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treatment interuption
Sep 6, 2001

Dear Dr., (You last answered me on 8/19 Drug Holiday.Your response was great.This is a follow-up Can you comment on what might be the viral load trend based on these labs.? I stopped meds on 5/29 with a <50 vl and cd4 935 36 6/20 vl<50 cd4 801 35 6/29 vl<50 cd4 968 39 7/13 vl 258,cd4 796 34 8/17vl 5790 cd4 855 35.

My first vl taken on 12/94=7926,highest 40,592 on 6/96. Started meds on 4/97 and vl always unded to lowest value avail at time of test I stopped to give my body a rest and plan to return to meds when vl>50,000 cd4<500 or 25 or some combo of factors. Thank you for your help.

Response from Dr. Cohen

Well, it appears that it took about one month for your HIV to go from <50 to above. And since then it continues to slowly rise. Almost three months later your viral load is still only about 6 thousand, and your CD4 counts are for the most part pretty stable.

The problem is that we still don't yet have a great way to predict what will happen next. There are a few generalizations to be made - one is that since your pretreatment viral load was <50 thousand, your ability to have a reduced set point through some manipulations is greater than those with higher set points - this is one of the observations from the largest treatment interruption study going on in Europe, the SSITT study, which stands for the Swiss-Spanish Intermittent Therapy Trial (for obvious reasons, the Hungarians were asked not to participate...).

In that study, they noted that after a year of periodic interruptions - those whose pretreatment viral load was <60 thousand had a better chance of reducing the off - treatment set point one year later than those with higher pretreatment viral loads. Also, they noted that those who did not have a viral load rebound after two weeks off meds had a better chance of a lower set point off meds. And you are fulfilling both of their criteria.

But we still lack a lot of info on what happens next - for example if you are only 6 thou at month three what to expect? Will your viral load stay low or increase in time? Was your set point truly about 7 thousand and was that 40 thousand just a temporary increase or will you go back up that high again? And if so, what would happen? Could it go higher still?

And here we are still in learning mode - so your experience and others will answer this question. For now, one thing we do see a slow loss of CD4 cells when people stop - but this can vary, and probably has some relationship both to your off treatment viral load as well as how high your CD4 count became as a result of meds. Since those who had very low CD4 counts before treatment seem to have a higher risk of losing these cells when stopping. Which has led to more caution in longer med interruptions for those with a low CD4 count in their history. And since you don't have that burden, you are again able to continue to monitor and see what happens.

And in time your experience, and the others in studies, will help answer your question with something more than this...



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