Sixth International Congress Drug Therapy in HIV Infection 17-21 November, 2002 Glasgow, UK

Background: Treatment interruption (TI) in HIV-1 infected patients with virologic failure may lead to a shift from a drug-resistant to a wild-type predominant viral population in plasma. However, long-term response to re-initiation of therapy has not been reported. The objective of this study was to assess if a long-term virologic response could be achieved in this setting.

We analyzed data from 56 patients, selected from 3145 patients’ charts recorded in our database, who interrupted HAART in the presence of detectable viral load, and resumed HAART after a minimum of two months of TI. Patients with plasma HIV-RNA < 400 copies/ml at week 48 after treatment resumption were defined as responder.

At treatment interruption mean (SD) CD4 cell counts and plasma viral load (pVL) were 363 (346) cells/µl and 5.16 (0.68) log₁₀ copies/ml respectively. Patients had been exposed to 7 (2) drugs before TI. After 150 (113) days of TI, patients resumed 3.2 (0.4) drugs. At week 48, 19 patients (34%) were responders and 37 (66%) were non-responders. At week 48, responders had a significant increase in CD4 cells compared with TI (111 cells/µl, P = 0.02). pVL at TI, nadir CD4 cell counts and peak pVL prior to TI, as well as having had at least one undetectable pVL prior to TI, were associated with virologic response. Days of treatment before TI, duration of TI, number of drugs used before TI, reason for discontinuation, as well as number and classes of drugs included in the new regimen were not associated with virologic response. At multivariate analysis (calculated using rank values), peak pVL prior to TI (P = 0.004) and duration of TI (P = 0.05) were independently associated with virologic response. Four HIV-related events were recorded through one year of observation after TI. All events occurred among patients with less than 200 CD4/µl at TI.

Treatment interruption in the setting of virologic failure may be safe and useful in HIV-1 infected patients with CD4 cell counts >200 cells/µl, especially in those with a history of lower peaks of pVL and longer TI.

Presenting author: Nicola Gianotti

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1 Clinic of Infectious Diseases, San Raffaele Scientific Institute, via Stamira d’Ancona, 20-20127, Milan, Italy.

2002-11-17
PL6-3

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