It is safe to stop antiretroviral therapy in patients with preantiretroviral CD4 cell counts >250 cells/microL.
OBJECTIVE
To study clinical, immunologic, and virologic outcomes in patients who stop antiretroviral therapy (ART) with relatively preserved CD4 cell counts.


METHODS
Patients with a documented CD4 cell count >250 cells/microL who stopped ART for any reason for at least 5 weeks were studied. Relevant clinical and laboratory data were collected using a standardized data collection form.


METHODS
Patients were monitored for outcomes including Centers for Disease Control (CDC) category B or C events, time to restarting ART, and time to reaching a CD4 cell count of < or = 250 cells/microL.


RESULTS
A total of 107 patients were included. The median time on ART was 45 months and median number of antiretroviral medications was 4. The median pre-ART CD4 cell count and HIV viral load were 463 cells/microL and 4.35 log copies/mL, respectively. The median CD4 cell at time of ART stop was 739 cell/microL. The slope of the CD4 decrease was 65 cells/mo in the first 2 months, which was greater than the subsequent decline of 8 cells/mo thereafter (P < 0.01). Similarly the median viral load increase was 2.54 log copies/mL in the first 2 months after stopping and was unchanged after that point. Two patients experienced the retroviral rebound syndrome after ART cessation but no CDC category B or C events were observed during 10 months of follow-up. The median time from stopping ART to reaching the combined endpoint of CD4 <250 or restarting ART was 8.9 months. In multivariate analysis, pre-ART CD4 cell count >250 was protective of reaching the combined endpoint (odds ratio = 0.156, P = 0.03). Other predictors of reaching the combined endpoint in multivariate analysis were older age and number of prior ART agents. Patients who restarted ART had a favorable virologic and immunologic response.


CONCLUSIONS
Patients with relatively high CD4 cell counts prior to starting ART did well after stopping ART. Pre-ART CD4 cell count can be used to predict outcomes after ART cessation.
Skiest
Daniel J
DJ
University of Texas, Southwestern Medical Center, Dallas, TX 75390-9113, USA. skiest@utsouthwestern.edu
Morrow
Patrick
P
Allen
Brady
B
McKinsey
Judith
J
Crosby
Craig
C
Foster
Barbara
B
Hardy
R Doug
RD
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D004334:Drug Administration Schedule; D006678:HIV / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D015999:Multivariate Analysis; D018579:Patient Selection; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D012449:Safety; D019562:Viral Load
D019380:Anti-HIV Agents; D012367:RNA, Viral