[procaare] Should treatment breaks be guided by CD4?

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Should treatment breaks be guided by CD4?
-[Healthlink],(15.10.03).
**************

Should treatment breaks be guided by CD4? Study suggests yes!

According to research presented as a poster to the Seventh ICAAC in Chicago on September
15th, individuals may be able to interrupt HAART (Highly Active Anti retroviral therapy)
if they have a high nadir CD4 cell count, lost CD4 cells slowly before starting anti-HIV
therapy, and have maintained an undetectable viral load for at least a year whilst taking
HAART.

Data presented at the 43rd Interscience Conference on Antimicrobial Agents and
Chemotherapy (ICAAC) suggested that patients whose nadir CD4 cell count was above 350
cells/mm3 and had achieved an undetectable viral load for at least a year whilst
sustaining a CD4 cell count of over 800 cells/mm3, could safely interrupt HAART for a
prolonged period.

Investigators conducted a multi-centre, observational, retrospective study involving 140
patients from several treatment centres in Italy, Sweden and the UK. To be included in the
analysis, a patient must have taken HAART for at least twelve months, have a nadir CD4
cell count above 250 cells/mm3, a pre-treatment interruption CD4 cell count of at least
500 cells/mm3, and to have taken a break from HIV therapy for at least four weeks.

HAART was restarted if a patient's CD4 cell count fell below 350 cells/mm3 or if they
expressed a wish to recommence treatment.  Median CD4 cell count when the study patients
initially started HAART was 410 cells/mm3, and median viral load was 26,000 copies/mL.

The study participants had been infected with HIV for an average of three and a half
years.  At the point of treatment interruption, median CD4 cell count was 804 cells/mm3
and median viral load was 50 copies/mL.

 As of April 1st 2003, 53% of patients were still off-therapy, 24.3% had experienced a
drop in their CD4 cell count to below 350 cells/mm3 and 22% had restarted HAART. The
median duration of the treatment interruption at this point was 104 weeks.

Investigators established that independent predictors of having to restart therapy were
lowest ever CD4 cell count, duration of an undetectable HIV viral load whilst on HAART,
the rate with which CD4 cell count declined before HAART was initially started, and HIV
viral load immediately before the treatment break was commenced.

An individual can interrupt HAART for a long-time, the investigators conclude, if their
CD4 cell count never dropped below 350 cells/mm3 prior to first commencing anti-HIV
therapy, HAART achieved a viral load below 50 copies/mL for at least twelve months, their
CD4 cell count fell slowly before HAART was initiated, and during the treatment break HIV
viral load only rebounds to low levels.

Michael Carter.

Reference: Mussini C et al. CD4-guided treatment interruptions: a new therapeutic
strategy. 43rd ICAAC, abstract H-856, Chicago 14 -17th September, 2003.

(Source:AIDSMAP, 16 September 2003)
Web: http://www.aidsmap.com/news/newsdisplay2.asp?newsId=2288

HealthLink Bulletin 15/10/2003
Web: http://www.hst.org.za

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