title: Does less frequent routine monitoring of patients on a stable, fully suppressed cART regimen lead to an increased risk of treatment failure?
abstract: OBJECTIVE
  To investigate whether HIV-infected patients on a stable and fully suppressive combination antiretroviral therapy (cART) regimen could safely be monitored less often than the current recommendations of every 3 months.
  
  
  METHODS
  Two thousand two hundred and forty patients from the EuroSIDA study who maintained a stable and fully suppressed cART regimen for 1 year were included in the analysis.
  
  
  METHODS
  Risk of treatment failure, defined by viral rebound, fall in CD4 cell count, development of new AIDS-defining illness, serious opportunistic infection or death, in the 12 months following a year of a stable and fully suppressed regimen was assessed.
  
  
  RESULTS
  One hundred thirty-one (6%) patients experienced treatment failure in the 12 months following a year of stable therapy, viral rebound occurred in 99 (4.6%) patients. After 3, 6 and 12 months, patients had a 0.3% [95% confidence interval (CI) 0.1-0.5], 2.2% (95% CI 1.6-2.8) and 6.0% (95% CI 5.0-7.0) risk of treatment failure, respectively. Patients who spent more than 80% of their time on cART with fully suppressed viraemia prior to baseline had a 38% reduced risk of treatment failure, hazard ratio 0.62 (95% CI 0.42-0.90, P = 0.01).
  
  
  CONCLUSIONS
  Patients who have responded well to cART and are on a well tolerated and durably fully suppressive cART regimen have a low chance of experiencing treatment failure in the next 3-6 months. Therefore, in this subgroup of otherwise healthy patients, it maybe reasonable to extend visit intervals to 6 months, with cost and time savings to both the treating clinics and the patients.
authors.affiliation: HIV Epidemiology & Biostatistics Group, Research Department of Infection & Population Health, Royal Free and University College Medical School, London, UK. j.reekie@pcps.ucl.ac.uk
authors.forename: Joanne
authors.initials: J
authors.lastname: Reekie
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Helen
authors.initials: H
authors.lastname: Sambatakou
authors.forename: Ladislav
authors.initials: L
authors.lastname: Machala
authors.forename: Antonio
authors.initials: A
authors.lastname: Chiesi
authors.forename: Jan
authors.initials: J
authors.lastname: van Lunzen
authors.forename: Nathan
authors.initials: N
authors.lastname: Clumeck
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
authors.forename: Brian
authors.initials: B
authors.lastname: Gazzard
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000191:economics / Q000821:virology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000821:virology; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D017211:Treatment Failure; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents