Stopping antiretroviral therapy in HIV-infected patients could be beneficial

Stopping antiretroviral therapy in HIV-infected patients from time to time could reduce the side effects and costs of the treatment, according to a study in this week's issue of The Lancet.

Though extremely effective at preventing AIDS, lifelong treatment with Highly Active Anti- Retroviral Therapy (HAART) is expensive and can lead to serious side effects, such as liver damage. Decreasing the time that patients receive HAART could solve these problems but interrupting therapy may increase the risk of the disease progressing. The virus may also become resistant to HAART if treatment stops and low concentrations of the drug remain in the body.

Bernard Hirschel (University Hospital of Geneva, Switzerland) and colleagues assessed whether taking scheduled breaks in HAART was as effective as giving patients treatment on a continuous basis.

430 patients with chronic HIV were either placed in a scheduled interruption group (284), where treatment was temporarily stopped depending on their immune response, or in a group where HAART was given continuously (146) for 22 months. The results showed that levels of resistance and control of the HIV virus were similar between the two groups. Certain side effects such as diarrhoea and nausea were also less frequent in this group, while minor manifestations of HIV, such as oral thrush, were more common.

Dr Hirschel concludes: 'The results provide reassurance about the one risk that was feared - development of resistance and loss of efficacy of treatment . . . Scheduled treatment interruptions lasting many months, with substantial drug savings, can be anticipated, particularly in patients whose immune systems were never damaged by HIV.

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