PMID- 17195761
OWN - NLM
STAT- MEDLINE
DCOM- 20070710
LR  - 20200930
IS  - 1525-4135 (Print)
IS  - 1525-4135 (Linking)
VI  - 44
IP  - 4
DP  - 2007 Apr 1
TI  - Effects of active treatment discontinuation in patients with a CD4+ T-cell nadir 
      greater than 350 cells/mm3: 48-week Treatment Interruption in Early Starters 
      Netherlands Study (TRIESTAN).
PG  - 395-400
AB  - OBJECTIVE: To evaluate the safety and efficacy of discontinuing highly active 
      antiretroviral therapy (HAART) in HIV-1-positive patients who initiated HAART at 
      a CD4+ T-cell count >350 cells/mm. METHODS: Eligible patients were identified 
      from the Dutch AIDS Therapy Evaluation, The Netherlands (ATHENA) national 
      observational cohort. Interruption or continuation of HAART was offered to all. 
      RESULTS: Of 71 patients enrolled, 46 (64%) interrupted HAART (STOP group) and 25 
      (36%) continued HAART (control group). The median CD4+ T-cell nadirs at the start 
      of HAART were 469 (interquartile range [IQR]: 430-720) cells/mm3 and 510 (IQR: 
      440-637) cells/mm3, respectively. At week 48, the median plasma HIV RNA level in 
      the STOP group had stabilized at approximately pre-HAART values (4.55 log10, IQR: 
      4.2-4.9 copies/mL), but the CD4+ T-cell count still exceeded the pre-HAART count 
      (563 cells/mm3, IQR: 450-710 cells/mm3). Only 5 patients (11%) had reinitiated 
      HAART after 48 weeks, all for personal reasons. No Centers for Disease Control 
      and Prevention category events or death occurred after interruption. In 6 (13%) 
      of 46 patients, mild symptoms of acute retroviral rebound syndrome (ARVS) were 
      identified. No improvement was observed in mental or physical health scores. In 
      37% of patients, nonnucleoside reverse transcriptase inhibitor drug 
      concentrations were still detectable 1 week after stopping. CONCLUSIONS: Although 
      HAART can safely be interrupted in patients with a high CD4 T-cell nadir, no 
      improvement in quality of life was established. Patients can experience ARVS, the 
      risk for development of resistance after treatment interruption is realistic, and 
      there is a potential hazard of HIV transmission to sexual partners. We would not 
      actively advise stopping treatment in patients who started treatment too early 
      according to current guidelines.
FAU - Pogany, Katalin
AU  - Pogany K
AD  - Department of Internal Medicine, Academic Medical Center, Amsterdam, The 
      Netherlands.
FAU - van Valkengoed, Irene G M
AU  - van Valkengoed IG
FAU - Prins, Jan M
AU  - Prins JM
FAU - Nieuwkerk, Pythia T
AU  - Nieuwkerk PT
FAU - van der Ende, Ineke
AU  - van der Ende I
FAU - Kauffmann, Robbert H
AU  - Kauffmann RH
FAU - Kroon, Frank P
AU  - Kroon FP
FAU - Verbon, Annelies
AU  - Verbon A
FAU - Nievaard, Marianne F
AU  - Nievaard MF
FAU - Lange, Joep M A
AU  - Lange JM
FAU - Brinkman, Kees
AU  - Brinkman K
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - J Acquir Immune Defic Syndr
JT  - Journal of acquired immune deficiency syndromes (1999)
JID - 100892005
SB  - IM
EIN - J Acquir Immune Defic Syndr. 2007 Apr 15;44(5):607. Vanvalkengoed, Irene G 
      [corrected to van Valkengoed, Irene G M]
MH  - Adult
MH  - *Antiretroviral Therapy, Highly Active
MH  - CD4 Lymphocyte Count
MH  - CD4-Positive T-Lymphocytes/*drug effects/immunology/virology
MH  - Female
MH  - HIV Infections/blood/*drug therapy/immunology
MH  - HIV-1/*drug effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Netherlands
MH  - Prospective Studies
MH  - Time Factors
MH  - Treatment Outcome
MH  - Viral Load
MH  - Withholding Treatment
EDAT- 2007/01/02 09:00
MHDA- 2007/07/11 09:00
CRDT- 2007/01/02 09:00
PHST- 2007/01/02 09:00 [pubmed]
PHST- 2007/07/11 09:00 [medline]
PHST- 2007/01/02 09:00 [entrez]
AID - 10.1097/QAI.0b013e31802f83bc [doi]
PST - ppublish
SO  - J Acquir Immune Defic Syndr. 2007 Apr 1;44(4):395-400. doi: 
      10.1097/QAI.0b013e31802f83bc.