Discontinuation of potent antiretroviral therapy: Predictive value of and impact on CD4 cell counts and HIV RNA levels

Linda Ahdieh Grant, Michael J. Silverberg, Herminia Palacio, Howard Minkoff, Kathryn Anastos, Mary A. Young, Marek Nowicki, Andrea Kovacs, Mardge Cohen, Alvaro Munoz

Research output: Contribution to journalArticle

Abstract

Objective To characterize predictors and consequences of discontinuing antiretroviral therapy (ART) in terms of CD4 cell count, HIV RNA, and reported side-effects in a large cohort of HIV-infected women. Design Cohort study. Methods A total of 1058 HIV-infected women initiated potent ART before September 1999. For each 6 month period after October 1996 we determined the proportion of potent ART users who downshifted to non-potent ART and who discontinued all ART. We examined the role of CD4 cell count and HIV RNA with regard to ART discontinuation. Results Between October 1996 and September 1999, 1058 individuals contributed 3362 visits at which potent ART was reported in the previous 6 months. Overall rates of 6 month downshifting and discontinuation were 10.0% and 6.7%. The proportion of individuals discontinuing all ART increased from 2.9% in late 1996 to 9.1% in mid 1999 (P <0.001). Individuals with high HIV RNA levels were more likely to discontinue (P <0.05). Compared to those who continued on potent ART, individuals who discontinued experienced large declines (P <0.001) in CD4 cell counts and were more than three times more likely (P <0.001) to experience HIV RNA increases. However, over one-third of those discontinuing ART reported side-effects and this subset had smaller CD4 cell count declines as compared to discontinuers not reporting side-effects (P = 0.147). Conclusions In a large cohort of HIV-infected women, an increasing proportion of potent ART users discontinued ART over 3 years. Higher HIV RNA levels predicted discontinuation. Immediate immunological/virological deleterious consequences were observed. Side-effects were the most common reason for discontinuation and CD4 cell count declines were larger among those who did not cite side-effects as the reason for discontinuation.

Original languageEnglish (US)
Pages (from-to)2101-2108
Number of pages8
JournalAIDS
Volume15
Issue number16
DOIs
StatePublished - Nov 9 2001

Fingerprint

CD4 Lymphocyte Count
HIV
RNA
Therapeutics
Cohort Studies

Keywords

  • CD4 cell count
  • Discontinuation
  • HIV
  • Plasma HIV RNA
  • Potent antiretroviral therapy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Discontinuation of potent antiretroviral therapy : Predictive value of and impact on CD4 cell counts and HIV RNA levels. / Grant, Linda Ahdieh; Silverberg, Michael J.; Palacio, Herminia; Minkoff, Howard; Anastos, Kathryn; Young, Mary A.; Nowicki, Marek; Kovacs, Andrea; Cohen, Mardge; Munoz, Alvaro.

In: AIDS, Vol. 15, No. 16, 09.11.2001, p. 2101-2108.

Research output: Contribution to journalArticle

Grant, LA, Silverberg, MJ, Palacio, H, Minkoff, H, Anastos, K, Young, MA, Nowicki, M, Kovacs, A, Cohen, M & Munoz, A 2001, 'Discontinuation of potent antiretroviral therapy: Predictive value of and impact on CD4 cell counts and HIV RNA levels', AIDS, vol. 15, no. 16, pp. 2101-2108. https://doi.org/10.1097/00002030-200111090-00005
Grant, Linda Ahdieh ; Silverberg, Michael J. ; Palacio, Herminia ; Minkoff, Howard ; Anastos, Kathryn ; Young, Mary A. ; Nowicki, Marek ; Kovacs, Andrea ; Cohen, Mardge ; Munoz, Alvaro. / Discontinuation of potent antiretroviral therapy : Predictive value of and impact on CD4 cell counts and HIV RNA levels. In: AIDS. 2001 ; Vol. 15, No. 16. pp. 2101-2108.
@article{97e8d663d66f450397e7020804857abc,
title = "Discontinuation of potent antiretroviral therapy: Predictive value of and impact on CD4 cell counts and HIV RNA levels",
abstract = "Objective To characterize predictors and consequences of discontinuing antiretroviral therapy (ART) in terms of CD4 cell count, HIV RNA, and reported side-effects in a large cohort of HIV-infected women. Design Cohort study. Methods A total of 1058 HIV-infected women initiated potent ART before September 1999. For each 6 month period after October 1996 we determined the proportion of potent ART users who downshifted to non-potent ART and who discontinued all ART. We examined the role of CD4 cell count and HIV RNA with regard to ART discontinuation. Results Between October 1996 and September 1999, 1058 individuals contributed 3362 visits at which potent ART was reported in the previous 6 months. Overall rates of 6 month downshifting and discontinuation were 10.0{\%} and 6.7{\%}. The proportion of individuals discontinuing all ART increased from 2.9{\%} in late 1996 to 9.1{\%} in mid 1999 (P <0.001). Individuals with high HIV RNA levels were more likely to discontinue (P <0.05). Compared to those who continued on potent ART, individuals who discontinued experienced large declines (P <0.001) in CD4 cell counts and were more than three times more likely (P <0.001) to experience HIV RNA increases. However, over one-third of those discontinuing ART reported side-effects and this subset had smaller CD4 cell count declines as compared to discontinuers not reporting side-effects (P = 0.147). Conclusions In a large cohort of HIV-infected women, an increasing proportion of potent ART users discontinued ART over 3 years. Higher HIV RNA levels predicted discontinuation. Immediate immunological/virological deleterious consequences were observed. Side-effects were the most common reason for discontinuation and CD4 cell count declines were larger among those who did not cite side-effects as the reason for discontinuation.",
keywords = "CD4 cell count, Discontinuation, HIV, Plasma HIV RNA, Potent antiretroviral therapy",
author = "Grant, {Linda Ahdieh} and Silverberg, {Michael J.} and Herminia Palacio and Howard Minkoff and Kathryn Anastos and Young, {Mary A.} and Marek Nowicki and Andrea Kovacs and Mardge Cohen and Alvaro Munoz",
year = "2001",
month = "11",
day = "9",
doi = "10.1097/00002030-200111090-00005",
language = "English (US)",
volume = "15",
pages = "2101--2108",
journal = "AIDS",
issn = "0269-9370",
publisher = "Lippincott Williams and Wilkins",
number = "16",

