Practice Short cuts

Intermittent treatment shortens survival for patients with HIV

BMJ 2006; 333 doi: (Published 07 December 2006) Cite this as: BMJ 2006;333:1213

Patients infected with HIV often struggle to stick with long term antiretroviral treatment. Regimens are complex and associated with serious side effects and the emergence of drug resistance. Giving patients a break, however, substantially increases their risk of an opportunistic disease or death, according to a recent trial (hazard ratio 2.6 (95% CI 1.9 to 3.7)).

The 5472 participants were either treated continuously or treated only when their CD4 cell count fell below 250/mm3. The researchers were hoping that the “drug sparing” regimen would reduce side effects and improve adherence without compromising the overall effectiveness of treatment. It didn't work. Patients on intermittent treatment did so badly that the trial was stopped early.

During breaks in treatment, the first of which averaged around 16 months, CD4 counts fell rapidly and viral loads rose rapidly. Contrary to expectations, patients given intermittent treatment had more major cardiovascular, renal, and hepatic disease than patients treated continuously (hazard ratio 1.7 (1.1 to 2.5) for all three combined). Intermittent treatment did not protect them from serious drug related toxicity.

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


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