Machado Carmen, Ríos-Villegas María José, Gálvez-Acebal Juan, Domínguez-Castellano Angel, Fernández-Cuenca Felipe, Palomo Virginia, Muniain Miguel Angel, Rodríguez-Baño Jesús
Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Seville, Avda Dr Fedriani 3, Seville, 41009, Spain.
BMC Res Notes. 2012 Oct 24;5:578. doi: 10.1186/1756-0500-5-578.
To describe the long term outcome of patients who interrupted highly active antiretroviral therapy (HAART) once, identify the variables associated with earlier need to re-start HAART, and the response when therapy was resumed. A retrospective observational cohort of 66 adult patients with HIV-1 infection who interrupted HAART with a CD4+cell count ≥ 350 cells/μL and undetectable viral load (VL) was performed. The pre-established CD4+ cell count for restarting therapy was 300cells/μL. Cox regression was used to analyse the variables associated with earlier HAART reinitiation.
The median follow-up was 209 weeks (range, 64-395). Rates of HIV-related or possible HIV-related events were 0.37 (one case of acute retroviral syndrome) and 1.49 per 100 patient-years, respectively. Two patients died after re-starting therapy and having reached undetectable VL. Three patients suffered a sexually transmitted disease while off therapy. Fifty patients (76%) resumed therapy after a median of 97 weeks (range, 17-267). Age, a nadir of CD4+ <250 cells/μL, and a mean VL during interruption of >10,000 copies/ml were independent predictors for earlier re-start. The intention-to-treat success rate of the first HAART resumed regimen was 85.4%. There were no differences by regimen used, nor between regimens that were the same as or different from the one that had been interrupted.
Our data suggest highly active antiretroviral therapy may be interrupted in selected patients because in these patients, when the HAART is restarted, the viral and clinical response may be achieved.
描述曾中断过一次高效抗逆转录病毒治疗（HAART）的患者的长期预后，确定与更早需要重新开始HAART相关的变量，以及恢复治疗后的反应。对66例CD4+细胞计数≥350个细胞/μL且病毒载量（VL）不可检测的HIV-1感染成年患者进行了一项回顾性观察队列研究。重新开始治疗的预先设定的CD4+细胞计数为300个细胞/μL。采用Cox回归分析与更早重新开始HAART相关的变量。
中位随访时间为209周（范围64 - 395周）。HIV相关或可能与HIV相关事件的发生率分别为每100患者年0.37（1例急性逆转录病毒综合征）和1.49。两名患者在重新开始治疗并达到不可检测的VL后死亡。三名患者在停止治疗期间感染了性传播疾病。50例患者（76%）在中位97周（范围17 - 267周）后恢复治疗。年龄、CD4+最低点＜250个细胞/μL以及中断期间平均VL＞10,000拷贝/ml是更早重新开始治疗的独立预测因素。首次恢复的HAART方案的意向性治疗成功率为85.4%。所用方案之间以及与中断方案相同或不同的方案之间均无差异。
我们的数据表明，在特定患者中可以中断高效抗逆转录病毒治疗，因为在这些患者中，当重新开始HAART时，可能实现病毒学和临床反应。
