Debate Over Antiretroviral Treatment Interruption Remains After Findings Show Method Increases HIV-Positive Patients' Risk of AIDS, Death
February 8, 2006
The Washington Post on Tuesday examined the debate surrounding the Strategies for Management of Antiretroviral Therapy trial, which compared daily antiretroviral therapy with a drug-conservation strategy that involved taking medication intermittently and was presented at the 13th Conference on Retroviruses and Opportunistic Infections in Denver on Wednesday. The results of the trial, which was stopped early, show that the strategy increased HIV-positive patients' risk of developing AIDS or dying, the Post reports (Brown, Washington Post, 2/7). The SMART trial, which involved 318 sites in 33 countries, began enrolling patients in January 2002 and included 5,472 HIV-positive participants when the trial was suspended on Jan. 11. SMART trial volunteers were randomly assigned to a daily antiretroviral therapy regimen or an episodic treatment strategy, which called for taking medication only when CD4+ T cell counts dropped below a specific level. Previously, smaller studies indicated that taking monitored breaks from daily antiretroviral treatment might control the progression of HIV while reducing some of the drugs' side effects, as well as lowering costs of the treatment regimens. However, interim studies of the National Institute of Allergy and Infectious Diseases trial conducted last month by the independent Data and Safety Monitoring Board showed that participants who took their medication on an irregular basis were more than twice as likely to experience increased progression of the virus or death compared with those on a daily treatment regimen. Patients taking episodic treatment also were more likely to experience cardiovascular and kidney complications as well as liver disease, all of which also have been related to antiretroviral drug use (Kaiser Daily HIV/AIDS Report, 1/19).
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