number of individuals, indicate that treatment interruption can be a feasible and safe option for patients who started ART with reasonably high CD4 cell counts. A cut-off of 200 cells/μL appears to be appropriate for patients who so wish to interrupt treatment." @default.
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• W1593196040 date "2010-12-23" @default.
• W1593196040 modified "2023-09-23" @default.
• W1593196040 title "Can antiretroviral therapy be safely interrupted and, if so, when?" @default.
• W1593196040 cites W1497170016 @default.
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• W1593196040 doi "https://doi.org/10.1111/j.1468-1293.2010.00853.x" @default.
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