37. Safe Interruption of Maintenance Therapy (MT) against Prior Infection with 4 Common HIV-Associated Opportunistic Pathogens during Highly Active Antiretroviral Therapy

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Session 7 Oral Abstract Session
Opportunistic Infections and Complications of Antiretroviral Therapy
Session Time: Monday, 10 am - 12:30 pm
Room 6E

11:30 37.

Safe Interruption of Maintenance Therapy (MT) against Prior Infection with 4 Common HIV-Associated Opportunistic Pathogens during Highly Active Antiretroviral Therapy
O. Kirk¹, P. Reiss², C. Uberti-Foppa³, M. Bickel⁴, J. Gerstoft⁵, C. Pradier⁶, F. Wit², B. Ledergerber⁷, J. D. Lundgren¹, and H. Furrer⁸ for 7 European HIV cohorts.
¹EuroSIDA, Copenhagen, Denmark; ²ATHENA, Amsterdam, Netherlands; ³HSR, Milan, Italy; ⁴Frankfurt HIV cohort, Germany; ⁵Danish cohort, Copenhagen, Denmark; ⁶DMI-2, Nice, France; and ^7/8Swiss HIV cohort study, Zurich/Bern, Switzerland

Background: The safety of interrupting MT for cytomegalovirus end-organ disease (CMV), disseminated Mycobacterium avium complex infection (MAC), cerebral toxoplasmosi, and extrapulmonary cryptococcosis while receiving HAART is not well documented.
Methods: A joint analysis of patients interrupting MT while receiving HAART and having a CD4 count above 50 cells/mm³.
Results: A total of 358 patients interrupted at least 1 type of MT (162 for CMV, 103 for MAC, 75 for toxoplasmosis, and 39 for cryptococcosis). Median nadir CD4 counts were: 10 (interquartile range: 3-40) for CMV, 8 (3-19) for DMAC, 30 (10-64) for toxoplasmosis, and 12 (5-46) cells/mm³ for cryptococcosis. At interruption of MT, the CD4 counts were 231 (150-386), 190 (129-290), 320 (233-474), and 297 (180-392) cells/mm³, respectively. Median duration of follow-up after interruption of MT was 29 (19-37), 26 (15-36), 18 (9-27), and 20 (12-29) months. Within 781 person-years, 5 relapses were diagnosed. 2 relapses (CMV and MAC) were diagnosed after MT was interrupted at a CD4 count below or only shortly above 100 cells/mm³. 2 relapses (CMV and MAC) were diagnosed after MT was interrupted following CD4 counts above 100 cells/mm³ for 10 and 8 months, respectively, and 1 relapse (toxoplasmosis) was diagnosed after MT interruption at a CD4 count which had been above 200 cells/mm³ for 15 months. Overall incidences of recurrent CMV, MAC, toxoplasmosis, and cryptococcosis were: 0.54 (95%-confidence interval: 0.07-1.95), 0.90 (0.11-3.25), 0.84 (0.02-4.68), and 0.00 (0.00-5.27) per 100 person-years, respectively.
Conclusion: MT against prior infections with cytomegalovirus, Mycobacterium avium complex, Toxoplasma gondii, or Cryptococcus neoformans in HIV-patients can be interrupted after sustained CD4 count increases to above 200 cells/mm³, or possibly even 100-200, for at least 6 months after starting HAART. The negative effects of continuous MT well outweigh the low risk of relapse after interrupting MT.

Š2002 9^th Conference on Retroviruses and Opportunistic Infections