Stopping Your HAART?

Conference Review
By Jeffrey T. Schouten, M.D., Brian Coppedge, HIV Treatment Specialist, and Dan Dawson

Perhaps the most sobering statement of the entire conference was that of British physician Dr. Brian Gazzard, who said, "The patients who have done best are those who have lived long enough to realize that my previous advice was incorrect." (He was referring to a time prior to the availability of protease inhibitors, when he had recommended use of sequential NRTI monotherapy, followed by the addition of 3TC.)

Dr. John Mellors corroborated this when he that one of the basic assumptions about HAART therapy is now proven wrong; that all drugs need to be changed out at the time of treatment failure. New studies are showing that when people fail a combination of two NRTIs and a PI they often show no resistance to the PI at the time of failure. [Note: Perspective editors wonder why the viral load can be increasing if the person is still taking a drug that should be preventing viral replication. Clearly, there is clinical failure, even if the resistance tests don't show resistance to the PI. So if the PI is not working, why continue it?]

There remain many unanswered questions about when to start therapy, what drugs to use, when to switch, and what drugs to switch to. Also, there still are very few options available for people with viral resistance to the current FDA-approved antiretroviral drugs. Metabolic complications of protease inhibitors are a major problem for the majority of people receiving them, and the role of resistance testing remains unclear.

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