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Drug Holiday at Recommendation of Doctor
Nov 24, 2005

Dear Dr.:

I have heard so many pros and cons about drug holidays, so there may be no one answer to this question, but I am a little concerned about the drug holiday I am taking at the recommendation of my doctor.

Before stopping my medication (I was on medication for a little over two years specifically Kaletra and Combivir and taking it religiously), I had a CD4 cell count of almost 800 (it has been rising continually from 320) and undetectable viral load (from the original 154 000). I felt great and the only side effect was slight anemia. My doctor, however, felt I should go on a drug holiday, saying that it would do my body good. As she is one of the leading experts on HIV in my country, I consented. I have now been off for 5 months and my CD4 cell count is down to 404 and my viral load is 166 000. She told me that I could still be off medication and that I would restart my medication probably in January after the next set of lab tests. (All my other blood tests were glowing, which pleased her.) However, having read that the benefits of drug holidays have not really been documented, or more precisely, that there is nothing to suggest that the benefits for the body outweigh the risk of viral resistance, I am slightly worried about my doctor's suggestion and my taking her up on it, although when asked she said I should not worry and that the viral load should again reach undetectable levels. Therefore, your opinion as another expert in a different country may be useful should a drug holiday be suggested to me again in the future or help others who may be asked to make this decision by their doctors. Thank you for your valuable time.

A.F.

Response from Dr. Pierone

Hello and thanks for posting. You are correct in that we don't know if drug holidays represent a preferred means of managing HIV infection. There is a very large global study called SMART which is comparing continuous therapy versus treatment interruptions. So the evidence is not in yet and it will take some time to answer this question.

My personal view is that either approach is ok, continuous treatment or periodic drug holidays along the lines of SMART (which we are participating in). Based on what I have observed, both groups do very well.

Getting to the specifics of your situation - the risk of developing drug resistance from an occasional therapy interruption on a Kaletra-based regimen is extremely low. Nonetheless, if it is your personal preference is to be on therapy and maintain an undetectable viral load then let your doctor know and see what she says. Let us know how things go and best of luck.



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