At the turn of the century, combinations of three or more HIV antiviralA medication or substance which is active against one or more viruses. May include anti-HIV drugs, but these are more accurately termed antiretrovirals. drugs were shown to be highly effective in treating HIV disease. At the time it was hoped that after long periods on these drugs it may be possible to ‘eradicate’ HIV from the body. In 2008 it is now known this is not possible with the current treatments.
For some people there are significant toxicities associated with using the current drugs for long periods. It is not surprising then that over the past few years one possible strategy examined to minimise long term side effects while attempting to maximize the length of antiviral benefit was the possibility of taking a break from your anti-HIV treatments. These breaks are commonly known as treatment breaks or structured treatment interruptions.
Recently, a large international trial was used to compare the people who continuously took their drugs and people who took treatment breaks. The study, initially designed to last nine years, was stopped after only two years due to the high number of people who took regular treatment breaks that developed AIDS-defining illnesses.
Except in very particular circumstances, as soon as you stop taking treatment HIV starts to reproduce again increasing viral loadA measurement of the quantity of HIV RNA in the blood. Viral load blood test results are expressed as the number of copies (of HIV) per milliliter of blood plasma. and CD4 cells decline. This is particularly so for people who have already had low CD4 counts, or have had an opportunistic illness in the past.
The results of this study clearly show that treatment breaks are associated with a rapid fall in CD4 counts, an increase in viral load, and illness, as well as the development of multiple drug resistanceHIV which has mutated and is less susceptible to the effects of one or more anti-HIV drugs is said to be resistant..
Sometimes, people stop treatments for just one or two days, e.g. during a party weekend. This is often referred to as a ‘drug holiday’. Stopping treatments for just one or two days could put you at real risk of developing resistance. There is some research to suggest that stopping drugs for short periods of time, or regularly missing some doses may be more risky in terms of resistance than stopping all at once for a longer time (e.g. a month). This is because different drugs remain active in your system for different periods of time between doses. You should not stop your drugs for these very short periods.
However, some people do feel the need to take longer, planned breaks from HIV drugs. This may be because of side effects, the desire to ‘have a rest’, or other factors like overseas travel. You should discuss this thoroughly with your doctor. Factors like viral load and CD4 counts are very important. If you have a very low CD4 count, stopping treatments could put you at risk of developing an opportunistic illness. You should consider whether you need prophylactic treatment during this time, particularly (but not only) if you have ever had an opportunistic infection.
Do you need a rest from HIV drugs? It’s important to discuss breaks and the reasons why with your doctor.
If you do want to stop your drugs for whatever reason, devise a plan with your doctor, including:
• whether you might need prophylactic treatment during this time;
• how long a break;
• at what point, if any (e.g. viral load, CD4 count) you would consider starting treatment again; and
• how you feel about monitoring, blood tests, etc. during this period.
Some doctors feel that if a person is having major trouble with adherence and missing doses or taking their drugs erratically, it may be more sensible to stop all the drugs and work through these problems over time, before trying again.