HIV interruption ineffective antiretroviral therapy in patients with multiple resistance

An attempt to interrupt antiretroviral therapy in patients with treatment failure has endured several negative results, report doctors at the Pitié-Salpêtrière Hospital (Paris, thirteenth district) in the journal "AIDS."

Effect of interruption of antiretroviral

Interruption of treatment aims to promote the resurgence of wild-ART-sensitive strains in patients with multiple resistances. Wild strains replicating faster than the resistant strains, treatment interruption would thus increase the effectiveness of antiretroviral drugs.

The team of Dr. Christine Katlama had achieved encouraging results in an interruption of eight-week trial. Twenty-four weeks after resumption of treatment, the researchers observed a decrease in viral load greater in patients who discontinued treatment than those having continued.

The same team investigated whether the results could be improved with a longer interruption of 24 weeks instead of 8. This interruption has a good reversion of viral phenotype. Patients were sensitive to antiretroviral 4.9 average effect, against 0.8 before the test.

Resumption of treatment, based on antiretrovirals to which the patients were sensitive again, however, has not had the desired effect. Twenty-four weeks after resumption of treatment, the viral load of patients had increased their CD4 counts were lower than the values recorded at the beginning of the trial, before the discontinuation.

Reappearance of resistance

In addition, antiretroviral resistance mutations recurred after four weeks of treatment in 13 patients, and after 24 weeks in the other 10.

Fifteen patients (65%) also underwent several conditions related to the virus, including eight cases of esophageal candidiasis. All these events occurred after rechallenge.

"It seems that the key point that the interruption is effective is the number of antiretrovirals to which the patient is still sensitive before interruption," the researchers assume.

In the first study, in which treatment interruption lasted eight weeks, the patients had an average sensitivity of 1.4 antiretroviral.

"In our study, the average was 0.8. There was therefore no new antiretroviral which patients had never been exposed.'s Rapid resurgence of these resistant strains after rechallenge shows that n 'had not disappeared, "noted the authors.