Virologic and immunologic values allowing safe deferral of antiretroviral therapy.
OBJECTIVE
To determine how long highly active antiretroviral therapy can be deferred in HIV-1 infected persons.


METHODS
Observational cohort study of HIV-1 infected men at four academic centers in the USA.


RESULTS
Progression to clinical AIDS or to CD4 cell counts < 200 x 10(6)/l in the absence of antiretroviral therapy among HIV-1 infected men.


RESULTS
No participant with a CD4 cell count between 201 x 10(6) and 350 x 10(6)/l and having < 20 000 copies/ml of HIV RNA progressed to clinical AIDS within 1 year. In men with > 350 x 10(6) CD4 cells/l and < 60 000 copies of HIV RNA/ml there were also no instances of progression to clinical AIDS within 1 year. No participant with < 10 000 copies HIV RNA/ml and between 201 x 10(6) and 350 x 10(6) CD4 cells/l had a decrease in CD4 cells to < 200 x 10(6)/l within 1 year. In men with baseline CD4 cell counts > 350 x 10(6)/l and HIV RNA < 30 000 copies/ml, only 3% had a decrease in CD4 cell count to < 200 x 10(6)/l within 1 year.


CONCLUSIONS
This analysis supports recommendations to defer therapy in HIV-1 infected individuals with CD4 cell counts > 350 x 10(6)/l and HIV RNA < 60 000 copies/ml and in persons with CD4 cell counts between 201 x 10(6) and 350 x 10(6)/l and < 20 000 copies/ml HIV RNA. Up to 79% of persons with > 350 x 10(6) CD4 cells/l and 29% with CD4 cell counts between 201 x 10(6) and 350 x 10(6)/l may, with close monitoring, safely defer therapy.
Phair
John P
JP
Division of Infectious Diseases, Department of Medicine, Northwestern University Medical School and the Howard Brown Health Center, 676 N. St. Clair, Suite 200, Chicago, IL 60611, USA.
Mellors
John W
JW
Detels
Roger
R
Margolick
Joseph B
JB
Muñoz
Alvaro
A
D000163:Acquired Immunodeficiency Syndrome / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003657:Decision Making; D018450:Disease Progression; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors