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my doctor want to stop meds on me
Jun 16, 2005

My doctor ask me if I want to stop meds for a while. She says that my cd4 right now is 965 and my virald load 1,000.00. She said that because I never been sick and never had a cd4 under 485 I could do it very well. What do you think about this new theory that some doctors stop meds(holiday)in some patients? I'm HIV poz since 1994 and after 1997 my cd4 has been in the range of 600 to 1,000.00. My Viral Load has been undetectable since 1997. What do you recomend me?

Response from Dr. Frascino

Hello,

No one really knows the right answer to this question. The problem is trying to balance the beneficial effects of HAART treatment against the potential long-term consequences (side effects and toxicities) of taking these potent meds year after year.

At the present time HIV treatment guidelines suggest HAART treatment be started when CD4 counts fall into the 250-350 range consistently. There are many folks like you who were started on medications with higher CD4 counts a number of years ago and have done well from both immunologic (high CD4 cell counts) and virologic (undetectable viral load) perspectives. The thought is perhaps we could (should?) stop HAART and let your body's own immune system try to control your HIV infection until your CD4 count falls into the 250-350 range. This may take years (or could happen relatively quickly). The hope would be that we are saving the potent medications until you need them the most and that we could perhaps decrease some of the cumulative long-term toxicities, i.e. lipodystrophy, lipid abnormalities, peripheral neuropathy, etc., etc., etc.)

No one really knows how to balance the risks vs. the benefits of stopping therapy when someone has been on it for years and is doing well. There are some ongoing clinical trials in progress that hopefully will help us to answer this question. Until then, the best I can offer is that it is a reasonable option to consider. Whether or not you should try it depends on many factors, including how well you are tolerating your current medications.

Good luck. Stay well.

Dr. Bob


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