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Editor's Correspondence
Mar 25, 2013

Immunovirologic Control 24 Months After Interruption of Antiretroviral Therapy Initiated Close to HIV Seroconversion

JAMA Intern Med. 2013;173(6):475-477. doi:10.1001/jamainternmed.2013.2176

Lodi et al1 recently reported that 11 of 259 patients (4.2%) starting combined antiretroviral therapy (cART) at the time of primary human immunodeficiency virus type 1 (HIV-1) infection (PHI) still controlled HIV replication (<50 copies/mL) 24 months after treatment interruption. They pointed out that the proportion of these “posttreatment controllers” (PTCs) was substantially lower than the 15.6% we reported,2 and speculated that this difference might have been because we excluded patients who restarted therapy less than 24 months after treatment interruption and used newer and more powerful drugs. However, the period of treatment initiation in our study was similar to that reported by Lodi et al1 (1996-2007 and 1996-2009, respectively), and the drug regimens we used were part of the contemporary standard-of-care recommendations. In addition, 91% of our patients had highly symptomatic PHI and, thus, a poor prognosis. Finally, we did not exclude patients who resumed therapy less than 24 months after treatment interruption but included them in the “noncontrollers” group, which resulted in a lower frequency of posttreatment controllers.