Virology & Mycology
Open Access
ISSN: 2161-0517
+44 1223 790975
ISSN: 2161-0517
+44 1223 790975
Jacques Leibowitch1, Dominique Mathez1, Pierre de Truchis1, Damien Ledu1, Jean Claude melchior1, Guislaine Carcelain2, Jacques Izopet3, Christian Perronne1 and John R David4
Posters-Accepted Abstracts: Virol-mycol
Background: Short intra-weekly cycles of anti-HIV combinations have provided intermittent yet effective therapy. The concept is now extended to 94 patients on treatment (Rx) 4 days a week (d/wk) or less over a median 2.7 discontinuous treatmentyears per patient. Patients & Combinations: On steadily suppressive combinations, 94 patients volunteered to 5 and 4 d/w treatment, or directly reduced stepwise to 4, 3, 2, 1 d/wk in respectively 94, 84, 66, 12 pts, on various triple (standard) or nonregistered quadruple antiviral combinations. Results: 4 d/wk RX aggregated 165 intermittent treatment-years recording no failure over 87 average Rx-weeks per patient; with 63/94 pts successfully passing the 144 weeks bore on any of the antiviral combinations prescribed. On highly (3d/wk) or ultra (2 d/wk) or hyper (1d/wk) intermittent Rx, HIV RNA surged >50 copies 4 weeks apart in 18 instances (6.8 viral escapes / 100 discontinuous maintenance-years), relatable to: Erratic adherence to regimen or follow-up (3 patients); base-drug at � the daily recommended dosage (8 pts) ; and/or overlooked archival resistant HIVs from antecedent treatment failures (6pts). Aside from such human blunders, HIV unexpectedly rebounded in 3 and 1 patients respectively on 2 and 1/d/wk Rx, = 2.2 intrinsic viral escapes per 100 ultra-hyper intermittent treatment-years. All 18 escapes were countered by 7 day-a-wk salvage combinations and 11/18 has been back to a second course of intermittent therapy 4 days a week or less. Both cell-activation markers on the surface of T- lymphocytes, and cell-bound HIV DNA levels remained stable or declined. CD4/CD8 ratios rose to ≥1 in 35% of patients, while CD4 counts went ≥500/μl in 75% - from 7% and 40% respectively on unremitting therapy. Conclusion: In our aging, long-HIV enduring, multi-treated patient cohort, ICCARRE cut into current overmedication by 60%, offering the equivalent of 3 drug-free/ 3 virus-free remission years per patient ≈3 million Euros unspent for just 94 patients, at the cost of 2.2 intrinsic viral failures per 100 ultra-hyper intermittent treatment-years. On-treatment 4 days a week would universally provide 40% cuts in dispensable medications at no risk of failure.