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Pulse Treatment
May 27, 2004

I was diagnosed about 7 month ago. I believe I have been positive for 3 year. My past 4 results have been: VL 5200 CD4 506 29% VL 5300 CD4 590 34% VL 10500 CD 570 22 % VL 11900 CD 710 26 % The last 2 results are from a different lab. My doctor does not suggest that I start on medication. His suggestion is to start at CD 4 level of 200-350 or VL of 50000. Presently I agree with him. But, what if I start taking medication for 3 months and then stopped for 6 months and then start again. Pulsing the treatment. Why wait until I have to take it regularly and then deal with all the side effects. Can I achieve undetectability or a manageable VL with a pulse treatment while achieving minimal side effects?

thx Kar

Response from Dr. Pierone

Hi and thanks for posting. The reason that we don't recommend pulse treatment is that it is not a proven strategy for HIV infection. However, the notion of taking HIV medications in a pulse format has some merit. So much in fact, that an enormous NIH sponsored study called SMART is currently underway to help sort this out. There are potential risks of pulse therapy; the one that engenders the most concern is the potential for a higher rate of viral resistance. There are risks of course with continuous treatment; short and long-term antiretroviral toxicity is the greatest concern. Here is a link to an article that I wrote on pulse therapy STI overview.

So we don't know the answer to your question yet, but stay tuned. Here is the web site for SMART to learn more.



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