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BMC Infectious Diseases

Open Access

Four days a week and less on appropriate antiviral combinations provided long-term optimal control over HIV-1 in 92 patients

  • Jacques Leibowitch1,
  • Dominique Mathez1,
  • Pierre de Truchis1,
  • Damien Ledu1,
  • Jean Claude melchior1,
  • Guislaine Carcelain1,
  • Jacques Izopet1,
  • John David1 and
  • Christian Perronne1
BMC Infectious Diseases201414(Suppl 2):O5

https://doi.org/10.1186/1471-2334-14-S2-O5

Published: 23 May 2014

Patients and treatments

92 volunteer patients on optimally suppressive antiviral combinations for 5 months or more consented to step wisely reduce their weekly treatment from 7 to 5 to 4 days/wk, or directly from 7 to 4 d/wk after bi-monthly checks on HIV plasma levels at < 50 copies. Weekly treatment was further reduced to 3, 2, and 1 d/wk for respectively 72, 59 and 12 pts. Antiviral combinations included : one integrase inhibitor-base + 2 or 3 NRTIs, or 1 NNRTI and 1 PI (for 4 d/wk regimens, (Rx); standard triple combinations of 1 PI or 1 NNRTI + 2 NRTIs (for 4, 3 , 2 d/wk Rx); novel quadruple antiviral compositions of 1 NNRTI + 3 NRTIs (for 4, 3 , 2, 1 d/wk Rx).

Results

Intermittent treatment fully controlled patients’ HIV over 20 592 treatment-weeks. Of the 92 patients at entry, 88, 66 and 51 had sustained 52 weeks with 3, 4 or 5 weekly days off-treatment periods respectively. Lymphocyte surface activation markers or cell-bound HIV DNA levels remained stable or declined further; CD4/CD8 ratios rose to ≥1 in 37% of patients – versus 7% patients before discontinuous treatment.

Viral failures: 13 viral escapes (plasma HIV RNA >50 copies 4 weeks apart; overall failures 3.3 per 100 discontinuous treatment-years) were countered by prompt re-adjustments with 7 day-a-week effective combinations. In retrospect 10 failures were ascribable to physician’s or patients’ errors or blunders: base-drug prescribed at sub (½) optimal daily dosage (3 pts); overlooked archival resistant HIVs from antecedent treatment failures (5 pts); acute erratic observance (2 pts); HIV inadvertently resurged while on a 5 day off (2 pts) or 6 days off-treatment period, all 3 under one quadruple combination, setting the antiviral power limit of the ultra-short treatment modality with that combination at 1.4 failures per 100 proper treatment-years.

Conclusion

discontinuous maintenance therapy in 92 patients on ARV 4 days a week and less over an average 219 treatment-weeks (median 131) offered 40 to 85 % medicinal cuts.

Authors’ Affiliations

(1)
Infectiology Department, Raymond Poincaré Hospital, Garches, France

Copyright

© Leibowitch et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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