Long-term outcome of patients after a single interruption of antiretroviral therapy: a cohort study

Abstract

BackgroundTo describe the long term outcome of patients who interrupted highly active antiretroviral therapy (HAART) once, identify the variables associated with earlier need to re-start HAART, and the response when therapy was resumed. A retrospective observational cohort of 66 adult patients with HIV-1 infection who interrupted HAART with a CD4+cell count ≥350 cells/μL and undetectable viral load (VL) was performed. The pre-established CD4+ cell count for restarting therapy was 300cells/μL. Cox regression was used to analyse the variables associated with earlier HAART reinitiation.ResultsThe median follow-up was 209 weeks (range, 64–395). Rates of HIV-related or possible HIV-related events were 0.37 (one case of acute retroviral syndrome) and 1.49 per 100 patient-years, respectively. Two patients died after re-starting therapy and having reached undetectable VL. Three patients suffered a sexually transmitted disease while off therapy. Fifty patients (76%) resumed therapy after a median of 97 weeks (range, 17–267). Age, a nadir of CD4+ <250 cells/μL, and a mean VL during interruption of >10,000 copies/ml were independent predictors for earlier re-start. The intention-to-treat success rate of the first HAART resumed regimen was 85.4%. There were no differences by regimen used, nor between regimens that were the same as or different from the one that had been interrupted.ConclusionsOur data suggest highly active antiretroviral therapy may be interrupted in selected patients because in these patients, when the HAART is restarted, the viral and clinical response may be achieved.

Predictors of unstructured antiretroviral treatment interruption and resumption among HIV‐positive individuals in Canada

“…Thus, certain predictors of TI were the opposite of predictors of resumption, with women and those with higher CD4 cell counts more likely to interrupt and men and those with lower CD4 cell counts more likely to resume cART. Other studies have found similar rates of resumption [5,41,49]. While the probability of restarting cART is relatively high, it is important to note that 15% of individuals never reinitiated treatment while under observation.…”