Document Detail


It is safe to stop antiretroviral therapy in patients with preantiretroviral CD4 cell counts >250 cells/microL.
MedLine Citation:
PMID:  15483464     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To study clinical, immunologic, and virologic outcomes in patients who stop antiretroviral therapy (ART) with relatively preserved CD4 cell counts. DESIGN AND METHODS: Patients with a documented CD4 cell count >250 cells/microL who stopped ART for any reason for at least 5 weeks were studied. Relevant clinical and laboratory data were collected using a standardized data collection form. MAIN OUTCOME MEASURES: Patients were monitored for outcomes including Centers for Disease Control (CDC) category B or C events, time to restarting ART, and time to reaching a CD4 cell count of < or = 250 cells/microL. RESULTS: A total of 107 patients were included. The median time on ART was 45 months and median number of antiretroviral medications was 4. The median pre-ART CD4 cell count and HIV viral load were 463 cells/microL and 4.35 log copies/mL, respectively. The median CD4 cell at time of ART stop was 739 cell/microL. The slope of the CD4 decrease was 65 cells/mo in the first 2 months, which was greater than the subsequent decline of 8 cells/mo thereafter (P < 0.01). Similarly the median viral load increase was 2.54 log copies/mL in the first 2 months after stopping and was unchanged after that point. Two patients experienced the retroviral rebound syndrome after ART cessation but no CDC category B or C events were observed during 10 months of follow-up. The median time from stopping ART to reaching the combined endpoint of CD4 <250 or restarting ART was 8.9 months. In multivariate analysis, pre-ART CD4 cell count >250 was protective of reaching the combined endpoint (odds ratio = 0.156, P = 0.03). Other predictors of reaching the combined endpoint in multivariate analysis were older age and number of prior ART agents. Patients who restarted ART had a favorable virologic and immunologic response. CONCLUSIONS: Patients with relatively high CD4 cell counts prior to starting ART did well after stopping ART. Pre-ART CD4 cell count can be used to predict outcomes after ART cessation.
Authors:
Daniel J Skiest; Patrick Morrow; Brady Allen; Judith McKinsey; Craig Crosby; Barbara Foster; R Doug Hardy
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  37     ISSN:  1525-4135     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-10-14     Completed Date:  2005-10-26     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1351-7     Citation Subset:  IM; X    
Affiliation:
University of Texas, Southwestern Medical Center, Dallas, TX 75390-9113, USA. skiest@utsouthwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Anti-HIV Agents / administration & dosage,  therapeutic use*
CD4 Lymphocyte Count*
Drug Administration Schedule
HIV / genetics,  isolation & purification*
Humans
Multivariate Analysis
Patient Selection
RNA, Viral / blood
Retrospective Studies
Safety
Viral Load*
Grant Support
ID/Acronym/Agency:
U01 AI046376/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Anti-HIV Agents; 0/RNA, Viral

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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