Long-term consequences of treatment interruptions in chronically HIV-1-infected patients.
OBJECTIVE
To evaluate the long-term effects of antiretroviral treatment (ART) interruptions on metabolic, immunological, virological and clinical outcomes in chronically HIV-1 infected patients.


METHODS
Multi-centric, prospective, controlled 24-month cohort study in HIV-1 infected patients interrupting ART once or several times and for at least two weeks. Patients were compared to a frequency-matched control group continuing on ART.


RESULTS
A total of 399 HIV-1 infected patients were included, among them 133 patients with treatment interruption (TI) and 266 control patients. Baseline characteristics were well matched. Median baseline CD4 cell count was 379/microl in TI-patients and 410/microl in control patients (p = ns). Median duration of the first TI was 1.1 months, and 37 % of patients had two or further TI's. Whereas CD4 cell count in control patients had increased significantly by a median of 67/microl at month 24 (p<0.0001), median CD4 cell count at month 24 in the TI-patients did not differ significantly from baseline. However, two-year AIDS-free survival was not significantly different between TI- and control patients. Liver enzymes and blood lipids improved significantly during TI.


CONCLUSIONS
TI was associated with a significant immunological disadvantage at 24-month follow-up compared to continued ART. In this relatively immunocompetent cohort, however, TI's did not lead to an increased risk of disease progression within two years of follow-up.
Wolf
E
E
MUC Research, Munich, Germany. eva.wolf@mucresearch.de
Hoffmann
C
C
Procaccianti
M
M
Mosthaf
F
F
Gersbacher
E
E
Ulmer
A
A
Karwat
M
M
Brust
J
J
Schuster
D
D
Jaegel-Guedes
E
E
Jaeger
H
H
D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000378:metabolism; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002908:Chronic Disease; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D015497:HIV-1 / Q000472:pathogenicity*; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D019562:Viral Load; D028761:Withholding Treatment
D008055:Lipids; D000469:Alkaline Phosphatase