Update #2 Day 3, Tuesday February 7 from the Retroviruses and Opportunistic Infections National Meeting

Conference - February 7th Transcript

Dr. Eric Daar offers perspectives of interest on topics from the 13th Conference on Retroviruses and Opportunistic Infections (held in Denver, Colorado February 5-8, 2006)

Treatment Interruptions

In a session entitled "Antiretroviral Therapy: New Insights and Treatment Strategies" there were a series of presentations on the topic of treatment interruptions. In fact, several of these have received a lot of attention in the media of late. One such study was called "The SMART Study." SMART was to enroll 6,000 people who had high CD4 cells. They were to be randomly assigned to either continue antiretroviral therapy or discontinue it when CD4 cells were >350 cells/uL and then reinitiate therapy when they declined to below 250 cells/uL. The primary end point of this study was time to clinical events, or progression to AIDS or death. At the time of a recent interim review, the data safety monitoring board terminated the treatment interruption arm of this study because of a highly significant increased risk of clinical events in these subjects. This study was described in some detail, focusing mostly on the primary end points, and recognizing that additional analyses will be performed to address a variety of other very important questions related to tolerability and quality of life. Of the approximately 2,500 people enrolled in each arm they found that most in the treatment interruption group maintained their T cell counts above 250 cells/uL. However, in this group there was nearly a 2.5 times increased risk or clinical endpoints, including progression to AIDS and death. While the outcomes were not related to CD4 cell nadir, it did relate to proximal CD4 cell count and was most notable in those who came into the study with a viral load of less than 400 copies/mL.