AEGiS-9CROI: Safe Interruption of Maintenance Therapy (MT) against Prior Infection with 4 Common HIV-Associated Opportunistic Pathogens during Highly Active Antiretroviral Therapy.

9th Conference on Retroviruses and Opportunistic Infections

Seattle, Washington - February 24 -February 28, 2002

Safe Interruption of Maintenance Therapy (MT) against Prior Infection with 4 Common HIV-Associated Opportunistic Pathogens during Highly Active Antiretroviral Therapy.

Conf Retroviruses Opportunistic Infect 2002 Feb 24-28;9:abstract no. 37
Kirk O, Reiss P, Uberti-Foppa C, Bickel M, Gerstoft J, Pradier C, Wit F, Ledergerber B, Lundgren JD, Furrer H, 7 European HIV cohorts; EuroSIDA, Copenhagen, Denmark

BACKGROUND: The safety of interrupting MT for cytomegalovirus end-organ disease (CMV), disseminated Mycobacterium avium complex infection (MAC), cerebral toxoplasmosi, and extrapulmonary cryptococcosis while receiving HAART is not well documented.

METHODS: A joint analysis of patients interrupting MT while receiving HAART and having a CD4 count above 50 cells/mm³.

RESULTS: A total of 358 patients interrupted at least 1 type of MT (162 for CMV, 103 for MAC, 75 for toxoplasmosis, and 39 for cryptococcosis). Median nadir CD4 counts were: 10 (interquartile range: 3-40) for CMV, 8 (3-19) for DMAC, 30 (10-64) for toxoplasmosis, and 12 (5-46) cells/mm³ for cryptococcosis. At interruption of MT, the CD4 counts were 231 (150-386), 190 (129-290), 320 (233-474), and 297 (180-392) cells/mm³, respectively. Median duration of follow-up after interruption of MT was 29 (19-37), 26 (15-36), 18 (9-27), and 20 (12-29) months. Within 781 person-years, 5 relapses were diagnosed. 2 relapses (CMV and MAC) were diagnosed after MT was interrupted at a CD4 count below or only shortly above 100 cells/mm³. 2 relapses (CMV and MAC) were diagnosed after MT was interrupted following CD4 counts above 100 cells/mm³ for 10 and 8 months, respectively, and 1 relapse (toxoplasmosis) was diagnosed after MT interruption at a CD4 count which had been above 200 cells/mm³ for 15 months. Overall incidences of recurrent CMV, MAC, toxoplasmosis, and cryptococcosis were: 0.54 (95%-confidence interval: 0.07-1.95), 0.90 (0.11-3.25), 0.84 (0.02-4.68), and 0.00 (0.00-5.27) per 100 person-years, respectively.

CONCLUSION: MT against prior infections with cytomegalovirus, Mycobacterium avium complex, Toxoplasma gondii, or Cryptococcus neoformans in HIV-patients can be interrupted after sustained CD4 count increases to above 200 cells/mm³, or possibly even 100-200, for at least 6 months after starting HAART. The negative effects of continuous MT well outweigh the low risk of relapse after interrupting MT.

Keywords: Antiretroviral Therapy, Highly Active, HIV Infections, CD4 Lymphocyte Count, Mycobacterium avium Complex, Cytomegalovirus Infections, Cryptococcosis, Incidence, Cytomegalovirus, Toxoplasmosis, Cerebral, HIV Seropositivity, Drug Therapy, Combination, Toxoplasmosis, Human, therapy, drug therapy

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Copyright © 2002 - Foundation for Retrovirology and Human Health. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Foundation for Retrovirology and Human Health. Licensed (AIDSLINE) from National Library of Medicine.