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Starting and Stopping Treatment
May 6, 2004

I was wondering what do you think about starting and stopping treatment. Say you started meds with t-cells at 250. Then after 3 yeras you stop with t-cells at 900. 2 years later its back at 250. Could you still go on the same treatment or do you have to switch? If you are 100% adherent, on avg. how long can meds works for? Thanks

Response from Dr. Young

Thanks for your question.

I think that occasional stopping and restarting therapy, like you've described is not irrational. I don't universally recommend this, and discontinuations should be monitored very closely. Now with those conflicting statements made, I do have patients like you who have gone off medications for a variety of reasons, following successful viral suppression and immune system recovery.

The time that one is able to stay off is dictated by how low your CD4 count was before starting and how high the viral load got during the holiday. There needs to be consideration into the potential that each discontinuation might cause drug resistance (which is why frequent starting and stopping is not a great idea, in my book); and we don't yet know the best way to stop medications that last for different times in the body.

Lastly, while I can't give you a precise answer to how long meds will work, I can say that I've got numbers of patients who have been sucessfully suppressed for over 8 years now (and counting).

Thanks for reading. BY

cd4 of 5, vl at 130,000 how long?

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