Long-term follow-up of asymptomatic HIV-infected patients who discontinued antiretroviral therapy

Background. Whether asymptomatic human immunodeficiency virus ( HIV) - infected patients can interrupt treatment remains unknown. Methods. We performed a prospective, observational study of 46 patients who started therapy with 1300 CD4(+) cells/ mm(3) and/ or < 70,0000 HIV- 1 RNA copies/ mL. Patients had been receiving highly active antiretroviral therapy ( HAART) for at least 6 months. HAART was discontinued, and plasma HIV- 1 RNA loads and CD4(+) cell counts were determined at 4- month intervals. Results. At the time of HAART discontinuation, the median CD4(+) cell count was 793 cells/ mm(3), and all patients had undetectable viral loads. A rapid decrease of 173 cells/ mm3 in the median CD4+ cell count was observed during the first 4 months after HAART was stopped, followed by a slower decrease of 234 cells/ mm(3) between months 5 and 20. The decrease in the median CD4(+) cell count early after HAART discontinuation was inversely correlated with the increase that occurred during receipt of therapy () and with the count at the time r = 0.653 of HAART discontinuation (). The decrease in the median CD4(+) cell count after the fourth month r = 0.589 without HAART was correlated with the nadir count before HAART initiation () and the increase r = 0.349 during treatment (). The median follow- up duration was 20 months. After 12, 24, and 36 months of r = 0.322 observation, 33 patients ( 71.7%), 22 patients ( 47.8%), and 16 patients ( 34.7%), respectively, remained free of therapy. Adverse clinical events were not seen, and all patients who reinitiated HAART responded rapidly. Conclusion. Selected asymptomatic HIV- infected patients can safely discontinue therapy for prolonged periods of time.