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Open Access Research article

Long-term outcome of patients after a single interruption of antiretroviral therapy: a cohort study

Carmen Machado1*, María José Ríos-Villegas12, Juan Gálvez-Acebal12, Angel Domínguez-Castellano12, Felipe Fernández-Cuenca1, Virginia Palomo1, Miguel Angel Muniain12 and Jesús Rodríguez-Baño12

Author Affiliations

1 Infectious Diseases Unit, Hospital Universitario Virgen Macarena. Seville, Avda Dr Fedriani 3, Seville, 41009, Spain

2 Departament of Medicine, University of Seville, Seville, Spain

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BMC Research Notes 2012, 5:578  doi:10.1186/1756-0500-5-578

Published: 24 October 2012

Abstract

Background

To describe the long term outcome of patients who interrupted highly active antiretroviral therapy (HAART) once, identify the variables associated with earlier need to re-start HAART, and the response when therapy was resumed. A retrospective observational cohort of 66 adult patients with HIV-1 infection who interrupted HAART with a CD4+cell count ≥350 cells/μL and undetectable viral load (VL) was performed. The pre-established CD4+ cell count for restarting therapy was 300cells/μL. Cox regression was used to analyse the variables associated with earlier HAART reinitiation.

Results

The median follow-up was 209 weeks (range, 64–395). Rates of HIV-related or possible HIV-related events were 0.37 (one case of acute retroviral syndrome) and 1.49 per 100 patient-years, respectively. Two patients died after re-starting therapy and having reached undetectable VL. Three patients suffered a sexually transmitted disease while off therapy. Fifty patients (76%) resumed therapy after a median of 97 weeks (range, 17–267). Age, a nadir of CD4+ <250 cells/μL, and a mean VL during interruption of >10,000 copies/ml were independent predictors for earlier re-start. The intention-to-treat success rate of the first HAART resumed regimen was 85.4%. There were no differences by regimen used, nor between regimens that were the same as or different from the one that had been interrupted.

Conclusions

Our data suggest highly active antiretroviral therapy may be interrupted in selected patients because in these patients, when the HAART is restarted, the viral and clinical response may be achieved.

Keywords:
HIV-1; Antiretroviral therapy; Treatment interruption; Outcome; Cohort study