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Treatment interruption in advanced failing patients
1HIVCENTER, Medical HIV Treatment & Research Unit, Hospital of the Johann Wolfgang Goethe University Frankfurt, 60590 Frankfurt, Germany. schlomo.staszewski@hivcenter.de
Current Opinion in HIV and AIDS
|April 18, 2009
Summary
Discontinuing HIV therapy in patients with advanced disease and treatment failure offers no virologic benefit and increases risks. Continuing even failing treatment may provide clinical benefits until new drugs are available.
Area of Science:
- Clinical Medicine
- Virology
- Immunology
Background:
- Previous hypotheses suggested treatment interruptions could re-sensitize HIV patients to antiretroviral drugs.
- This approach was considered for individuals experiencing therapy failure in advanced stages of HIV disease.
Purpose of the Study:
- To review the rationale and outcomes of clinical trials on treatment interruption strategies.
- To evaluate the impact of interrupting therapy in HIV-positive patients with advanced disease and failing treatment regimens.
Main Methods:
- Analysis of major international clinical trials investigating treatment interruption in HIV patients.
- Comparison of outcomes between patients who interrupted therapy versus those who continued failing regimens.
Main Results:
- Most clinical trials found no virologic response benefit from treatment interruption in this patient group.
- Treatment interruption was associated with an increased risk of disease progression and mortality.
- Continuing failing antiretroviral therapy (ART) demonstrated potential clinical benefits compared to interruption.
Conclusions:
- Treatment interruption in advanced HIV patients with failing therapy poses significant risks, including disease progression and CD4 cell count decline.
- Maintaining ART, even if failing, may offer clinical advantages until novel therapeutic agents become accessible.
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