Magnitude and determinants of CD4 recovery after HAART resumption after 1 cycle of treatment interruption.
OBJECTIVE
The extent of immune reconstitution following HAART resumption after 1 cycle of treatment interruption (TI) is not well known.


METHODS
Multicenter retrospective analysis of patients who discontinued HAART with a CD4 > 500 cells/microL. Cox proportional hazards models were used to identify prognostic factors for immunologic response after treatment resumption. CD4 trends were investigated using linear mixed models.


RESULTS
One hundred and eighty-three individuals were included. Median CD4 at TI and at treatment restart were 748 and 459 cells/microL, respectively. Median time from TI to treatment restart was 5.52 months. Ninety percent of the patients reached an undetectable viral load. One hundred and twenty-five subjects experienced immunologic response; 66 patients reached their pre-TI CD4 levels. At 3, 6, 12, and 24 months after treatment restart, the median CD4 increase was 149, 153, 161, and 178 cells/microL, respectively. Subjects with less steep CD4 declines during TI tended to have a lower initial CD4 increase, as did those reinitiating HAART with viral loads < 5000 copies/mL, whereas subjects who had experienced a virologic response to their initial HAART regimen had slower CD4 increases.


CONCLUSIONS
Patients willing to discontinue treatment should be advised that immune reconstitution to pre-TI values is possible in fewer than 50% of patients at 2 years after treatment restart.
Mussini
Cristina
C
Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy. crimuss@unimo.it
Touloumi
Giota
G
Bakoyannis
Giorgos
G
Sabin
Caroline
C
Castagna
Antonella
A
Sighinolfi
Laura
L
Erikson
Lars E
LE
Bratt
Goran
G
Borghi
Vanni
V
Lazzarin
Adriano
A
Cossarizza
Andrea
A
Esposito
Roberto
R
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016312:Treatment Refusal
D019380:Anti-HIV Agents