Garcia F, Plana M, Vidal C, Cruceta A, Tortajada C, Gil C, Niebla G, Soriano A, Palou E, Maleno MJ, Barcelo JJ, Gallart T, Miro JM, Pumarola T, Gatell JM; Conference on Retroviruses and Opportunistic Infections.
Program Abstr 6th Conf Retrovir Oppor Infect Conf Retrovir Oppor Infect 6th 1999 Chic Ill. 1999 Jan 31-Feb 4; 6th: 186 (abstract no. 629).
Gatell JM
To describe dynamics of viral load (VL) rebound and immune system changes in a cohort of 8 consecutive patients in very early stages who discontinued HAART after 1 year of therapy. In the setting of the Spanish EARTH-1 study, 30 HIV-1 infected patients with a CD4+ T cell counts > 500 x 10(6) cells /L and VL > 10000 copies/ml were randomized to receive one year of d4T + 3TC + Ritonavir. Eight out of 9 patients recruited in one of the sites had a plasma VL below 20 copies/ml at one year and decided to discontinue the antiretroviral therapy. Medical visits were scheduled at baseline and days 3, 7, 14, 21, 28 and monthly thereafter. The same antiretroviral therapy was initiated when plasma viral load became detectable. At baseline plasma viral load was below 20 copies/ml in all cases (below 5 copies/ml in 5 of 8 cases), CSF below 20 copies/ml in all the patients and tonsillar tissue viral load below 40 copies/mg of tissue in all 5 patients who had tonsils. A rebound in plasma viral load was detected in all cases from day 2 to day 27 with a mean +/- SD doubling time of 2.1 +/- 0.89 days. Three out of 8 patients achieved a peak viral load higher (> 0.5 log10) (all of the group of < 5 copies/ml) than baseline value before starting therapy. Mutations associated with resistance to d4T or 3TC were not detected. During the period of viral rebound (at 0 and 25 days) percentage of CD4+ and CD8+CD28+ lymphocytes decreased (from a mean +/- SD 45 +/- 14 to 36 +/- 7, p= 0.07, and from 54 +/- 13 to 39 +/- 12, p= 0.027, respectively) and percentage of CD8+CD38+increased (from a mean +/- SD 56 +/- 7 to 66 +/- 10, p= 0.05). SI index of PHA and CD3 (at 0 and 25 days) decreased from a mean +/- SD 33 +/- 31 to 15 +/- 21, p= 0.1 and from 25 +/- 22 to 8 +/- 13, p= 0.03, respectively in the five patients with a plasma viral load in day 0 of < 5 copies/ml. However, SI index of PHA and CD3 did not change in the patients with a plasma viral load at day 0 between 5 and 20 copies/ml. Viral load dropped below 20 copies/ml in all patients after one month of restarting the same antiretroviral regimen. Antiretroviral therapy can not be discontinued after one year of HAART even in early chronic HIV-1 disease and good response to treatment. In the patients with viral load below 5 copies/ml the sequence of immunologic and virologic events associated with an acute infection can be reproduced after interruption of treatment. The response to the same antiretroviral treatment is very quick.
Publication Types:
Keywords:
- Antigens, CD4
- Antiretroviral Therapy, Highly Active
- CD4-Positive T-Lymphocytes
- HIV-1
- Humans
- Lamivudine
- Ritonavir
- Stavudine
- Viral Load
- immunology
- organization & administration
Other ID:
UI: 102195394
From Meeting Abstracts