Timed-cycle STI have not been proven to be safe in the short term. Although CD4-guided STI strategy has reported favorable outcomes in the short term, the long-term safety, efficacy and tolerability of this strategy has not been fully investigated. Based on the studies we reviewed, the evidence to support the use of timed-cycle STI and CD4-guided STI cycles as a standard of care in the management of chronic suppressed HIV infection is inconclusive.
Prolonged treatment interruption after immunologic response to highly active antiretroviral therapy.
Duration of treatment interruption (TI) was investigated in 105 human immunodeficiency virus-infected patients whose antiretroviral therapy was interrupted with the intention to resume therapy on the basis of clinical or laboratory indicators. In a mixed cohort study, 57% of patients had not resumed therapy at the time of writing (median TI duration, 114 weeks); the most recent analysis of this group revealed a mean CD4 cell count of 500 cells/mm3. Patients with lower CD4 cell counts at therapy initiation were more likely to resume therapy than were those with counts of >500 cells/mm3 (<200 cells/mm3 [relative hazard, 4.4]; and 200-350 cells/mm3 [relative hazard, 2.9]). Patients who met current United States Department of Health and Human Services criteria for starting therapy at the time of therapy initiation were 3 times more likely to resume therapy than were those who did not. Our results have implications for this TI strategy: there may be a subset of patients who can safely discontinue therapy for prolonged periods of time.