Incidence and risk factors of thrombocytopenia in patients receiving intermittent antiretroviral therapy: a substudy of the ANRS 106-window trial.
BACKGROUND
Incidence and risk factors for thrombocytopenia in patients discontinuing highly active antiretroviral therapy (HAART) have not been fully investigated.


METHODS
Well-suppressed patients on HAART were randomized to continuous (CT) or intermittent therapy (IT) for 96 weeks. Incidence of thrombocytopenia (<150 x 10(3) platelets/mm(3)) was assessed and multivariate analysis performed to identify baseline predictors. Correlations were assessed between platelet, CD4, CD8 T-cell counts, and viral load after treatment interruption.


RESULTS
Three hundred ninety-one patients were included, with a median baseline platelet count of 243,000/mm(3). The incidence of thrombocytopenia at week 96 was significantly higher in the IT versus the CT arm (25.4% versus 9.8%, respectively, P < 0.001) and median time to thrombocytopenia was 9 weeks. In multivariate analysis, the IT strategy: odds ratio (OR) = 4.1 (2.1-7.9; P < 0.0001), a history of thrombocytopenia: OR = 11.9 (2.4-57.9; P = 0.002), and a low baseline platelet count: OR = 3.4 (2.3-5.1; P < 0.0001) were associated with an increased risk of thrombocytopenia. Also, after treatment interruption, changes from baseline in platelet counts were correlated with changes in CD4 T-cell counts and plasma HIV RNA levels (P < 0.001 for both).


CONCLUSIONS
Intermittent therapy is associated with a high incidence of thrombocytopenia, especially among patients with low platelet counts and a history of thrombocytopenia.
Department of Infectious Diseases, Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris and University of Paris Diderot-Paris 7, France. marie-anne.bouldouyre@sls.aphp.fr
Marie-Anne
MA
Bouldouyre
Isabelle
I
Charreau
Bruno
B
Marchou
Philippe
P
Tangre
Christine
C
Katlama
Philippe
P
Morlat
Vincent
V
Meiffredy
Daniel
D
Vittecoq
Philippe
P
Bierling
Jean-Pierre
JP
Aboulker
Jean-Michel
JM
Molina
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D005602:France; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D015497:HIV-1; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D013921:Thrombocytopenia / Q000453:epidemiology* / Q000209:etiology; D016896:Treatment Outcome; D028761:Withholding Treatment
D019380:Anti-HIV Agents; D012367:RNA, Viral