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participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



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Effect of Cessation of Highly Active Antiretroviral Therapy during a Discordant Response: Implications for Scheduled Therapeutic Interruptions [Hawley-Foss, N. et al. CID 2001;33:344]: This is a report from Ottawa concerning patients who had virologic failure with increasing viral load, combined with a discordant increase in CD4 cell count over three months, and discontinued treatment. Analysis measured the impact of therapy discontinuation on CD4 cell count. Charts of over 1,000 patients were reviewed, and eight were found who met the inclusion criteria of rising virus, rising CD4 cell count, and discontinuation of treatment at that time. The analysis showed that all eight patients had a significant decrease in CD4 cell count during the next three-four months, usually 100-150/mm3.
Comment: This paper points out the potential consequences of treatment interruption in patients who have virologic failure with a discordant CD4 cell response. The authors caution that continued treatment despite virologic failure in the absence of alternative treatment options may be preferable to discontinuing treatment, notwithstanding the recent report by Deeks demonstrating reversion to PI sensitive strains.
posted 8/10/2001





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