Intermittent treatment shortens survival for patients with HIV

doi:10.1136/bmj.333.7580.1213

BMJ 2006;333:1213 (9 December), doi:10.1136/bmj.333.7580.1213

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Intermittent treatment shortens survival for patients with HIV

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Patients infected with HIV often struggle tostick with long term antiretroviral treatment. Regimens arecomplex and associated with serious side effects and the emergenceof drug resistance. Giving patients a break, however, substantiallyincreases their risk of an opportunistic disease or death, accordingto a recent trial (hazard ratio 2.6 (95% CI 1.9 to 3.7)).

The 5472 participants were either treated continuouslyor treated only when their CD4 cell count fell below 250/mm³.The researchers were hoping that the "drug sparing" regimenwould reduce side effects and improve adherence without compromisingthe overall effectiveness of treatment. It didn't work. Patientson intermittent treatment did so badly that the trial was stoppedearly.

During breaks in treatment, the first of whichaveraged around 16 months, CD4 counts fell rapidly and viralloads rose rapidly. Contrary to expectations, patients givenintermittent treatment had more major cardiovascular, renal,and hepatic disease than patients treated continuously (hazardratio 1.7 (1.1 to 2.5) for all three combined). Intermittenttreatment did not protect them from serious drug related toxicity.

It seems clear that breaks in treatment arebad for patients with chronic HIV infection, says a linked editorial(pp 2359-61). We must find other ways to make long term treatmentmore tolerable.