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To continue Meds or Not?
Sep 9, 2004

Hello: If you have been treated on the theory of hit it early and hard with meds and you are doing great on meds with no reactions and counts are at vl 0 and cd4 1000, would it make any sense to stop? Or continue for as long as the meds are working? Being he is 21 and his immune system is strong which direction would you advise, staying on meds or coming off and seeing how his numbers react?

Response from Dr. Pierone

Good question that we don't know the answer to. That is why we are doing the SMART study. This huge multi-country study is randomly assigns people to one of two treatment schemes. The first is to take continuous antiretroviral therapy with a goal to keep viral load undetectable. The other group is observed off HAART until the CD4 count drops below 250 at which time they go on meds until CD4 count rises to above 350 on two consecutive readings. They then stop and restart again when count drops below 250 once again. One could quarrel with the threshold at which to start and stop, but the idea is to compare aggressive continuous long-term therapy to more of a watchful waiting plan.

Since we don't know which is best, either approach is appropriate for your friend. If he is happy on therapy and not really inclined to stop, then he should continue. If he is anxious to get off, then it is likely he would do well for at least some time off meds. If he can go either way, he might consider participating in the SMART study if there is an investigative site nearby. Here is the link for the web site. Thanks for posting.



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