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Can I Take a Pause

Aug 21, 2000

I have been taking Anti Viral drugs for three years.

Now my Virus amount is less than 50; CD4 level is 940 which is excellent.

I feel my body needs a break. If I stop taking the medicine for a fast would my excellent levels decrease???

Response from Dr. Cohen

The short answer is we don't know from what you've written what would happen. Since we don't know what your viral load was before you took medication. In general, after stopping meds, most will have a viral rebound back towards where it was before starting any medication -- what is called the set point. Some don't even know their set point as they started antivirals before viral load testing was available. And after you stop antivirals, that is the first consequence -- a regrowth of HIV. When this happens there can be some initial loss of the CD4 count -- in studies of those more advanced that you, the average drop in CD4 cell counts was about 100 -- but some might have fewer or greater numbers of CD4 count drops. And a few have even seen CD4 count increases!

Over time what generally happens is that you wind up similar to what it was like before treatment was used -- you have a steady decline in the CD4 count at a rate largely predicted by the viral load set point. If it is lower, then some lose T4 cells at 20-30 per year -- while others with a higher set point lose 50 or more T4 cells per year. So we can't predict what would happen to you.

It is clear however that with 940 you have quite a bit of "buffer" between you and serious HIV related illness -- even the minor aspects of HIV illness were rare events with a CD4 count over 500. And the general news about stopping and restarting is that for most, stopping with a viral load below 50 doesn't lead to viral resistance to these meds -- so you probably could restart this or some other combo in the future when you needed the help... no guarantees of course -- that's why there is still some anxiety about med interruptions.

And one alternative to stopping would be substitutions -- since we have 14 meds in the US -- and if whatever you are taking is no longer acceptable to you, you might have the option to just simplify the combo in some way. This would require discussion with a clinician who knows the rules of substitutions...

Hope that helps.

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