JAIDS Journal of Acquired Immune Deficiency Syndromes. 38(3):320-328, MARCH 1ST, 2005
PMID: 15735452
Issn Print: 1525-4135
Publication Date: March 1st, 2005
Interruption and Discontinuation of Highly Active Antiretroviral Therapy in the Multicenter AIDS Cohort Study
Xiuhong Li;Joseph Margolick;Craig Conover;Sheila Badri;Sharon Riddler;Mallory Witt;Lisa Jacobson;
+ Author Information
From the *Department of Epidemiology and †Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ‡Cook County Bureau Health Service, Infectious Diseases, John Stroger Hospital, Chicago, Illinois; §Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania; and ∥Division of HIV Medicine, University of California at Los Angeles School of Medicine, Los Angeles, California.
Abstract
Identify the determinants and consequences of interrupting and discontinuing highly active antiretroviral therapy (HAART) among a population-based cohort of HIV-infected men.Longitudinal analyses were applied to 2916 person-visit pairs (589 men) of continuous HAART use, 243 person-visit pairs (154 men) during which HAART was interrupted, and 151 person-visit pairs (130 men) in which HAART was discontinued by the second visit. HIV RNA increase was defined as ≥1 log10 copies/mL across the visit pairs.Younger age, black race, geographic location, higher HIV RNA level, depression, shorter time on HAART, lower medication adherence, and not taking a lamivudine-containing regimen predicted interrupting HAART use. Younger age, higher HIV RNA level, depression, and taking an abacavir- or lopinavir-containing regimen predicted discontinuing HAART. Among men with ≤1000 HIV RNA copies/mL, approximately 5% of those who interrupted HAART for ≤7 days and those who continued HAART had an HIV RNA increase. Men with longer interruptions and HAART discontinuers had significantly higher rates of HIV RNA increases (35.7% and 70.5%, respectively). Discontinuation and long interruptions resulted in lower CD4 cell counts.Host characteristics play a role in short interruptions, whereas longer interruptions may be clinically indicated. These longer stoppages had further virologic and immunologic consequences, however.
