Montserrat Olmo

Publications (2)6.32 Total impact

• Article: Short-term and long-term clinical and immunological consequences of stopping antiretroviral therapy in HIV-infected patients with preserved immune function.

  Arkaitz Imaz, Montserrat Olmo, Maria Peñaranda, Félix Gutiérrez, Joan Romeu, Maria Larrousse, Pere Domingo, José Antonio Oteo, Jordi Curto, Concepción Vilallonga, Mar Masiá, José López-Aldeguer, José Antonio Iribarren, Daniel Podzamczer
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  ABSTRACT: OBJECTIVE: To assess the short-term and long-term consequences of stopping antiretroviral therapy (ART) in patients with preserved immune function. METHODS: Randomized, 144-week follow-up CD4+ count-guided treatment-interruption trial. HIV-1 infected adults with plasma HIV-1 RNA <50 copies/mL, CD4+ count >500/µL, and nadir CD4+ count >100/µL were randomized to continuous therapy (CT) or treatment interruption (TI) until CD4+ count decreased to <350/µL. The primary endpoints were AIDS-defining illnesses, death, CD4+ count <200/µL, or virologic failure after restarting ART. RESULTS: A total of 106 patients were included, 50 in the CT arm and 56 in the TI arm. A trend to a higher rate of primary endpoints was observed in the TI group (26.8% vs. 14%, difference: 12.8%, 95% CI -2.3% to 27.8%; p=0.105). In addition, 10 patients presented clinical events related with HIV rebound, including 8 cases of thrombocytopenia. The CD4+ count significantly decreased in the TI group (even in patients with persistently high CD4+ counts and no clinical events) versus the CT group (median change -408 cell/µL vs -21.5 cell/µL, p<0.001), whereas a significant increase in CD8+ count was observed (+256 cell/µL, vs -59 cell/µL, p<0.001). The time to ART re-initiation was significantly associated with nadir and baseline CD4+ counts. CONCLUSIONS: Discontinuation of ART in patients with preserved immune function is followed by significant immunological impairment even in those with no clinical events, and may be associated with an increased risk of HIV-related complications. Hence, patients who stop ART voluntarily should be closely monitored, regardless their CD4+ count. (www.controlled-trials.com, ISRCTN75856952).
  Antiviral therapy 07/2012; · 3.16 Impact Factor
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  Available from: Arkaitz Imaz

  Article: Evolution of HIV-1 genotype in plasma RNA and peripheral blood mononuclear cells proviral DNA after interruption and resumption of antiretroviral therapy.

  Arkaitz Imaz, Montserrat Olmo, Maria Peñaranda, Félix Gutiérrez, Joan Romeu, Maria Larrousse, Pere Domingo, José A Oteo, Jordi Niubó, Jordi Curto, Concepción Vilallonga, Mar Masiá, José López-Aldeguer, José A Iribarren, Daniel Podzamczer
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  ABSTRACT: Structured antiretroviral therapy interruption (TI) is discouraged because of poorer AIDS and non-AIDS-related outcomes, but is often inevitable in clinical practice. Certain strategies could reduce the emergence of resistance mutations related to TI. A total of 106 HIV-1-infected patients on stable HAART with undetectable plasma viral load were randomized to therapy continuation (n=50) or CD4(+) T-cell-guided TI (n=56). Staggered interruption involved stopping non-nucleoside reverse transcriptase inhibitors (NNRTIs) 7 days before the nucleoside backbone. Genotypic resistance testing (GRT) was performed on proviral DNA from peripheral blood mononuclear cells (PBMCs) at baseline and before each TI, and on plasma RNA after each TI. At baseline, GRT on PBMCs detected mutations in nine patients and only two major mutations were identified. GRT on plasma samples performed after TIs showed nucleoside reverse transcriptase inhibitors (NRTI), NNRTI and protease inhibitor major resistance associated mutations in 10/56, 3/46 and 1/8 patients receiving these drugs, respectively. Only in two patients had the same mutations been observed in GRT on PBMCs at baseline. Three patients presented virological failure after resumption of therapy, all receiving NNRTIs. In one of them, resistance mutations detected at failure had been also observed previously in GRT on plasma after TI. Staggered interruption of NNRTIs 7 days before the nucleoside backbone does not avoid resistance emergence completely, but does not necessarily lead to virological failure after treatment resumption. Plasma HIV-1 RNA genotype after the interruption and the patient's treatment history seem to be more useful than baseline proviral DNA genotype to assess the risk of virological failure after restarting therapy.
  Antiviral therapy 12/2011; 17(3):577-83. · 3.16 Impact Factor