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Taking a break
Nov 22, 2007

I am a + male 41 years old and in excellent health. My viral load is undetectable and mi CD4 are above 1200. I have been in treatment since the day I found out I was positive 11 years ago. I have great tolerance to medications and fortunatelly no side effects whatsoever. Nevertheless, after so many years of taking pills, I would like to take a break. I am a little concerned about the implications of not taking the medicine and irreversible damage to my immune sytem. For how long or what should I look for if I do not take my medicines and how would this affect my overall health in the future? Would you recommend taking this break or would you think this is irresponsible behavior of me?

Thank you for taking the time of answering my question and please keep up the good work. You are definitelly angels on earth.

Response from Dr. Daar

Thank you for your posting.

You ask a very important question for which there are many unknowns. In order to answer your specific question I would need to know more about your treatment history, how low your CD4 cells have been in the past and whether you have ever had any symptoms associated with HIV infection. Since this information is not avaialable to me I will provide some general comments that I hope might help guide further discussion between you and your HIV provider.

First of all one needs to consider why they want to stop treatment. If it is because of side effects or concern that medications are being missed and resistance may develop then these issues need to be addressed. Often things can be done to deal with these specific issues and treatment can be continued. Other times for any one of a variety of reasons consideration of stopping therapy persists. In this case most would agree that this should be done with great caution in those with a history of HIV-related symptoms or CD4 cells less than 200 cells/uL. In those who have never had symptoms or low CD4 cells it is generally felt that treatment can be stopped and the CD4 count monitored without excessive short-term risks. It is important that this be done in a deliberate way since different regimens are best stopped in different ways and this needs to be addressed in advance with ones provider.

It is important to note that several recent studies, in particular the SMART Study has raised concerns that simply being off therapy may be a bad thing. This may relate to some immunologic damage, but also potential effects of simply having ongoing viral replication. In light of this experience the discussion regarding the risks of treatment interruption needs to be expanded to deal with a variety of theoretical risk that remain to be defined. Moreover, I believe that many HIV providers are increasingly reluctant to recommend people stop treatment unless there really is a good reason.

Please think these issues over and discuss them with your provider. Ultimately the decision is yours and as long as you work with your provider and are monitored closely I am sure you will do very well regardless of what you decide to do.

Best, Eric


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