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Julio Montaner, Marianne Harris, Robert Hogg, Structured Treatment Interruptions: A Risky Business, Clinical Infectious Diseases, Volume 40, Issue 4, 15 February 2005, Pages 601–603, https://doi.org/10.1086/427707
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HAART has dramatically altered the natural history of HIV disease [1–5]. However, currently available treatments are suppressive and cannot eradicate HIV infection [6–8]. As a result, antiretroviral therapy in 2004 represents a life-long proposition requiring exceptionally good—if not perfect—adherence [9]. Unfortunately, many issues, including the complexity of the regimens, drug toxicities, drug interactions, lifestyle issues, and comorbidities, may interfere with achievement of this goal [10–14]. In recent years, a variety of therapeutic strategies have been developed to alleviate some of these problems: several safer and better-tolerated agents have been approved, simpler regimens with once-daily dosing are now possible, and fixed-dose combinations of antiretroviral agents are also available. In addition, deferring initiation of antiretroviral therapy has been widely recommended [15–18].
As an alternative approach with the potential to reduce drug exposure, promote adherence to therapy, and decrease treatment-related fatigue, several treatment interruption strategies are currently under evaluation [19]. Treatment interruptions have been explored in various distinct clinical situations with different aims. For patients who initiated therapy during acute seroconversion, treatment interruption has been explored as a means to enhance HIV-specific immune response and, consequently, allow better control of viral replication in the absence of continued therapy [20, 21]. This remains an attractive yet elusive hypothesis. Until results of ongoing, prospective, controlled clinical trials are available, this intervention should be regarded as experimental in nature and cannot be recommended.
