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Stopping Meds

May 21, 2005

Is it possible to stop meds? What are good numbers to have? I have been on meds for about 2 years and my most recents numbers where CD4 416 and VL less than 400

Response from Dr. Young

Thanks for your post.

Of course, it's possible to stop medications-- though it is not generally recommended without considering a number of factors.

We are learning a lot about when and how it might be safe to discontinue medications in patients who have undetectable viral loads. Much of this information is being collected from cohorts of patients who have elected to stop treatment-- what we can say is that the ability to stay off medications (without significant decline in CD4 counts) is related to the nadir (lowest ever) CD4 cell count and baseline HIV viral load. For those persons who started treatment with CD4 counts that were above 300-400, staying off treatment for some time seems possible. For those who started with low CD4 counts, stopping comes with the risk of a large drop off in CD4s.

The ongoing SMART study (from the CPCRA) is evaluating the strategy of stopping treatment when CD4 counts rise above 350. So far, the approach seems to work, though it is far too premature to be sure enough about this to endorse this for everyone. Bear in mind that with each treatment discontinuation, there is a very real theoretical risk of developing drug resistance (especially if the drugs that you take have different half lives in the body). This is one of the most important risks in starting and stopping treatment and needs to be weighed carefully.

I hope that this discussion is helpful to you, BY

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