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JAC Advance Access originally published online on December 30, 2005
Journal of Antimicrobial Chemotherapy 2006 57(3):520-526; doi:10.1093/jac/dki472
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Safety and factors predicting the duration of first and second treatment interruptions guided by CD4+ cell counts in patients with chronic HIV infection

Andrea Boschi1,*, Carmine Tinelli2, Patrizia Ortolani1 and Massimo Arlotti1

1 Division of Infectious Diseases, AUSL Rimini, Via Settembrini 2, 47900 Rimini, Italy; 2 Clinical Epidemiology and Biometry Unit—IRCCS San Matteo, Pavia, Italy

Received 21 October 2005; returned 16 November 2005; revised 30 November 2005; accepted 2 December 2005

* Corresponding author. Tel: +390541705500; Fax: +390541705431; E-mail: boschia{at}libero.it

Objectives: To evaluate the safety of treatment interruption (TI) guided by CD4+ count in HIV-infected patients followed-up prospectively.

Methods: Patients on HAART with a CD4+ cell count >500 cells/mm3 discontinued therapy with instructions to start therapy again before their CD4+ count dropped below 200 cells/mm3.

Results: We report data on 112 HIV-infected patients. The median follow-up after starting the first TI was 34.7 months (IQR: 23.1–43.8). The median duration of the first TI was 12 months (IQR: 5.2–25). In the multivariate analysis the factor which most strongly correlated with the duration of the first TI was the CD4+ cell count at the end of the TI. Among the 34 patients who had completed a second TI, the duration of the two periods of interruption was similar if the treatment was recommenced at the end of the first TI at a CD4+ count higher than the nadir count.

Conclusions: The strategy of TI is safe if the criteria for restarting therapy are applied correctly. The factor with the greatest influence on the duration of the first TI is the number of CD4+ cells at the end of the TI.

Keywords: nadir CD4+ cell count , highly active antiretroviral therapy , immunological set-point


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