Trials That Matter: CD4+ T-Lymphocyte Count–Guided Interruption of Antiretroviral Therapy in HIV-Infected Patients
Authors: Jeffrey M. Jacobson, Barbara J. Turner, Elias Abrutyn
Journal: Annals of Internal Medicine (2007)

Editorials1 May 2007Trials That Matter: CD4+ T-Lymphocyte Count–Guided Interruption of Antiretroviral Therapy in HIV-Infected PatientsJeffrey M. Jacobson, MD, Barbara J. Turner, MD, and Elias Abrutyn, MDJeffrey M. Jacobson, MDFrom Drexel University College of Medicine, Philadelphia, PA 19102, and University of Pennsylvania School of Medicine, Philadelphia, PA 19104.Search for more papers by this author, Barbara J. Turner, MDFrom Drexel University College of Medicine, Philadelphia, PA 19102, and University of Pennsylvania School of Medicine, Philadelphia, PA 19104.Search for more papers by this author, and Elias Abrutyn, MDFrom Drexel University College of Medicine, Philadelphia, PA 19102, and University of Pennsylvania School of Medicine, Philadelphia, PA 19104.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-146-9-200705010-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Editor's Note:We are deeply sorry to report that Dr. Abrutyn died unexpectedly while preparing this editorial for publication. He was an associate editor of Annals for 29 years, which is just one of many accomplishments of a splendid life in medicine. An appreciation of his career appears elsewhere in this issue.Advances in antiretroviral chemotherapy have been remarkably successful in suppressing HIV replication, preventing or reversing much of the immunologic damage from HIV infection, reducing the incidence of clinical events and hospitalizations, and prolonging life (1). However, treatment is merely suppressive, not curative (2), and antiretroviral therapy is associated with ...References1. Hammer SM, Saag MS, Schechter M, Montaner JS, Schooley RT, Jacobsen DM, et al. Treatment for adult HIV infection: 2006 recommendations of the International AIDS Society—USA panel. Top HIV Med. 2006;14:827-43. [PMID: 17016878] MedlineGoogle Scholar2. Finzi D, Blankson J, Siliciano JD, Margolick JB, Chadwick K, Pierson T, et al. Latent infection of CD4+ T cells provides a mechanism for lifelong persistence of HIV-1, even in patients on effective combination therapy. Nat Med. 1999;5:512-7. [PMID: 10229227] CrossrefMedlineGoogle Scholar3. 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Virologic and immunologic consequences of discontinuing combination antiretroviral-drug therapy in HIV-infected patients with detectable viremia. N Engl J Med. 2001;344:472-80. [PMID: 11172188] CrossrefMedlineGoogle Scholar7. Lawrence J, Mayers DL, Hullsiek KH, Collins G, Abrams DI, Reisler RB, et al. Structured treatment interruption in patients with multidrug-resistant human immunodeficiency virus. N Engl J Med. 2003;349:837-46. [PMID: 12944569] CrossrefMedlineGoogle Scholar8. Ruiz L, Ribera E, Bonjoch A, Romeu J, Martinez-Picado J, Paredes R, et al. Role of structured treatment interruption before a 5-drug salvage antiretroviral regimen: the Retrogene Study. J Infect Dis. 2003;188:977-85. [PMID: 14513417] CrossrefMedlineGoogle Scholar9. Katlama C, Dominguez S, Gourlain K, Duvivier C, Delaugerre C, Legrand M, et al. Benefit of treatment interruption in HIV-infected patients with multiple therapeutic failures: a randomized, controlled trial (ANRS 097). AIDS. 2004;18:217-26. [PMID: 15075539] CrossrefMedlineGoogle Scholar10. Danel C, Moh R, Minga A, Anzian A, Ba-Gomis O, Kanga C, et al. CD4-guided structured antiretroviral treatment interruption strategy in HIV-infected adults in west Africa (Trivacan ANRS 1269 trial): a randomised trial. Lancet. 2006;367:1981-9. [PMID: 16782488] CrossrefMedlineGoogle Scholar11. Strategies for Management of Antiretroviral Therapy (SMART) Study Group. El-Sadr WM, Lundgren JD, Neaton JD, Gordin F, Abrams D, et al. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med. 2006;355:2283-96. [PMID: 17135583] CrossrefMedlineGoogle Scholar12. Ananworanich J, Gayet-Ageron A, Le Braz M, Prasithsirikul W, Chetchotisakd P, Kiertiburanakul S, et al. CD4-guided scheduled treatment interruptions compared with continuous therapy for patients infected with HIV-1: results of the Staccato randomised trial. Lancet. 2006;368:459-65. [PMID: 16890832] CrossrefMedlineGoogle Scholar13. DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Washington, DC: U.S. Department of Health and Human Services; 2006. Accessed at www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf on 19 February 2007. Google Scholar14. Sackoff JE, Hanna DB, Pfeiffer MR, Torian LV. Causes of death among persons with AIDS in the era of highly active antiretroviral therapy: New York City. Ann Intern Med. 2006;145:397-406. [PMID: 16983127] LinkGoogle Scholar15. Aberg JA. The changing face of HIV care: common things really are common [Editorial]. Ann Intern Med. 2006;145:463-5. [PMID: 16983135] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Drexel University College of Medicine, Philadelphia, PA 19102, and University of Pennsylvania School of Medicine, Philadelphia, PA 19104.Disclosures: Grants received: B. Turner (Pfizer).Corresponding Author: Jeffrey M. Jacobson, MD, Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, 245 North 15th Street, Mail Stop 461, Philadelphia, PA 19102; e-mail, jeffrey.[email protected]edu.Current Author Addresses: Dr. Jacobson: Drexel University College of Medicine, 245 North 15th Street, Mail Stop 461, Philadelphia, PA 19102.Dr. Turner: Division of General Internal Medicine, University of Pennsylvania School of Medicine, 1123 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021. 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