Document Detail


Retrospective analysis of suspending HAART in selected patients with controlled HIV replication.
MedLine Citation:
PMID:  16053400     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We sought to determine the consequences of stopping highly active antiretroviral therapy (HAART) in a group of 41 HIV-infected individuals with undetectable HIV viral loads and CD4+ counts greater than 500 cells per microliter for 6 months or more. Clinical and laboratory parameters were monitored, as was the time to HAART reinitiation. Three months after HAART interruption, the median CD4+ count declined by 162 cells per microliter and HIV viral load increased by 24,000 copies per milliliter. Over the next year, CD4+ counts continued to decrease by an average of 11 cells per microliter per 3-month intervals. In contrast, HIV viral loads remained stable over the same period. Five of 7 patients (71%) with elevated cholesterol levels and 6 of 13 patients (46%) with elevated triglyceride levels had these values normalize after stopping HAART. After a median of 21 months follow-up, 26 of 41 patients (63%) have restarted HAART. Patients with Centers for Disease Control (CDC) HIV/AIDS C classification were more likely to restart HAART than those with A or B classification (p = 0.008). Reasons for HAART restart included clinical events in 8 patients. Fifteen patients restarted HAART for immunologic reasons: CD4+ count less than 300 cells per microliter (n = 7); HIV viral load greater than 55,000 copies per milliliter (n = 3); or both (n = 5). Three patients restarted HAART because of personal preference. Within 4 months, all 26 patients who restarted HAART achieved HIV viral loads less than 50 copies per milliliter. Although patients were able to rapidly achieve nondetectable HIV viral loads after restarting HAART, the inability to foresee clinical events among 8 patients (20%) is disconcerting. We advise caution before HAART interruption, particularly for those patients with a preceding history of significant HIV-related complications.
Authors:
Benjamin Jacobs; Nancy Neil; David M Aboulafia
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  AIDS patient care and STDs     Volume:  19     ISSN:  1087-2914     ISO Abbreviation:  AIDS Patient Care STDS     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-08-01     Completed Date:  2005-09-01     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9607225     Medline TA:  AIDS Patient Care STDS     Country:  United States    
Other Details:
Languages:  eng     Pagination:  429-38     Citation Subset:  X    
Affiliation:
University of Washington College of Arts and Sciences, Seattle, Washington, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Antiretroviral Therapy, Highly Active / methods*
CD4 Lymphocyte Count
Cohort Studies
Drug Administration Schedule
Female
HIV Infections / diagnosis*,  drug therapy*
Humans
Male
Middle Aged
Prognosis
Retrospective Studies
Risk Assessment
Severity of Illness Index
Survival Rate
Treatment Outcome
Viral Load*

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


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