Since there are experts that advise witholding HAART in asymptomatic patients, should I stop therapy in my patients who have never had an OI, are asymptomatic? Some of them have known coronary artery disease, and many have adverse side effects of medication

This is a question we are wrestling with. There are many patients we started on therapy in years past that we might hav e not started today, say those with 400-500 CD4 cells and viral loads 10-50,000. Some of them now have CD4 counts in the 600-700 range. Should they continue?

There are no data and no consensus. I think a common sense approach is best for now. For most patients, who are tolerating therapy, and whose CD4 counts remain less than fully normal (say less than 600) few would routinely advocate stopping, and I am not doing this. There may be exceptions however. People with CD4 counts of 700 or 800 may be fine for several years off therapy, and if they are having problems with payment, compliance or moderate side effects, stopping is an option, albeit one with no data. For those patients with severe side effects and decent CD4 counts, such as uncorrectable, scary cholesterols in the setting of known coronary artery disease or overt diabetes, the risks of continuing may outweigh the benefits. Of course, for other side effects, such as body shape changes, it may end up being a matter of patient choice even though we cannot give them a good answer.

ATP