Immunological success is predicted by enfuvirtide but not interleukin-2 therapy in immunodepressed patients.

Objectives: To evaluate the efficacy of adding interleukin-2 (IL-2) to an optimized background treatment in HIV-1 patients with advanced failure. Design: Randomized, open-label, multicentre controlled trial. Methods: Patients with CD4 T-cell count of less than 200cells/mu l, plasma HIV-1 RNA of more than 10000copies/ml and a genotypic sensitivity score showing two or less active drugs were randomized to either eight IL-2 cycles with optimized background treatment or optimized background treatment alone. Optimization was made according to genotypic sensitivity score. Enfuvirtide was added in enfuvirtide-naive patients. Evaluation was performed at week 52 on the proportions of patients with CD4 cell count of at least 200 cells/mu l (primary outcome), of patients with a CD4 cell count increase of at least 50cells/mu l from week 0, on plasma HIV-1 RNA and HIV-related events. Results: Fifty-six patients were analysed. Median age was 43 years, 61% were at Center for Disease Control and Prevention stage C, 43% had a genotypic sensitivity score of 0, median baseline CD4 cell count and plasma HIV-1 RNA values were 64cells/mu l and 4.9 log(10) copies/ml, respectively. Treatment could be optimized in 23 patients. At week 52, in the IL-2 and control groups, the proportion of patients with CD4 cell count of at least 200 cells/mu l (14 and 18%) or a CD4 cell count increase of at least 50 cells/mu l (25 and 32%) and median plasma HIV-1 RNA were not significantly different. In multivariate analysis, optimization with enfuvirtide and baseline CD4 cell count were statistically associated with CD4 cell count of at least 200cells/mu l at week 52 (P=0.003 and P=0.01). Optimization with enfuvirtide was the only factor associated with a CD4 cell count gain of at least 50 cells/mu l (P<0.001). There was no difference in the rate of AIDS events between groups. Conclusion: IL-2 failed to increase CD4 cell count in immunocompromised patients with multiple therapeutic failures. Enfuvirtide use was highly associated with success. (C) 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins