The Body Covers: The 39th Annual Meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy
Session 93.I: Late-Breaker Slide Session II
September 27, 1999
Abstract: Virologic and Immunologic Profiles of Newly Infected Individual Electing Discontinuation of HAART After Approximately Three Years of Apparently Suppressive Therapy (Paper LB-16)
This study, reported by Dr. Marty Markowitz of the Aaron Diamond Institute, looked at the disposition of 4 patients who were part of the recent seroconverter cohort, who self-selected by deciding to stop antiretroviral therapy after 3 years. Dr. Markowitz reviewed two studies that looked at early discontinuation, the COMET study, which discontinued drugs at day 28 and showed rapid rebound in 4 to 7 days and another study reported at the Vancouver AIDS Conference that also showed a rapid rise in viral load following treatment cessation after 39 to 542 days.
This study looked at 4 newly infected patients who completed 3 years of HAART with ZDV/3TC plus indinavir or ritonavir. Patients in the larger cohort started treatment 7 to 60 days post infection and had a viral load of 3.8 to 6.8 logs with an inverted CD4/CD8 ratio.
At discontinuation, the 4 patients studied had a normal CD4 count and a normal CD4/CD8 ratio. Detectable virus was found after 14 to 26 days, with the time to peak viremia at 25-193 days. Dr. Markowitz pointed out that this was a longer time to rebound than that described in previous studies, which he felt could be explained by this groups lower residual plasma viremia and lower number of HIV proliferating cells.
One patient had a rapid spike in viral load and elected to restart therapy. The other 3 patients have remained off treatment for 154 to 266 days as of this report. There have been variable responses of CD4 counts, with one patient increasing his count, one decreasing and one staying the same.
This study appears very consistent with the growing feeling at this meeting and others that we are far from a true eradication strategy, and that even after 3 years of suppression HIV is ready to spring out again rapidly. However, it is reassuring that the fear that people going off suppression will suddenly rebound to very high viral loads and become ill quickly remains unfounded.
Authored by: M. Markowitz, et al.
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