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7th Annual Conference Of The British HIV Association [BHIVA]27 – 29 April 2001, The Hove Centre, Brighton |
[AUTHOR(S):] M Poulton1, CA Sabin2, M Fisher1
1 Royal Sussex County Hospital, Brighton, and 2 Royal Free and University College Medical School, UK
BHIVA Conf 2001 Apr 27-29;7:O22
INTRODUCTION: Although the possible beneficial effects of HIV TIs remain unproven, many patients are stopping therapy. Studies have shown that there is a risk of significant falls in CD4 count when therapy is interrupted. Identification of risk factors for CD4 drops may inform treatment decisions.
METHODS: Patients who had interruptions of highly active antiretroviral therapy (HAART) lasting 2 months or more were identified. Data were collected on reason for stopping therapy, CD4 count and HIV RNA histories, drug therapy and clinical events.
RESULTS: Thirty-eight patients were identified. TI occurred a median of 2.7 (0.5–10.5) years after starting antiretroviral therapy and 1.5 (0.5–3.2) years after starting HAART. The duration of TI was a median of 289 (77–1036) days. Baseline TI RNA levels were undetectable in 18 (47%) patients. During TI there was a significant drop in CD4 count from 348 to 231 (P=0.0001) and CD4 percentage from 17.5 to 14% (P=0.0001) and a significant increase in viral load from 2.78 to 5.17 log (P=0.0001). Those with higher baseline CD4 counts (P=0.0001), but lower nadir CD4 counts (P=0.04) prior to the TI had the largest drops. For patients with sufficient data (n=24) the median rate of CD4 loss prior to HAART was 62.8 cells/µl per year. This was significantly correlated with the change in CD4 count over the TI (r=0.56, P=0.005). Twenty-nine patients had at least one clinical event during TI; in four this was an AIDS defining illness. No factors predicted the development of a clinical event.
CONCLUSIONS: Treatment interruptions are accompanied by significant CD4 cell loss and associated disease progression. Individuals with lower nadir CD4 counts and more rapid CD4 cell loss prior to HAART are more at risk and should be fully informed of the potential risks of TIs.
PRESENTING AUTHOR: M Poulton
010427
O22
Copyright © 2001, 2011 - British HIV Association (BHIVA) Reproduction of this abstract (other than one copy for personal reference) must be cleared through the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD