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Reviewing an earlier (March 6, 2005) posting about drug holidays
Apr 20, 2005

A warning about resistance and staying undetectable, posted Mar 6, 2005 brought about an issue that is most important, as you pointed out in your answer. I am adding my weight to this particular problem of thinking that because you are doing well that a drug holiday is acceptable. The thought process behind this seems to invariably be, from those I've read or heard from personally, is that their CD4 count was at a level that their health was thought to be ok enough to take a break from regimented days and the psychological break it brings. This couldn't be further from the truth. There are many factors that have to be looked at first. The stress brought on, naturally, over potentially having a problem even though you think you're handling it ok. Usually you aren't because there's always this nagging worry about your decision affecting your health, thus the stress issue entering into the equation and stress is the biggest setback youll face short of having hiv in the first place. There are issues such as nevirapine (in my particular case) now being known to remain in the system longer than previously thought, thus the other drugs (usually zerit/epivir) suddenly being dropped causing a problem, even though you think you've removed all three from your body by stopping cold turkey: you haven't due to the nature of the drugs themselves. What prior resistances, usually unknown to the individual, have caused your hiv to potentially mutate and gain a moderate resistance that this holiday is exacerbating. And from those that I've spoken to that view their holiday as a break in every regimented thought process they spent years building, there is also a relaxing in their approach to sex and sexual attitudes because of the perceived invincibleness (is that a word?) that allowed the formation of the drug holiday thought process in the first place. I think something that has become commonplace anymore is that while many, many people out there have become very expert in dealing with their meds and their effects and the regimens and the various and sundry of hiv-living AND the constant push by doctors and health care providers to force hiv-ers to be a part of their medical decisions, thus enabling many to bridge the gap between denial and acceptance, and with it the treatment they may need, I think this has brought about an era of people thinking that they are now medical experts and that they are able to completely decide on making a decision that could potentially doom their eventual recovery from this decision making process. They forget that usually, not always, we only know what weve experiencednot what the bigger picture is where hiv and the decisions for treatment are concerned that a doctor looks at. This is not to say that drug holidays aren't successful at times. But you must approach it with every bit of support and medical advice and studies curved toward your particular regimen, age, etc you can find out there. And you still maybe have to brace yourself for not handling it psychologically, thus impeding the entire attempt from the beginning. I was forced into a drug holiday thru loss of a job, insurance, etc and the ensuing government red-tape kept me from effective treatment for close to a year, regardless of those that will say theres help out there, you just have to know where to find it. I was part of a process that still denied me access due to specific circumstances. I was lucky and am part of the system again and have slowly been recovering from a staggering loss of cd4 and skyrocketing viral load. But that recovery is taking three times the effort and time it originally took to erase the negative numbers I had when I first started meds 5 years ago. Being 50 years old, 8 years positive and seemingly mature enough to make decisions for myself, albeit thru actions outside my ability to control initially, wasn't enough. I still am suffering the consequences of my drug holiday and rue ever being placed in a situation where I was forced into it. But before it happened, I was thinking about doing it voluntarily because I thought I was healthy enough to withstand it. Now I know better. It isn't about just telling yourself you can do it. Your genes, your environment, your mental health, your social life, your sexual life, your self-respect and self-awareness are only one part of the equation of making the drug holiday decision. Thinking that you want to have your life be like it was before you sero-converted just because you look good, feel healthy and are undetectable is really just denial in disguise. Act like you want to live as long as you can and then study the decisions that will help this come true. Maybe a drug holiday will help. But maybe it won't at all.

wayne-

Response from Dr. Sherer

Thank you for these thoughtful cautions about treatment interruption. I urge the readers of this website to read it carefully.


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