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new strategy
Aug 5, 2003

IF I GET MY Tcells in normal range then stop therapy until cd4 count reaches almost aids levels start the therapy until cells normal again. Is this possible to do because if thats the case it takes mostly about 8 years to reach aids levels which means that i can go on and off therapy until there is a cure?

Response from Dr. Pierone

Our current approach to HIV therapy is primarily directed at controlling viral load with the goal to get virus levels undetectable. By doing this, the expectation is that CD4 cells will obligingly rise and generally they do. But when, if ever, to stop therapy?

Many experts would say you never stop treatment once you start. The burden of proof is on those that suggest that strategic treatment interruption (STI) is advisable. For a more in depth discussion of STI see coverage of the STI debate at the recent International AIDS Society meeting in Paris.

The approach that you describe is similar to CD4 directed antiretroviral therapy that is being investigated in the SMART study.

You mention that it takes about 8 years to reach AIDS levels from normal CD4 counts and this is not entirely accurate. For untreated HIV infection the average natural history of progression is more like 10 years, although there is quite a lot of variation among people (that viral load levels help predict). But once someone has allowed CD4 counts to drop to just above 200 CD4 cells (AIDS level), the situation is very different from newly diagnosed HIV infection. Once CD4 levels are low, even if treatment is started and CD4 counts return back to normal, the immunologic reserve has been compromised to some degree. So if treatment is interrupted the CD4 decline will tend to be faster than the natural history numbers. So going off therapy in this scenario with hope of cure in 8 years is probably not realistic, partly because progression back to low CD4 cells may be faster and we don't know the timeframe for a cure.



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