Cautions on Stopping Therapy

Unfortunately, research into structured treatment interruptions has been disappointing. There are still many risks, so stopping anti-HIV medications on your own is not recommended. Some of the potential hazards of taking treatment interruptions include:

• Stopping treatment will likely reverse the benefits you've had from anti-HIV medications.

• During a treatment interruption, the viral load will likely rise and the CD4 count will likely fall. This can increase the risk of developing AIDS-related infections
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• Stopping and restarting medications may make it easier for the virus to develop resistance to anti-HIV drugs.

• Some PHAs who restart their treatment after stopping may find their viral load does not drop to previous low or undetectable levels.

• Some PHAs experience flu-like symptoms during an increase (rebound) in their viral load.

• Some PHAs may find it harder to re-develop the habit of taking medications regularly after stopping medications for a while.

As well, we don't know if there might be certain negative consequences that have so far been little studied. For example, researchers have reported that during treatment interruptions there was a rebound of virus in the cerebrospinal fluid, suggesting a possible negative consequence for the central nervous system (brain)

If, however, despite all these unknowns and cautions, you're thinking about taking a drug holiday, it will be very important to plan it carefully with your doctor.

• Review your overall health and lab tests with your doctor. Talk about your reasons for taking a break and find out about the possible risks and benefits to your own health.

• Have viral load and CD4+ count tests done more frequently.

• Decide on the guidelines for restarting your cocktail. For example, you may want to take a break of a certain amount of time, or plan to re-start when your viral load or CD4+ count hits a certain level.

• If your CD4+ count drops, you may need to consider taking medication to prevent opportunistic infections.

• Plan ahead of time the specifics of the cocktail that you will start back on. If your viral load was below 50 copies when you stopped, you could re-start the same combination. If it was higher, and there were signs of drug resistance, you would probably want to start a new combination when your drug holiday ends.

• Talk with your doctor and pharmacist about which drug(s) to stop first. Some drugs remain in your blood longer than others. For example, the non-nuke efavirenz (Sustiva) can stay at fairly high levels for many weeks after your last dose. The other drugs in the cocktail may be gone from your body but some efavirenz remains and, for a time, it will be the only drug the virus is exposed to. Exposure to just that one drug may be enough for HIV to build up resistance to it C and to the related drugs nevirapine and delavirdine. Such resistance would rule out these non-nukes as future options.

What to Expect if You Take a Break

• Be prepared for your viral load to rise. Eventually it can climb back up to the pre-treatment level or even higher. The rise in viral load may happen fairly quickly after stopping treatment.

• Be prepared for your CD4+ count to drop. If your treatment interruption is long enough, your CD4+ count may return to its pre-treatment level or go even lower. If it falls below 200, you could be at risk for serious illnesses, especially PCP.

• Some drug side effects may decrease. For example, peripheral neuropathy (PN) -- the nerve damage that causes pain, tingling or numbness in the hands and feet -- may improve after a number of weeks or months off the causative drugs. Elevated levels of blood fats (cholesterol and triglycerides) may decrease. Drug-induced diarrhea or intestinal gas will probably disappear. However, be aware that in some people there may be little or no improvement with certain side effects. For example, if the nerve damage is too far advanced, the PN may not improve.

• If you had HIV-related symptoms (such as skin problems, chronic fatigue, neurologic problems, weight loss or diarrhea) before you started treatment, they may come back.

• Some people may experience what is called a "retroviral syndrome," the combination of flu-like symptoms that many people experience during acute infection.