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Treatment discontinuation in patients with marginal indications for HAART



Treatment discontinuation in patients with marginal indications for HAART



Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 41: 324-325



Background: Many patients on HAART would not have been started on therapy based on today's more conservative guidelines. We present short-term follow-up data on a group of patients in whom HAART was discontinued, some of whom had marginal indications for therapy by today's standards. Methods: Patients were referred by their clinicians at the time of DC and followed prospectively. All decisions about DC and reinitiation (RI) were made by the primary clinicians. CD4 count and viral load (VL) by RT-PCR were evaluated at baseline (pre-treatment), while on HAART, after DC, and prior to and following RI, if applicable. Results: HAART was DC'd in 39 patients without a history of OIs or CD4 count <200/mm3. Med. pre-treatment CD4 count was 430/mm3 with med. VL of 24,746 c/mL; 30 (77%) met prior DHHS criteria for HAART (CD4<500/mm3 or VL>20,000 c/mL); and 15 (38%) met 2001 criteria (CD4<350 mm3 or VL>55,000 c/ml). Med. CD4 at DC was 669/mm3 and VL was 376 c/mL (<50 c/mL in 13 (33%)). Of the 6 (15%) who have restarted therapy (Group 1, mean DC 16 wks), med. CD4 decline was 249/mm3 and med. VL increase was 190,195 c/mL. Med. CD4 count at RI was 255/mm3 and med. VL was 141,250 c/mL. Among the 33 (85%) who remain off therapy (Group 2, mean F/U 32 wks), med. CD4 is 492/mm3 with a med. decline of 174/mm3 following DC, and med. VL is 26,555 c/mL. 3 (50%) patients in Group 1 and 11 (33%) in Group 2 met current criteria for HAART at baseline. Resistance testing was performed at or within 3 wks of DC in 16/39 (41%); results will be presented. Conclusions: Many patients now being treated had marginal indications for therapy based on current guidelines and may be able to remain off therapy for a substantial period of time following DC. DC of therapy may lead to improved quality of life, decreased drug toxicity, and delayed resistance. Resistance testing performed at the time of DC or virologic rebound may help guide decisions about subsequent therapy.

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Accession: 035980130

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