Question
Can you take a treatment break?
21 May 2008. Related: All topics, Living with HIV long-term, Resistance.
Is there any chance in the near future that some one can have a HIV treatment break?
Answer
Everything in HIV care should be individualised. So there may be some people, and some circumstances where the advantages of a treatment break are greater than the risks. In general, treatment breaks are not a good idea and this is something you will need to discuss with your doctor.
The SMART study showed that interrupting treatment carries an increased risk of serious, including fatal, complications that we previously thought might be related to treatment.
In SMART, people who interrupted treatment were 3 to 4 times more likely to have a heart attack, or serious liver or kidney disease, compared to people who stayed on treatment and who had an undetectable viral load. These results were unexpected and caused this large international study to close after only two years. See this HTB report for results first presented in February 2006.
The study also showed that the drop in CD4 count that people in the study got when they stopped treatment was very difficult to gain back. Even 18 months after restarting treatment, CD4 counts still remained an average of 100 CD4 cells lower than at the start of the study. See this HTB report for details.
Putting the SMART results into context though is more complicated. The actual ‘absolute’ risk of a serious illness was still fairly low. Over 95% of the almost 3000 people who took the treatment break did not experience a serious AIDS-defining illness. The ‘relative’ risk – the rate of serious events in the interruption group compared to being on continuous effective treatment – was still 3-4 times higher. So you are left knowing something is generally unlikely, but significantly more likely, when off meds. Tricky to explain and understand.
The researchers are still trying to find out whether it is possible to find out why the treatment break was so risky in some people. This recent analysis showing that having detectable viral load increases markers of immune activation and inflammation may have some of the answers.
Until then, your doc is likely to say it is a bad idea, unless you have really difficult side effects, really poor adherence, a really strong CD4 count (and you started treatment with a high CD4 count), and based on the most recent SMART results, you have particularly low levels of D-dimer and IL-6.
Sorry to have answered in such detail :)
Me? I’m staying on treatment til they find the cure…
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