Treatment Interruption No Benefit to Multidrug Resistant
November 10, 2006
(Reuters Health) - No advantages in structured treatment interruption (STI) are seen in patients with multi-drug-resistant HIV, according to final results of a study of the CPCRA 064 study.
In the October 1st issue of the Journal of Acquired Immune Deficiency Syndromes, Dr. Jody Lawrence of the University of California, San Francisco and colleagues point out that it has been known for some time that treatment interruption often results in an abrupt decline in CD4 T cells. However, the long-term impact after re-initiating therapy has not been previously studied.
"We enrolled volunteers with highly resistant HIV who were experiencing antiretroviral treatment failure," Dr. Lawrence told Reuters Health. "Participants were randomized to undergo either a 4-month treatment interruption prior to switching therapy -- STI arm -- or an immediate switch in therapy."
There were 140 participants in the STI group and 134 controls. "Differences in CD4 count responses always favored the control arm," they write. This ranged from 84 cells at 4 months to 43 cells at 24 months.
Rates for the first progressive disease event were 14.3 per 1000 person-years in the control group versus 17.5 in the STI group.
"Our study," continued Dr. Lawrence, "is the first to show in a randomized trial that even a single treatment interruption in HIV disease can have a prolonged negative impact on CD4 T-cell response lasting well after antiretroviral treatment is reinitiated."
"This is relevant in clinical care," she concluded, "and may impact how outcomes in other STI strategy trials are viewed."
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