Hi: To any doctor, realistically how far are we from chronic HAART, to some sort of therapy that will allow us to take intermittant breaks from HAART for viral control? Thanks.

The current paradigm for HIV treatment is chronic use of effective antiretroviral medications without interruption. For many patients who have little/no drug resistance and who now have suppressed virus and CD4 counts > 350-500 and who are not missing any doses--the goal is life long control of HIV (aiming for a normal life expectancy). Since current HIV drugs stop the growth of HIV but don't kill/eliminate resting or integrated HIV, certain forms of HIV persist for decades and can start growing again when treatment is stopped. Treatment interruption studies have generally been a failure (with generally unacceptable rates of clinical problems or resistance) except for those who have never had a low CD4 count (above 350) when treatment is stopped or started at relatively high CD4 cell levels (started when CD4 falls to 350), and results have been better when a boosted protease inhibitor has been used (to reduce resistance). For now treament interruption has to be viewed as a research approach not proven safe or effective for widespread use. KH