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Stopping Drug Therapy-- Started during acute infection
May 27, 2002

Hello, I have been HIV + for two years (March 4, 2000). My Viral Load is undetectable, my T-Cell count is 1550. I caught my virus in the early stages and have been able to keep it under control. I am on Viracept and Combivir. My doctors has indicated to me that he would like me to stop my drug therapy, as he puts it "you are healthier than those without HIV". I am just concerned that I was lucky enough to catch the virus soon, and I am fortunate that the meds have been working. I do not feel comfortable putting the facts aside to try something that may or may not work. He told me that he just wants me to be aware that the drugs can cause liver failure as a result of long-term use. I do know that in some patients when the virus was caught early on and treated aggressively that once patients were taken off meds the body regulated the virus and kept the virus in check without meds. I am at a cross roads here, I have been so lucky. My meds work and I feel great. To this point HIV has not changed one aspect of my life. I am hoping to keep this going.

Please help! I need information from expects to help me make a very difficult situation. As the say, "If it isnt broken, why fix it"?

Thank you for your time, I truly appreciate it.

TH

Response from Dr. Young

Thanks for your question.

You've raised some very interesting and important points about starting and stopping therapy during acute infection. The benefits of starting therapy during this period are largely immunological, with probable preservation of HIV-specific immunity and the possibility of enhanced immune-mediated control of HIV-- leading to lower "setpoint" or baseline viral load.

Several studies have suggested that if or when drug therapy is stopped, that the rebounding virus might act as an auto-vaccination, to which your immune system might become trained to recognize and fight. This point is at the moment, largely anectdoal though theoretically plausible.

My general approach has been to offer therapy to those acutely infected with the understanding that therapy will eventually be discontinued; but the when and how of discontinuation is not yet optimally defined. Major questions that I continue to look for answers include the benefits of structured interruptions, the optimal time on and off of therapy and the possible risks of the development of drug resistance with each treatment schedule. Because HIV has the potential to rapidly destroy the very part of the host immunity that is required to achieve HIV control, I worry about premature discontinuation of therapy, or interruptions performed without good scientifically-based guidelines.

So, until we have such data, and assuming that my patients are tolerating and adhering to their HAART therapy, I have favored continued therapy until the clinical and immunological studies provide additional guidance and insight. I believe that these data should be available in the near- or intermediate-range future and will be clinically valuable.

I hope this is helpful, good luck. BY



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