Jan 20, 2002
I am on 3TC, Nevirapine, D4T for 2 years with ideal results. I am, however, very tired of taking the drugs. I tried a drug holiday last year but felt sick after a few days and wasn't up to continuing the break. I would dearly love to have a break from treatment but am worried by the idea. I don't want to get sick and don't want to develop resistance. But if it's possible to be off the drugs to avoid cosmetic and other side effects and to preserve them for later, I'd like to try again. I'd also like to see how I feel without the drugs. Should I have any concerns? My doctors have suggested the holiday to me.
Thanks for all your advice here. It helps to have access to advice when you wake in the middle of the night sick of having HIV. Also helps to get different perspectives as it's not a black and white area of medicine.
Response from Dr. Little
As you have already suggested, this is not a question with a black and white answer. My opinion regarding treatment interruptions has a lot to do with your CD4 cell count at present and your viral load off therapy (ie what does your viral load rebound to when you discontinue your therapy - or what was it before you started medications). In general, I do not think that the treatment interruption studies have shown much of a benefit. Some of the more recent trial results are more promising, but again, these results suggest that larger trials are needed to validate the findings on a larger scale, not necessarily that the methods are suitable for use in the community. So, if your CD4 cell count is high (ie greater than about 400), I think that the risk of a treatment interruption is relatively small, unless your pre-treatment (or off treatment) viral load is high. Even with a high CD4 cell count, if your viral load off therapy is high, then you are more likely to have a rapid depletion of your CD4 cells when you stop your therapy. If you have a high CD4 and a low off-treatment viral load, then you are at a lower risk for progressing off therapy and a treatment interruption might be lower risk. Finally, if your CD4 cell count is low (ie less than 200) then I do not feel that treatment interruptions are a good idea regardless of your viral load - since the risk of developing an HIV-related illness is high. If your CD4 falls in the middle range (ie between 200-400), then this is the grey zone. Again, my opinion is that the choice of a treatment interruption really comes down to how miserable you are on therapy. If you are tolerating your meds well and not having any problem with treatment adherence, then I would not advise a treatment interruption. If you have many side effects, it may be worth it for you - given the advice outlined above. Keep in mind that this advice is my opinion, and that in the absence of clear cut studies to guide us, you will be receiving many different opinions from many different physicians on this topic. Good luck.
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