Retrospective Analysis of Suspending HAART in Selected Patients with Controlled HIV Replication

Jacobs, Benjamin; Neil, Nancy; Aboulafia, David M.
July 2005
AIDS Patient Care & STDs;Jul2005, Vol. 19 Issue 7, p429
Academic Journal
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.


Related Articles

  • CD4+ Count—Guided Interruption of Antiretroviral Treatment.  // New England Journal of Medicine;11/30/2006, Vol. 355 Issue 22, p2283 

    Background: Despite declines in morbidity and mortality with the use of combination antiretroviral therapy, its effectiveness is limited by adverse events, problems with adherence, and resistance of the human immunodeficiency virus (HIV). Methods: We randomly assigned persons infected with HIV...

  • Early but limited effects of raltegravir intensification on CD4 T cell reconstitution in HIV-infected patients with an immunodiscordant response to antiretroviral therapy. Negredo, Eugènia; Massanella, Marta; Puertas, Maria C.; Buzón, Maria J.; Puig, Jordi; Pérez-Alvárez, Núria; Pérez-Santiago, Josué; Bonjoch, Anna; Moltó, José; Jou, Antoni; Echeverría, Patricia; Llibre, Josep M.; Martínez-Picado, Javier; Clotet, Bonaventura; Blanco, Julià // Journal of Antimicrobial Chemotherapy (JAC);Oct2013, Vol. 68 Issue 10, p2358 

    Background Immune hyperactivation in immunodiscordant patients can induce residual HIV replication and limit CD4 T cell recovery. We assessed the impact of raltegravir intensification on CD4 T cell recovery and viral persistence. Methods We performed a randomized, controlled, pilot trial....

  • Stable partnership and progression to AIDS or death in HIV infected patients receiving highly active antiretroviral therapy: Swiss HIV cohort study. Young, Jim; Bucher, Heiner C.; Battegay, Manuel; De Geest, Sabina; Spirig, Rebecca; Flepp, Markus; Rickenbach, Martin; Furrer, Hansjakob; Bernasconi, Enos; Hirschel, Bernard; Telenti, Amalio; Vernazza, Pietro // BMJ: British Medical Journal (International Edition);1/3/2004, Vol. 328 Issue 7430, p15 

    Presents a paper on stable partnership and progression to AIDS or death in HIV infected patients receiving highly active antiretroviral therapy.

  • Structured Intermittent Therapy with Seven-Day Cycles of HAART for Chronic HIV Infection: A Pilot Study in São Paulo, Brazil. Casseb, Jorge; Da Silva Duarte, Alberto Jos // AIDS Patient Care & STDs;Jul2005, Vol. 19 Issue 7, p425 

    In the last 6 years, an impressive impact of the highly active antiretroviral therapy (HAART) on survival and morbidity in HIV-1–infected individuals has been attained. However, their prolonged use may induce metabolic adverse effects such as lipodistrophy, hypertension, diabetes...

  • HIV-associated cognitive impairment before and after the advent of combination therapy. Sacktor, Ned; McDermott, Michael P.; Marder, Karen; Schifitto, Giovanni; Selnes, Ola A.; McArthur, Justin C.; Stern, Yaakov; Albert, Steve; Palumbo, Donna; Kieburtz, Karl; De Marcaida, Joy A.; Cohen, Bruce; Epstein, Leon // Journal of NeuroVirology;Apr2002, Vol. 8 Issue 2, p136 

    The objective of this study was to describe the occurrence of HIV dementia and neuropsychological testing abnormalities in a new cohort of HIV-seropositive individuals at high risk for HIV dementia and to compare these results to a cohort before the advent of highly active antiretroviral therapy...

  • HAART-Persistent HIV-1 Latent Reservoirs: Their Origin, Mechanisms of Stability and Potential Strategies for Eradication. Kulkosky, Joseph; Bray, Stacie // Current HIV Research;Apr2006, Vol. 4 Issue 2, p199 

    HIV-1 infection persists despite long-term administration of highly active antiretroviral therapy (HAART). The mechanism of this persistence appears to result primarily from viral infection of CD4+ T-lymphocytes that have the ability to duplicate and revert into a quiescent state. These infected...

  • CD8+ Cell Noncytotoxic Antiviral Response in Long-Term HIV-1 Infected Former Blood Donors in China. Lin Yuan; Liying Ma; Xiujuan Fan; Yi Feng; Hong Peng; Quanbi Zhao; Yuhua Ruan; Levy, J. A.; Yiming Shao // Current HIV Research;Jul2009, Vol. 7 Issue 4, p437 

    Most of the HIV-infected long term survivors show strong CD8+ cell noncytotoxic antiviral response (CNAR) that plays as an important factor for maintaining the relative healthy state of infected individuals. HIV infected former blood donors (FBDs) in Anhui, China are the unique population that...

  • Antivirograma, sensible, rápido y fácil de interpretar por un método de bioluminiscencia para el VIH-1. Lara, H. H.; Ixtepan-Turrent, L.; Rivera-Silva, G.; González-Salazar, F.; Moreno-Treviño, G. // Revista Latinoamericana de Patología Clínica y Medicina de Lab;abr-jun2013, Vol. 60 Issue 2, p79 

    Objective: To demonstrate that our assay is sensitive capable to detect 10 HIV infected cells per well and that is feasible to quantify HIV-1 resistance in seropositive patients. Method: To compare 3 different phenotypic assays by quantifying their sensitivities, first we co-cultivated...

  • Maintaining Patients on a Failing Antiretroviral Regimen Reduces the Risk of AIDS-defining Events. Winslow, Dean L. // Infectious Disease Alert;Mar2009, Vol. 28 Issue 6, p28 

    For this study, 12,765 patients from the large French Hospital Database for HIV with CD4+ lymphocyte counts < 200 cells/uL who received cART during 2000-2005 were selected. Three groups of patients were identified: patients who interrupted cART at least once, patients with detectable HIV RNA...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics