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Stop meds program
Nov 14, 2005

Dear Doctors I was asked by my doctor to participate in a worldwide program of a study concerning in stopping meds. My tests are Ok (CD4 550 and VL undetectable). Have you already heard about this study and if so what do you think about that?

Response from Dr. Sherer

Yes. The SMART study is a study that tests a very important question in HIV care, i.e. whether a patient like yourself who has had an excellent response to ART, and has high CD4 cells and an undetectable viral load for a long time, has a better prognosis if he or she continues to take their ART, or safely stops their medications and allows their viral load to increase and their CD4 cells to gradually fall back to a level at which ART is resumed.

I think the study tests an extremely important question, and I think it is well-designed to answer that question. No doctor can tell you at this point whether its better for you to continue on your ART or to stop TEMPORARILY.

So I support the study, and your enrollment in it, as your doctor suggests. I advise you to talk to your doctor about the study again, and about this response.

There are a few important points to make, which ever way a patient chooses to go.

If a patient and their doctor chooses to stop medications in this way, it is best if it is done as part of a research study, so we learn from the outcome.

If a patient and their doctor choose to stop medications temporarily in this way outside of a study, ongoing close followup and monitoring are extremely important. It would be wrong for a patient to conclude that because their medications are stopped, there is no further problem, and no follow up or lab tests are needed.

And it is important that ART be stopped carefully. A patient should talk to their doctor about how to do this. ART containing nevirapine or efavirenz should be stopped either by first stopping the NVP or EFV, and then the NRTIs one week later, or by substituting a protease inhibitor for the EFV or NVP for one week before all meds are stopped at the same time.

If patients stay on their medicines, they should not relax with their level of adherence, as this can allow resistance to occur, even when the CD4 cells are high and the viral load has been undetectable for a long time.

azt resistance
changing meds--does this really cause drug resistances

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