Interruption and discontinuation of highly active antiretroviral therapy in the multicenter AIDS cohort study.
OBJECTIVE
Identify the determinants and consequences of interrupting and discontinuing highly active antiretroviral therapy (HAART) among a population-based cohort of HIV-infected men.


METHODS
Longitudinal analyses were applied to 2916 person-visit pairs (589 men) of continuous HAART use, 243 person-visit pairs (154 men) during which HAART was interrupted, and 151 person-visit pairs (130 men) in which HAART was discontinued by the second visit. HIV RNA increase was defined as > or =1 log10 copies/mL across the visit pairs.


RESULTS
: Younger age, black race, geographic location, higher HIV RNA level, depression, shorter time on HAART, lower medication adherence, and not taking a lamivudine-containing regimen predicted interrupting HAART use. Younger age, higher HIV RNA level, depression, and taking an abacavir- or lopinavir-containing regimen predicted discontinuing HAART. Among men with < or =1000 HIV RNA copies/mL, approximately 5% of those who interrupted HAART for < or =7 days and those who continued HAART had an HIV RNA increase. Men with longer interruptions and HAART discontinuers had significantly higher rates of HIV RNA increases (35.7% and 70.5%, respectively). Discontinuation and long interruptions resulted in lower CD4 cell counts.


CONCLUSIONS
Host characteristics play a role in short interruptions, whereas longer interruptions may be clinically indicated. These longer stoppages had further virologic and immunologic consequences, however.
Li
Xiuhong
X
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
Margolick
Joseph B
JB
Conover
Craig S
CS
Badri
Sheila
S
Riddler
Sharon A
SA
Witt
Mallory D
MD
Jacobson
Lisa P
LP
D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003863:Depression; D015224:Dideoxynucleosides / Q000627:therapeutic use; D005006:Ethnicity; D006678:HIV / Q000235:genetics / Q000254:growth & development; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D016015:Logistic Models; D061466:Lopinavir; D008297:Male; D008875:Middle Aged; D011744:Pyrimidinones / Q000627:therapeutic use; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D016312:Treatment Refusal; D000099227:Abacavir
D015224:Dideoxynucleosides; D061466:Lopinavir; D011744:Pyrimidinones; D012367:RNA, Viral; D000099227:Abacavir