What's So Bad About a Little HIV Treatment Break? (Editor's Pick)

Question

Dr Young,

I keep reading that Drug Holiday's are dangerous. I understand that there are reasons why a person would or would not want to take a drug holiday but my question is more specifically on the danger.

Is the danger because the virus could come back and even faster or stronger.. does it have more to do with mutations or is there something in the body that coming off strong medication could produce an effect not even associated with HIV? If a person has been undetectable for years and wishes to simply stop putting toxic chemicals in their body for a short period of time (a month or 2) is it truly "dangerous" to the body?

Answer

Hello and thanks for posting.

Back in the day, when treatments were toxic, it was thought the virus would be better than toxicities- so we initiated treatment late (ie., hit late, but hit hard). As medications got a little better, we thought that we could boost CD4s to healthy levels, the stop until levels drifted back down, and then resume treatment (i.e, hit hard, some of the time).

Then came the SMART study. As reported in TheBodyPro in this nice audio interview with Dr. Waafa El-Sadr, strategic interruption of ART (compared with continuous treatment) was bad. Interruptions were associated with increased risk of complications and death, and in other studies, interruptions also appear to be related to lower levels of CD4 count recovery.

There are always worries about the risk of drug resistance during treatment interruptions (proven) or in poorly adherent people while on treatment (also proven), but with some of the newer regimens (especially single tablet regimens, or those with boosted protease inhibitors or the integrase inhibitor, dolutegravir), the risk of resistance is much lower than with older (now outdated) regimens.

Hope that helps, BY