HAART interruption strategies: how, when & why?

Mark Dybul, MD

Although structured treatment interruptions (STIs) are no longer the most pressing topic among the many researchers who were initially charmed by their multifaceted potential, STIs very much remain in the hearts and minds of clinicians and people living with HIV. And why shouldn’t they?

The reasons for wanting to halt therapy, even temporarily, are just as valid today as they once were. Even in this day and age, in which once-daily drug regimens with low pill burdens are plausible, there are countless patients who continue to grapple with adherence issues and treatment ‘burnout’. There is also the issue of long-term side effects, whether it’s preventing, delaying, or reversing their onset.

Immune augmentation still remains a worthwhile goal, although its potential seems limited to those fortunate few diagnosed during the primary stages of infection. Finally, there is the possibility of using STIs to overcome drug-resistant virus in patients running low on fresh treatment options.

It is encouraging to know that numerous researchers, Dr. Mark Dybul being one of them, still see hope in treatment interruption strategies. “It’s important to remember that treatment interruptions have implications on a global scale,” Dr. Dybul said during his opening remarks. “Both in resource-rich and resource-poor areas of the world, toxicities and quality-of-life issues are important factors to consider when discussing long-term treatment. In resource-poor settings, there is also the cost issue to consider. The costs of antiretroviral medication are prohibitive if our goal is to make these therapies more widely available. Reducing the length of time a patient needs to be treated is certainly one way to deal with this issue.”

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