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Drug Holiday
May 8, 2005

Dear Doctor

Thank you for the wonderful work you do.

I am form South Africa and Sero-Converted around the beginning of April last year.

The anti-body test was still negative but additional tests confirmed infection.

My viral load at the time was 750 000 and my CD4 count 312.

My doctor decided to treat me immediately as I was quite ill at the time.

I am on a regimen of Stocrin,Zerit and 3TC.

6 weeks after commencing treatment my viral load was 300 and my CD4 750.

12 weeks later my viral load was undetected and has remained undetected to date. My last CD4 count was 1426.

My doctor is thinking of suspending treatment and give me drug holiday. (I have been on treatment for 1 year)

I must add that I tolerate the drugs very well and do not have any side effects.

Is it wise for me to suspend treatment? Is a year of treatment enough before taking a drug holiday?

Will it not be wiser to protect my immune system to benefit from future treatment options like CCR5 inhibitors?

Response from Dr. Pierone

It sounds like you were started on therapy before antibody development - the very earliest phase of HIV infection. This may be fortunate since a recent study suggested potential long-term benefit for those who began treatment within 2 weeks of seroconversion. In this observational cohort, the very early treatment group seemed to benefit as evidenced by better CD4 counts and lower viral load after they eventually stopped medications

In your case stopping therapy a reasonable way to see what is going on. If the CD4 count stays high and the viral load settles at a low and stable level then you may be able to remain off medication for years. Of course, some people in your situation would prefer to stay on medications until some ongoing studies better define the risks and benefits of stopping. There is no right or wrong approach based on the paucity of data to guide us. Regardless of what you decide to do, please give us an update on your status at some future point. Best of luck!



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