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"Drug Holidays" Pose Significant Risks, No Proven Benefits

May 5, 2000

A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

Structured treatment interruptions (STIs), sometimes referred to as "drug holidays," continue to attract much interest among people living with HIV and researchers looking for alternatives to a lifetime of drug therapy. Unfortunately, most of the research conducted on STIs so far has been in very small studies, and the data coming out of these studies is inconclusive as to whether the potential benefits of STIs outweigh the risks.


What is the Theory Behind STIs?

There are a couple of theories about how STIs work and how they can be useful for people with HIV. One theory addresses increasing HIV-specific immune response in people with viral suppression to undetectable levels, the other theory has to do with attempts to achieve reversion to drug-sensitive, "wild-type" virus. Following is a brief explanation of both of these theories.

One theory behind STIs is that structuring an interruption in medication and allowing viral rebound to occur will stimulate an HIV-specific immune response, creating a "vaccine-like" effect that controls HIV reproduction without the need for medication. It was reported in the AIDS Treatment News, April 21, 2000 edition, that a study is beginning in San Francisco to examine this theory. However, at this time, there is insufficient information from any study to indicate whether this theory is true.

Another theory supporting the use of STIs is that treatment interruptions may allow the virus to revert to "wild-type" strains that are not resistant to current medications. If true, this poses some opportunities for people who have drug-resistant strains of virus as they could potentially stop therapy, allow the "wild-type" virus to emerge, and then re-start therapy with the hopes of getting suppression to undetectable levels. A couple of studies have shown that some people do get improved short-term response, while others do not. However, this strategy needs to be researched further before any final conclusions can be made.

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What are the Risks of Doing STIs?

There are significant risks to stopping and starting medications, particularly for those on successful therapies with good viral suppression. Some of the potential risks are:
  • Development of drug-resistant strains of virus during the treatment interruption that limit future drug options (particularly for people on NNRTIs).

  • A decline in CD4 counts and increase in viral load that may lead to increased risk of developing an opportunistic infection.

  • Failure to regain viral suppression to undetectable levels when re-starting medications.

  • Failure to get significant CD4 count increase when re-starting medications.

People who want to try STIs in spite of the many risks need to work closely with their provider and be closely monitored, or participate in a study with rigorous controls and follow-up.


Want More Information on STIs?

For more information on STIs you can review the current information on the AEGIS website. Their web address is: www.aegis.com. From their homepage, use the search engine and type in the words "structured treatment interruptions." This will take you to the current information they have on the topic.


A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!



  
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This article was provided by Seattle Treatment Education Project. It is a part of the publication STEP Ezine.
 
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