October 16, 2008

Treatment Interruption After an Early Start Produced Steep CD4 Declines

Interrupting antiretroviral (ARV) treatment in people who started treatment in the first few weeks or months after HIV infection led to large and steep CD4 decreases, according to a study published online in the Journal of Acquired Immune Deficiency Syndromes.

For the last decade, scientists have been trying to determine whether starting ARV treatment very early after infection may preserve anti-HIV immune responses and lead to increased health and survival. Thus far, however, even though a substantial number of people with HIV have started treatment early, the results have not been consistently favorable.

To determine whether it may be safe to interrupt ARV treatment in people who started early, Remonie Seng, MD, from the Institut National de la Santé et de la Recherche Médicale (INSERM) in Le Kremlin-Bicêtre, France, and her colleagues analyzed the medical records of 170 HIV-positive patients who had started ARV therapy within weeks of infection, stayed on treatment for at least six months and then interrupted treatment for at least three months. The average CD4 count before starting treatment was 489, and the average CD4 count just before interrupting treatment was 769.

Dr. Seng’s team found that CD4 counts fell significantly after interrupting treatment. Initially, the decline was quite dramatic, dropping from nearly 800 before interruption to about 590 by the end of the first year off treatment. After three years off treatment, the average CD4 count was 416, a drop of nearly 400 CD4 cells. When Seng’s team compared the CD4 declines in their study to the natural declines in a similar group of patients who’d never started ARV treatment, they found that both groups ended up in roughly the same place after three years of HIV infection, but that the decline was much larger in the early treatment group, because their CD4 counts had initially increased by nearly 300 cells due to treatment.

Ultimately, the authors recommend that people who start treatment early, and had fairly low CD4 counts when they started, should not interrupt their ARV therapy.

Search: primary infection, early infection, treatment interruption, Remonie Seng, INSERM

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faramangin james, jimeta, 2008-10-17 08:09:41
I am in support of people on ARVs should not be interrupted. I am a living witness. Started ARV at 74 CD4 count IN 2002. But now am 1300 CD4. Early treatment is adviceable.