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Interruption of combination antiretroviral therapy and risk of clinical disease progression to AIDS or death.
HIV Med. 2007 Mar; 8(2):96-104.HM

Abstract

OBJECTIVES

The aim of the study was to compare incidence rates (IRs) of AIDS/death in patients with and without treatment interruption (TI) of combination antiretroviral therapy (cART) for periods of 3 months or more for different categories of CD4 cell count and viral load, and to determine risk factors for clinical progression to AIDS/death.

METHODS

Patients starting cART with a CD4 cell count and a viral load available within 6 months of starting cART were included in the study. The IR and risk factors of TI were determined. We assessed the incidence rate ratios (IRRs) for TI and AIDS/death events using Poisson regression models.

RESULTS

Of 3811 patients included in the study, 26% were ART-naïve prior to cART. The median date of starting cART was July 1997, the median CD4 cell count was 226 cells/microL and the median viral load was 4.36 log(10) HIV-1 RNA copies/mL. We observed 1243 interruptions and 403 AIDS-events/deaths. The IR of AIDS/death was higher in patients with lower CD4 cell counts or higher viral loads, regardless of TI. After adjusting for baseline factors, the IR of AIDS/death was significantly higher in the TI group than in the non-TI group [IRR 2.63; 95% confidence interval (CI) 2.01-3.44; P<0.0001]; this could be explained by current CD4 cell counts and viral loads, as the CD4 cell count- and viral load-adjusted IRR was 1.14 (95% CI 0.86-1.51; P=0.37). Within the TI group, patients with a current CD4 cell count of <200 cells/microL had a 3-fold higher risk of AIDS/death than those with a CD4 cell count of 200-350 cells/microL, whereas patients with a current CD4 cell count of >350 cells/microL had a 4-fold lower risk of disease progression.

CONCLUSIONS

TI is common in clinical practice. The risk of AIDS/death increased more than 2-fold for patients stopping all cART regimen drugs for 3 months or more. Among patients experiencing a TI, those with low CD4 cell counts, high viral loads or prior AIDS had an increased risk of AIDS/death. Hence, TI should be discouraged and closely monitored if it occurs.

Authors+Show Affiliations

Copenhagen HIV Programme, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark. cho@cphiv.dkNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

17352766

Citation

Holkmann Olsen, C, et al. "Interruption of Combination Antiretroviral Therapy and Risk of Clinical Disease Progression to AIDS or Death." HIV Medicine, vol. 8, no. 2, 2007, pp. 96-104.
Holkmann Olsen C, Mocroft A, Kirk O, et al. Interruption of combination antiretroviral therapy and risk of clinical disease progression to AIDS or death. HIV Med. 2007;8(2):96-104.
Holkmann Olsen, C., Mocroft, A., Kirk, O., Vella, S., Blaxhult, A., Clumeck, N., Fisher, M., Katlama, C., Phillips, A. N., & Lundgren, J. D. (2007). Interruption of combination antiretroviral therapy and risk of clinical disease progression to AIDS or death. HIV Medicine, 8(2), 96-104.
Holkmann Olsen C, et al. Interruption of Combination Antiretroviral Therapy and Risk of Clinical Disease Progression to AIDS or Death. HIV Med. 2007;8(2):96-104. PubMed PMID: 17352766.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interruption of combination antiretroviral therapy and risk of clinical disease progression to AIDS or death. AU - Holkmann Olsen,C, AU - Mocroft,A, AU - Kirk,O, AU - Vella,S, AU - Blaxhult,A, AU - Clumeck,N, AU - Fisher,M, AU - Katlama,C, AU - Phillips,A N, AU - Lundgren,J D, AU - ,, PY - 2007/3/14/pubmed PY - 2007/11/9/medline PY - 2007/3/14/entrez SP - 96 EP - 104 JF - HIV medicine JO - HIV Med VL - 8 IS - 2 N2 - OBJECTIVES: The aim of the study was to compare incidence rates (IRs) of AIDS/death in patients with and without treatment interruption (TI) of combination antiretroviral therapy (cART) for periods of 3 months or more for different categories of CD4 cell count and viral load, and to determine risk factors for clinical progression to AIDS/death. METHODS: Patients starting cART with a CD4 cell count and a viral load available within 6 months of starting cART were included in the study. The IR and risk factors of TI were determined. We assessed the incidence rate ratios (IRRs) for TI and AIDS/death events using Poisson regression models. RESULTS: Of 3811 patients included in the study, 26% were ART-naïve prior to cART. The median date of starting cART was July 1997, the median CD4 cell count was 226 cells/microL and the median viral load was 4.36 log(10) HIV-1 RNA copies/mL. We observed 1243 interruptions and 403 AIDS-events/deaths. The IR of AIDS/death was higher in patients with lower CD4 cell counts or higher viral loads, regardless of TI. After adjusting for baseline factors, the IR of AIDS/death was significantly higher in the TI group than in the non-TI group [IRR 2.63; 95% confidence interval (CI) 2.01-3.44; P<0.0001]; this could be explained by current CD4 cell counts and viral loads, as the CD4 cell count- and viral load-adjusted IRR was 1.14 (95% CI 0.86-1.51; P=0.37). Within the TI group, patients with a current CD4 cell count of <200 cells/microL had a 3-fold higher risk of AIDS/death than those with a CD4 cell count of 200-350 cells/microL, whereas patients with a current CD4 cell count of >350 cells/microL had a 4-fold lower risk of disease progression. CONCLUSIONS: TI is common in clinical practice. The risk of AIDS/death increased more than 2-fold for patients stopping all cART regimen drugs for 3 months or more. Among patients experiencing a TI, those with low CD4 cell counts, high viral loads or prior AIDS had an increased risk of AIDS/death. Hence, TI should be discouraged and closely monitored if it occurs. SN - 1464-2662 UR - https://www.unboundmedicine.com/medline/citation/17352766/Interruption_of_combination_antiretroviral_therapy_and_risk_of_clinical_disease_progression_to_AIDS_or_death_ L2 - https://doi.org/10.1111/j.1468-1293.2007.00436.x DB - PRIME DP - Unbound Medicine ER -