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TILT: a randomized controlled trial of interruption of antiretroviral therapy with or without interleukin-2 in HIV-1 infected individuals

Angus, Briana,b; Lampe, Fionac; Tambussi, Guiseppef; Duvivier, Claudineg; Katlama, Christineg; Youle, Mikec; Williams, Iand; Clotet, Bonaventurah; Fisher, Martine; Post, Frank Ad; Babiker, Abdulb; Phillips, Andrewc; TILT trial Steering Committee

doi: 10.1097/QAD.0b013e3282f511f1
Clinical Science

Objective: We aimed to see if structured treatment interruption (STI) could be supported safely with the use of two cycles of IL-2 (4.5 MIU q12h subcutaneously 5 days) before STI to prolong the time before therapy restarted.

Methods: Subjects were randomly allocated to either A - continuous ART; B – continue for 9 weeks, then STI; restart with the same ART when the CD4 count falls below 200 cells; or C - two cycles of IL-2, 8 weeks apart, while still on ART; at week 9 stop ART and use a new cycle of IL-2 alone whenever the CD4 count falls < 300 cells. Patients were followed until week 105.

Results: 86 mostly white middle aged homosexual men with a baseline median CD4 count of 754 cells/ml (range 240–1400) and a nadir CD4 count of 268 cells/ml (range 62–822) enrolled. By 96 weeks there was a 66% probability of having restarted ART in arm B compared with 34% in arm C (p = 0.002; log rank test). New drugs were used in 60% in arm A, 57% in arm B and 45% in arm C. 4 subjects had a dose modification in the first cycle due to toxicity with 2 interrupting. There were 39 SAEs with 21 in arm C. There were no deaths.

Conclusions: The primary aim of the trial was to gain experience in using IL-2. IL-2 delayed restarting drugs and fewer new drugs were used.

From the aNuffield Department of Medicine, John Radcliffe Hospital, Oxford, UK

bMedical Research Council, London, UK

cRoyal Free and University College London Medical School, UK

d5 King's College London, London, UK

eRoyal Sussex County Hosp, Brighton, UK

fMario Negri Inst, Milan, Italy

gHosp Pitie-Salpetriere, Paris, France

hUniv Hosp Germans Trias i Pujol, Barcelona, Spain.

Received 2 October, 2007

Revised 13 November, 2007

Accepted 30 December, 2007

Correspondence to Brian Angus, Nuffield Department of Medicine, Room 5801a, Level 5, John Radcliffe Hospital, Headington, Oxford, OX3 9D4. E-mail: brian.angus@ndm.ox.ac.uk

© 2008 Lippincott Williams & Wilkins, Inc.