Question

Can I stop treatment if missing weekend doses has been okay?

9 September 2014. Related: All topics, Changing treatment, Living with HIV long-term, South Africa, Stopping treatment.

I have been taking Sustiva (efavirenz) and Epzicom (abacavir+3TC) for the entire 12 years that I have had HIV. I have maintained an undetectable viral load this entire time as well with CD4 counts that range from 700-900 also consistently.

For the past year I have eliminated taking my medications on weekends and my CD4 counts and viral load have remained the same.

I would like to stop taking the medications completely. I have no other health issues and I can see that my body is beginning to respond with bloating abdomen and upper back fat and I believe it is the long term side effect of these medications.

Answer

Answer: Simon Collins

Hi

Thanks for you question which raises several issues.

The first is about taking the break from your meds at the weekends. You have partly been lucky that this worked for you, but it is also related to the drugs in your combination.

About five years ago a study called FOTO (Five On, Two Off) reported similar results from people using a combination of efavirenz+tenofovir+FTC. These three drugs all have good drug levels that mean that for most people, missing a dose or two may be safe, even doing this every weekend. It is not thought to be as safe to do this with abacavir + 3TC (compared to using tenofovir + FTC), so this is not generally recommended, but it seems to have worked for you.

The second part of your question talks about stopping treatment completely. This is a very different situation and there are lots of studies to know what is likely to happen.

Nearly everyone who stops HIV meds will see their viral load quickly become detectable again. This could happen within a week. If you stay off meds, the viral load will then rebound to a similar level as when you first started treatment.

You CD4 count is likely to drop. Although this might take a month or two before it happens, The SMART study showed that it can take a long time to regaining your CD4 count when you restart treatment and that even after 18 months, many people still don’t reach the pre-interruption level.

All treatment guidelines have the same recommendation that treatment should not be stopped unless there is an important medical reason to do this.

If you are concerned about potential side effects, it would be much better to talk to your doctor about these worries. It would be safer to switch to alternative drugs that to stop altogether.

The SMART study was also important for showing that people who took treatment breaks had higher risks of serious complications compared to people on continuous treatment. This include a higher risk of liver, kidney and heart-realted problems and higher rates of some cancers.