}

TY - JOUR

T1 - Discontinuation of potent antiretroviral therapy

T2 - Predictive value of and impact on CD4 cell counts and HIV RNA levels

AU - Grant, Linda Ahdieh

AU - Silverberg, Michael J.

AU - Palacio, Herminia

AU - Minkoff, Howard

AU - Anastos, Kathryn

AU - Young, Mary A.

AU - Nowicki, Marek

AU - Kovacs, Andrea

AU - Cohen, Mardge

AU - Munoz, Alvaro

PY - 2001/11/9

Y1 - 2001/11/9

N2 - Objective To characterize predictors and consequences of discontinuing antiretroviral therapy (ART) in terms of CD4 cell count, HIV RNA, and reported side-effects in a large cohort of HIV-infected women. Design Cohort study. Methods A total of 1058 HIV-infected women initiated potent ART before September 1999. For each 6 month period after October 1996 we determined the proportion of potent ART users who downshifted to non-potent ART and who discontinued all ART. We examined the role of CD4 cell count and HIV RNA with regard to ART discontinuation. Results Between October 1996 and September 1999, 1058 individuals contributed 3362 visits at which potent ART was reported in the previous 6 months. Overall rates of 6 month downshifting and discontinuation were 10.0% and 6.7%. The proportion of individuals discontinuing all ART increased from 2.9% in late 1996 to 9.1% in mid 1999 (P <0.001). Individuals with high HIV RNA levels were more likely to discontinue (P <0.05). Compared to those who continued on potent ART, individuals who discontinued experienced large declines (P <0.001) in CD4 cell counts and were more than three times more likely (P <0.001) to experience HIV RNA increases. However, over one-third of those discontinuing ART reported side-effects and this subset had smaller CD4 cell count declines as compared to discontinuers not reporting side-effects (P = 0.147). Conclusions In a large cohort of HIV-infected women, an increasing proportion of potent ART users discontinued ART over 3 years. Higher HIV RNA levels predicted discontinuation. Immediate immunological/virological deleterious consequences were observed. Side-effects were the most common reason for discontinuation and CD4 cell count declines were larger among those who did not cite side-effects as the reason for discontinuation.

AB - Objective To characterize predictors and consequences of discontinuing antiretroviral therapy (ART) in terms of CD4 cell count, HIV RNA, and reported side-effects in a large cohort of HIV-infected women. Design Cohort study. Methods A total of 1058 HIV-infected women initiated potent ART before September 1999. For each 6 month period after October 1996 we determined the proportion of potent ART users who downshifted to non-potent ART and who discontinued all ART. We examined the role of CD4 cell count and HIV RNA with regard to ART discontinuation. Results Between October 1996 and September 1999, 1058 individuals contributed 3362 visits at which potent ART was reported in the previous 6 months. Overall rates of 6 month downshifting and discontinuation were 10.0% and 6.7%. The proportion of individuals discontinuing all ART increased from 2.9% in late 1996 to 9.1% in mid 1999 (P <0.001). Individuals with high HIV RNA levels were more likely to discontinue (P <0.05). Compared to those who continued on potent ART, individuals who discontinued experienced large declines (P <0.001) in CD4 cell counts and were more than three times more likely (P <0.001) to experience HIV RNA increases. However, over one-third of those discontinuing ART reported side-effects and this subset had smaller CD4 cell count declines as compared to discontinuers not reporting side-effects (P = 0.147). Conclusions In a large cohort of HIV-infected women, an increasing proportion of potent ART users discontinued ART over 3 years. Higher HIV RNA levels predicted discontinuation. Immediate immunological/virological deleterious consequences were observed. Side-effects were the most common reason for discontinuation and CD4 cell count declines were larger among those who did not cite side-effects as the reason for discontinuation.

KW - CD4 cell count

KW - Discontinuation

KW - HIV

KW - Plasma HIV RNA

KW - Potent antiretroviral therapy

UR - http://www.scopus.com/inward/record.url?scp=0035834475&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035834475&partnerID=8YFLogxK

U2 - 10.1097/00002030-200111090-00005

DO - 10.1097/00002030-200111090-00005

M3 - Article

C2 - 11684929

AN - SCOPUS:0035834475

VL - 15

SP - 2101

EP - 2108

JO - AIDS

JF - AIDS

SN - 0269-9370

IS - 16

ER -