[Can treatment interruption strategies improve the management of HIV infection ?]

Despite clear success, there is growing appreciation that there are significant limitations with continuous administration of antiretroviral therapy. Currently available treatments are suppressive and cannot eradicate HIV infection. Long-term toxicity may negatively impact quality of life and long-term adherence to anti-HIV therapy and favors emergence of resistant variants. New strategies based on scheduled treatment interruption have been evaluated in various distinct clinical situations with different aims. For patient successfully treated, two major strategies have been proposed : stimulate anti-HIV immune response and reduce drug exposure consisting in off and on treatment periods. For patients with virological failure, stopping antiretroviral therapy during a short period in order to modify the HIV-resistance profile from multidrug resistance to a more sensitive pattern might improve the chances of obtaining durable virological suppression and immunological benefit after resumption of therapy. This review covers the main findings of these investigations and examines the main limitations of scheduled treatment interruptions in terms of clinical progression, emergence of resistance, virus reservoir and risk of viral transmission.