[Interruption of antiretroviral therapy in chronically HIV-infected patients].
OBJECTIVE
To describe the immunological, virological and clinical outcomes of HIV-infected patients who stop antiretroviral therapy (ART) and to identify the factors related to durability.


METHODS
Retrospective study of patients who interrupt therapy after six months without clinical events, level of CD4+ > or = 500 cells/microl and HIV RNA > or = 5,000 copies/ml (3.7 log10).


RESULTS
In October 2004, 44 patients were included, 32 (72%) of them were stables after one year of ART cessation (group A) and 12 (28%) patients had to restart therapy due to a decreased CD4+ count < 300 cells/microl (group B). Both groups were compared. CD4 cell count nadir (414 cells/microl [199] versus 171 cells/microl [107]; p = 0.000) and CD4+ count level at time of ART stop (920 [302] cells/microl versus 633 cells/microl [177] p = 0.004) showed differences with statistical significance. The most important CD4+ count fall was observed at third month after stopping ART; 588 cells/microl (288) on group A and 382 cells/microl (167) on group B. The mean time without ART was 27 months on group A and 7 months on group B. Two patients had acute retroviral syndrome, and one had Pneumocystis jiroveci pneumonia. Cholesterol levels were 199 mg/dl (42) and triglycerides 257 mg/dl (271) on ART and during interruption decreased to 155 (38) and 165 (122) mg/dl respectively. After multivariate analysis, a CD4+ count nadir > 200 cells/microl (p = 0,0005; OR = 0,12; 95% CI, 0.036-0,398) and a CD4+ count at time of ART stop > 800 cells/microl (p = 0,04; OR: 0,11; CI 95%: 0,015-0,936) were independently related to durability of therapy interruption.


CONCLUSIONS
Prolonged discontinuation of ART guided by CD4+ response causes a low morbi-mortality. The cell count CD4+ nadir and the CD4+ count at time of ART cessation are protective factors of durability. An improvement of metabolic parameters is observed during the discontinuation of ART.
Amador
Concepción
C
Unidad VIH, Servicio de Medicina Interna, Hospital Marina Baixa, Villajoyosa, Alicante, Spain. c.amador@coma.es
Pasquau
Francisco
F
Ena
Javier
J
Benito
Concepción
C
Ruiz de Apodaca
Rosa F
RF
D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015704:CD4 Antigens / Q000187:drug effects / Q000276:immunology; D002452:Cell Count; D002908:Chronic Disease; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D006801:Humans; D008297:Male; D012367:RNA, Viral / Q000187:drug effects / Q000276:immunology; D012189:Retrospective Studies; D012192:Retroviridae Infections / Q000453:epidemiology / Q000276:immunology; D028761:Withholding Treatment / Q000706:statistics & numerical data*
D044966:Anti-Retroviral Agents; D015704:CD4 Antigens; D012367:RNA, Viral