Magnitude and determinants of CD4 recovery after haart resumption after 1 cycle of treatment interruption

Cristina Mussini, Giota Touloumi, Giorgos Bakoyannis, Caroline Sabin, Antonella Castagna, Laura Sighinolfi, Lars E. Erikson, Goran Bratt, Vanni Borghi, Adriano Lazzarin, Andrea Cossarizza, Roberto Esposito

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

OBJECTIVE: The extent of immune reconstitution following HAART resumption after 1 cycle of treatment interruption (TI) is not well known. METHODS: Multicenter retrospective analysis of patients who discontinued HAART with a CD4 > 500 cells/μL. Cox proportional hazards models were used to identify prognostic factors for immunologic response after treatment resumption. CD4 trends were investigated using linear mixed models. RESULTS: One hundred and eighty-three individuals were included. Median CD4 at TI and at treatment restart were 748 and 459 cells/μL, respectively. Median time from TI to treatment restart was 5.52 months. Ninety percent of the patients reached an undetectable viral load. One hundred and twenty-five subjects experienced immunologic response; 66 patients reached their pre-TI CD4 levels. At 3, 6, 12, and 24 months after treatment restart, the median CD4 increase was 149, 153, 161, and 178 cells/μL, respectively. Subjects with less steep CD4 declines during TI tended to have a lower initial CD4 increase, as did those reinitiating HAART with viral loads <5000 copies/mL, whereas subjects who had experienced a virologic response to their initial HAART regimen had slower CD4 increases. CONCLUSIONS: Patients willing to discontinue treatment should be advised that immune reconstitution to pre-TI values is possible in fewer than 50% of patients at 2 years after treatment restart.

Original languageEnglish (US)
Pages (from-to)588-594
Number of pages7
JournalJournal of Acquired Immune Deficiency Syndromes
Volume52
Issue number5
DOIs
StatePublished - Dec 1 2009
Externally publishedYes

Fingerprint

Highly Active Antiretroviral Therapy
Therapeutics
Viral Load
Proportional Hazards Models
Linear Models

Keywords

  • HAART resumption
  • HIV infection
  • Immunological response
  • Prognostic factors
  • Treatment interruption
  • Virologic response

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Magnitude and determinants of CD4 recovery after haart resumption after 1 cycle of treatment interruption. / Mussini, Cristina; Touloumi, Giota; Bakoyannis, Giorgos; Sabin, Caroline; Castagna, Antonella; Sighinolfi, Laura; Erikson, Lars E.; Bratt, Goran; Borghi, Vanni; Lazzarin, Adriano; Cossarizza, Andrea; Esposito, Roberto.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 52, No. 5, 01.12.2009, p. 588-594.

Research output: Contribution to journalArticle

Mussini, C, Touloumi, G, Bakoyannis, G, Sabin, C, Castagna, A, Sighinolfi, L, Erikson, LE, Bratt, G, Borghi, V, Lazzarin, A, Cossarizza, A & Esposito, R 2009, 'Magnitude and determinants of CD4 recovery after haart resumption after 1 cycle of treatment interruption', Journal of Acquired Immune Deficiency Syndromes, vol. 52, no. 5, pp. 588-594. https://doi.org/10.1097/QAI.0b013e3181b9e94d
Mussini, Cristina ; Touloumi, Giota ; Bakoyannis, Giorgos ; Sabin, Caroline ; Castagna, Antonella ; Sighinolfi, Laura ; Erikson, Lars E. ; Bratt, Goran ; Borghi, Vanni ; Lazzarin, Adriano ; Cossarizza, Andrea ; Esposito, Roberto. / Magnitude and determinants of CD4 recovery after haart resumption after 1 cycle of treatment interruption. In: Journal of Acquired Immune Deficiency Syndromes. 2009 ; Vol. 52, No. 5. pp. 588-594.
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AU - Bakoyannis, Giorgos

AU - Sabin, Caroline

AU - Castagna, Antonella

AU - Sighinolfi, Laura

AU - Erikson, Lars E.

AU - Bratt, Goran

AU - Borghi, Vanni

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AU - Cossarizza, Andrea

AU - Esposito, Roberto

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N2 - OBJECTIVE: The extent of immune reconstitution following HAART resumption after 1 cycle of treatment interruption (TI) is not well known. METHODS: Multicenter retrospective analysis of patients who discontinued HAART with a CD4 > 500 cells/μL. Cox proportional hazards models were used to identify prognostic factors for immunologic response after treatment resumption. CD4 trends were investigated using linear mixed models. RESULTS: One hundred and eighty-three individuals were included. Median CD4 at TI and at treatment restart were 748 and 459 cells/μL, respectively. Median time from TI to treatment restart was 5.52 months. Ninety percent of the patients reached an undetectable viral load. One hundred and twenty-five subjects experienced immunologic response; 66 patients reached their pre-TI CD4 levels. At 3, 6, 12, and 24 months after treatment restart, the median CD4 increase was 149, 153, 161, and 178 cells/μL, respectively. Subjects with less steep CD4 declines during TI tended to have a lower initial CD4 increase, as did those reinitiating HAART with viral loads <5000 copies/mL, whereas subjects who had experienced a virologic response to their initial HAART regimen had slower CD4 increases. CONCLUSIONS: Patients willing to discontinue treatment should be advised that immune reconstitution to pre-TI values is possible in fewer than 50% of patients at 2 years after treatment restart.

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