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How many structured interruptions possible?

Feb 9, 2007

Dear Doctor, After a four-year break I have now to restart treatment: no big shock, I was prepared to the idea and, on the whole, even surprised that I had been able to live without medications for such a long time (restart is not due to any opportunistic infection but to a constant loss in CD4 count and % decrease). Do you believe that a second structured interruption will be possible in the future? On the one side being on medications with an undetectable VL made me feel less anxious (I am the HIV+ female in a magnetic couple and despite the use of condoms I am always worried about the possibility of infecting my partner), on the other side, medications had caused marked lipodistrophy and very high lipid levels.

Thanks a lot

Response from Dr. Pierone

Hello, and thanks for posting.

I have seen patients cycle through more than one treatment interruption and do fine. Although the SMART study was stopped early because the treatment interruption arm had a greater risk of complications and death, there is still ongoing interest and research in this field. We know that some patients with higher CD4+ lymphocyte counts do fine for periods of time off therapy. An ongoing challenge is determining how to best target the use of HIV medications to maximize benefit and reduce side effects.

One bright area is that in the 4 years since you have been on treatment the medications have improved and it is quite possible that your next regimen may not result in the side effects that you had in the past.

Let us know how things go for you and best of luck!

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