Intermittent HIV Therapy Increases Risk of Death
Increased risk due to fewer CD4+ T cells, higher viral load
WEDNESDAY, Nov. 29 (HealthDay News) -- Intermittent rather than continuous antiretroviral therapy significantly increases the risk of opportunistic infections and death in HIV-infected individuals, largely due to fewer CD4+ T cells and higher viral load, researchers report in the Nov. 30 issue of the New England Journal of Medicine.
Wafaa M. El-Sadr, M.D., from Columbia University in New York City, and colleagues randomly assigned 5,472 patients with HIV and more than 350 CD4+ T cells per cubic millimeter to either continual antiretroviral therapy or episodic antiretroviral therapy. The episodic antiretroviral therapy group was only treated when their CD4+ T-cell count dropped below 250 per cubic millimeter and therapy was stopped when counts increased to more than 350 per cubic millimeter.
The researchers found that significantly more patients receiving episodic antiretroviral therapy developed opportunistic infections (3.3 events per 100 person-years versus 1.3 per 100 person-years, hazard ratio 2.6). Patients in this group also had a significantly higher risk of death from any cause (HR, 1.8) or from cardiovascular, renal or hepatic disease (HR, 1.7). Lower numbers of CD4+ T cells and higher HIV RNA levels were primarily responsible, the authors note.
Intermittent therapy "may be appropriate in certain circumstances," Judith S. Currier, M.D., and Lindsey R. Baden, M.D., from the University of California Los Angeles, comment in an accompanying editorial. "Given the deleterious effects of uncontrolled HIV replication, we must continue to reevaluate the optimal criteria for the initiation of antiretroviral therapy."