Virological rebound and its consequences during treatment interruption

Abstract

This paper provides an overview of the current knowledge on virological rebound during treatment interruption and its consequences in patients with chronic HIV-1 infection. After interruption of antiretroviral therapy, plasma viremia inevitably returns to individual pretherapy set point levels in almost all patients with chronic HIV infection. This virological rebound leads to a state of massive immune activation and consequently an increased turnover of CD4+ and CD8+ T cells resulting in a biphasic decay of T-helper cell numbers. Rebound has been shown to be associated with an increased risk of clinical events by some (albeit not all) randomized trials published during the last few months. Secondary consequences of immunologic deterioration include worsening of comorbidity (e.g. hepatitis and renal impairment) and an increased risk of cardiovascular disease as well as an elevated HIV transmission risk during treatment interruption. The individual course after treatment interruption cannot be predicted by any of the known surrogate markers. Treatment interruptions cannot be recommended in HIV-infected patients outside clinical trials, especially when profound immune deficiency is found to be preexisting.