Predictors of sustained response to therapy resumption after treatment interruption in HIV-infected patients failing antiretroviral therapy.
In order to evaluate whether a sustained virologic response to therapy resumption after treatment interruption can be achieved in the setting of virologic failure, we reviewed retrospectively the data relating to 56 human immunodeficiency virus (HIV)-infected subjects selected from 3,145 patient charts. At the time of treatment interruption (study entry), the median (interquartile range) CD4+ counts and HIV-RNA levels were respectively 247 (127-502) x 10(6) cells/L and 4.24 (3.68-5.02) log(10) copies/ml, and the patients had been exposed to eight (5-9) antiretroviral drugs. After treatment interruption, the patients received at least three drugs depending on their treatment history. Forty-eight weeks after the resumption of therapy, 19 of the 56 patients (34%) had HIV-RNA levels of <400 copies/ml and, in comparison with study entry, the difference in the median increase in CD4+ counts between the virologic responders and non-responders (83 vs. 8.5 x 10(6) cells/L) was statistically significant (P = 0.02). Multivariate analysis showed that higher peak HIV-RNA levels before treatment interruption were independently predictive of virologic failure, whereas a longer treatment interruption period independently correlated with a virologic response. Four patients with CD4+ counts of <200 x 10(6) cells/L at study entry developed HIV-related clinical events. A sustained virologic response to therapy resumption after treatment interruption can be achieved in the setting of virologic failure. An evaluation of clinical history may help to identify the patients who are more likely to respond.
Gianotti
Nicola
N
Clinic of Infectious Diseases, Vita-Salute San Raffaele University, Milan, Italy. nicola.gianotti@hsr.it
Soria
Alessandro
A
Galli
Laura
L
Castagna
Antonella
A
Cernuschi
Massimo
M
Hasson
Hamid
H
Lazzarin
Adriano
A
D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D011237:Predictive Value of Tests; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D016879:Salvage Therapy; D017211:Treatment Failure; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors