CD4+ Count–Guided Interruption of Antiretroviral Treatment

Long-term antiretroviral therapy for the treatment of human immunodeficiency virus infection is associated with a substantial rate of complications. Structured interruption of antiretroviral therapy, in the setting of a preserved CD4+ count, has been considered in order to minimize these side effects. In this randomized study of 5472 patients, CD4+ count–guided intermittent use of antiretroviral drugs was found to be associated with increased rates of opportunistic disease, death from any cause, and severe adverse events, as compared with the continuous use of antiretroviral therapy. CD4+ count–guided intermittent use of antiretroviral drugs was found to be associated with increased rates of opportunistic disease, death from any cause, and severe adverse events, as compared with the continuous use of antiretroviral therapy. With the advent of potent combination antiretroviral therapy came the hope that such therapy might lead to the eradication of infection with the human immunodeficiency virus (HIV). 1 It was soon recognized, however, that this goal was unlikely to be achieved owing to the existence of latent reservoirs; people infected with HIV would need to receive antiretroviral therapy for many years, if not for life. 2 , 3 Potent antiretroviral therapy is associated with substantial benefits with regard to morbidity and mortality. 4 – 6 However, the therapy is also associated with both short-term and long-term adverse events. 7 , 8 Major metabolic and cardiovascular complications have . . .