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Safe Interruption of Maintenance Therapy against Previous Infection with Four Common HIV-Associated Opportunistic Pathogens during Potent Antiretroviral Therapy

Ole Kirk, MD; Peter Reiss, MD; Caterina Uberti-Foppa, MD; Markus Bickel, MD; Jan Gerstoft, MD; Christian Pradier, MD; Ferdinand W. Wit, MD; Bruno Ledergerber, PhD; Jens D. Lundgren, MD; Hansjakob Furrer, MD, for Seven European HIV Cohorts*
[+] Article and Author Information

From Hvidovre Hospital, University of Copenhagen, Hvidovre, and Rigshospitalet, Copenhagen, Denmark; Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; San Raffaele Hospital, Milan, Italy; J.W. Goethe University Clinic, Frankfurt, Germany; Hôpital l'Archet, Nice, France; University Hospital Zurich, Zurich, Switzerland; and University Hospital Bern, Bern, Switzerland.


Grant Support: The EuroSIDA study was supported by grants from the European Commission BIOMED 1 (CT94-1637) and BIOMED 2 (CT97-2713) programs and the fifth framework program (QLK2-2000-00773); from GlaxoSmithKline, Roche, and Boehringer-Ingelheim; and from the Swiss Federal Office for Education and Science (Swiss sites only). The Swiss HIV Cohort Study was supported by grant 3345-062041 from the Swiss National Science Foundation. The AIDS Therapy Evaluation Project Netherlands was supported by grant CURE/97-46486 from the Health Insurance Fund Council, Amstelveen, the Netherlands. The Frankfurt HIV Cohort was supported by grants from the Bundesministerium für Bildung und Forschung (BMBF 01KI9406/6 and 01KI9718) and GlaxoSmithKline Research.

Requests for Single Reprints: Ole Kirk, MD, Coordinating Centre of EuroSIDA, Department of Infectious Diseases, Hvidovre University Hospital, Kettegaard Alle, 2650 Hvidovre, Denmark; e-mail, oki@cphiv.dk.

Current Author Addresses: Drs. Kirk and Lundgren: Coordinating Centre of EuroSIDA, Department of Infectious Diseases, Hvidovre University Hospital, Kettegaard Alle, 2650 Hvidovre, Denmark.

Drs. Reiss and Wit: Academic Medical Center, University of Amsterdam, Division of Infectious Diseases, Tropical Medicine, and AIDS, and National AIDS Therapy Evaluation Center, Amsterdam, The Netherlands.

Dr. Uberti-Foppa: San Raffaele Hospital, Infectious Diseases Department, Milan, Italy.

Dr. Bickel: J.W. Goethe University Clinic, Department of Infectious Diseases, Frankfurt, Germany.

Dr. Gerstoft: Rigshospitalet, Department of Infectious Diseases, Copenhagen, Denmark.

Dr. Pradier: Hopital l'Archet, Tropical and Infectious Diseases Department, Nice, France.

Dr. Ledergerber: University Hospital Zürich, Division of Infectious Diseases and Hospital Epidemiology, Zürich, Switzerland.

Dr. Furrer: University Hospital Bern, Division of Infectious Diseases, Bern, Switzerland.

Author Contributions: Conception and design: O. Kirk, P. Reiss, B. Ledergerber, J.D. Lundgren, H. Furrer.

Analysis and interpretation of the data: O. Kirk, B. Ledergerber, J.D. Lundgren, H. Furrer.

Drafting of the article: O. Kirk, B. Ledergerber, J.D. Lundgren, H. Furrer.

Critical revision of the article for important intellectual content: O. Kirk, P. Reiss, J.D. Lundgren, H. Furrer.

Final approval of the article: O. Kirk, P. Reiss, C. Uberti-Foppa, M. Bickel, J. Gerstoft, C. Pradier, F.W. Wit, B. Ledergerber, J.D. Lundgren, H. Furrer.

Provision of study materials or patients: O. Kirk, P. Reiss, C. Uberti-Foppa, M. Bickel, J. Gerstoft, C. Pradier, F.W. Wit, H. Furrer.

Statistical expertise: O. Kirk, B. Ledergerber.

Obtaining of funding: O. Kirk, J.D. Lundgren, H. Furrer.

Administrative, technical, or logistic support: O. Kirk, B. Ledergerber, H. Furrer.

Collection and assembly of data: O. Kirk, C. Uberti-Foppa, M. Bickel, C. Pradier, F.W. Wit, H. Furrer.


Ann Intern Med. 2002;137(4):239-250. doi:10.7326/0003-4819-137-4-200208200-00008
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Our results provide substantial evidence that sustained increases of CD4 lymphocyte counts to greater than 100 to 200 × 106 cells/L are associated with a sufficient degree of immune recovery to safely interrupt maintenance therapy against recurrent CMV end-organ disease, disseminated MAC infection, toxoplasmosis, and cryptococcosis. This conclusion was also suggested by published case series (5, 14, 3545) and is consistent with the proven safety of discontinuation of maintenance therapy against P. carinii(17, 27).

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Summary for Patients

Can Maintenance Therapy for Opportunistic Infections in HIV-Infected People Be Stopped Safely?

The summary below is from the full report titled “Safe Interruption of Maintenance Therapy against Previous Infection with Four Common HIV-Associated Opportunistic Pathogens during Potent Antiretroviral Therapy.” It is in the 20 August 2002 issue of Annals of Internal Medicine (volume 137, pages 239-250). The authors are O Kirk, P Reiss, C Uberti-Foppa, M Bickel, J Gerstoft, C Pradier, FW Wit, B Ledergerber, JD Lundgren, and H Furrer, for Seven European HIV Cohorts.

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