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Titolo:
Dynamics of viral load rebound and immunological changes after stopping effective antiretroviral therapy
Autore:
Garcia, F; Plana, M; Vidal, C; Cruceta, A; OBrien, WA; Pantaleo, G; Pumarola, T; Gallart, T; Miro, JM; Gatell, JM;
Indirizzi:
Univ Barcelona, Infect Dis Unit, Inst Invest Biomed, August Pi I Sunyer Hosp Clin,Fac Med, E-08036 Barcelona, Spain Univ Barcelona Barcelona Spain E-08036 Fac Med, E-08036 Barcelona, Spain Univ Barcelona, Immunol Lab, Inst Invest Biomed, August Pi I Sunyer Hosp Clin,Fac Med, Barcelona, Spain Univ Barcelona Barcelona Spain nyer Hosp Clin,Fac Med, Barcelona, Spain Univ Barcelona, Microbiol Lab, Inst Invest Biomed, August Pi I Sunyer HospClin,Fac Med, Barcelona, Spain Univ Barcelona Barcelona Spain unyer HospClin,Fac Med, Barcelona, Spain Univ Texas, Med Branch, Dept Med, Div Infect Dis, Galveston, TX 77550 USA Univ Texas Galveston TX USA 77550 Div Infect Dis, Galveston, TX 77550 USA Univ Lausanne, Div Infect Dis, CHU Vaudois, CH-1015 Lausanne, Switzerland Univ Lausanne Lausanne Switzerland CH-1015 CH-1015 Lausanne, Switzerland
Titolo Testata:
AIDS
fascicolo: 11, volume: 13, anno: 1999,
pagine: F79 - F86
SICI:
0269-9370(19990730)13:11<F79:DOVLRA>2.0.ZU;2-M
Fonte:
ISI
Lingua:
ENG
Soggetto:
HIV-1 INFECTION; DISEASE; PLASMA; RNA; DISCONTINUATION; LYMPHOCYTES; GENE;
Keywords:
viral load; HAART; antiretroviral treatment; immunophenotyping; viral rebound;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Life Sciences
Citazioni:
22
Recensione:
Indirizzi per estratti:
Indirizzo: Garcia, F Univ Barcelona, Infect Dis Unit, Inst Invest Biomed, August Pi ISunyer Hosp Clin,Fac Med, Villarroel 170, E-08036 Barcelona, Spain Univ Barcelona Villarroel 170 Barcelona Spain E-08036 na, Spain
Citazione:
F. Garcia et al., "Dynamics of viral load rebound and immunological changes after stopping effective antiretroviral therapy", AIDS, 13(11), 1999, pp. F79-F86

Abstract

Background: This study addresses the dynamic of viral load rebound and immune system changes in a cohort of eight consecutive HIV-l-infected patientsin very early stages fall the patients were taking highly active antiretroviral therapy (HAART} and were recruited in the coordinating center from a larger study] who decided to discontinue HAART after 1 year of treatment and effective virologic response. The safety of this procedure and the outcome with reintroduction of the same treatment was also investigated. Methods: Plasma, cerebrospinal fluid (CSF), and lymphatic tissue viral loads were measured at baseline; lymphocyte immunophenotyping and CD4 lymphocyte proliferative responses to mitogens and specific antigens were assessed. The same antiretroviral therapy was reintroduced as soon as plasma viral load became detectable (above 200 copies/ml). Results: At day 0, plasma viral load was below 20 copies/ml in all eight patients land below 5 copies/ml in five of eight patients). A rebound in plasma viral load was detected in all patients from day 3 to day 31 with a mean doubling time of 2.01 (SE 0.29) days. Three out of eight patients achieved a peak plasma viral load at least 0.5 log,, above baseline, pretreatment values. Mutations associated with resistance to reverse transcriptase or protease inhibitors were not detected. After 31 days off therapy, CD4 lymphocytes decreased [mean 45% (SE 4) to 37% (SE 3); P = 0.04], CD8+CD28+ lymphocytes decreased [mean 59% (SE 5) to 43% (SE 4); P = 0.03], and CD8+CD38+ lymphocytes increased [mean 55% (SE 3) to 66% (SE 4); P = 0.009]. Mean stimulation indices of lymphocytes treated with phytohemagglutinin (PHA) and CD3 decreased from day 0 to day 31 from 34% (SE 8) to 17% (SE 9) (P = 0.06) and from 24% (SE 8) to 5% (SE 2) (P = 0.02), respectively. These changes were mainly contributed by the group of five patients with plasma viral load below 5 copies/ml at day 0. Viral load dropped below 20 copies/ml in all patients after 1 month of restarting the same antiretroviral regimen. Conclusions: Discontinuation of HAART after 1 year of successful treatmentis followed by a rapid rebound of viral load; this rapidly returns to undetectable levels following reintroduction of the same treatment. In patientswith more effective control of virus replication (viremia below 5 copies/ml), discontinuation of treatment was associated with more severe impairmentof immunologic parameters. (C) 1999 Lippincott Williams & Wilkins.

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Documento generato il 05/12/20 alle ore 20:08:20