I'm not a big fan of "structured" interruptions, though agree that many patients can benefit for time off medications. Those with high CD4 counts (and not too low CD4 nadirs)appear to be able to take a break from medications without significant adverse risk. The ongoing CPCRA SMART study will provide useful insight into the relative merits of such approaches.
Rather than a time-structured therapy, I'd rather use CD4 counts as the basis for triggering starting and stopping (as seen in SMART). The would expose the patient to a minimal number of treatment discontinuations and theoretically decrease the risk of the emergence of drug resistance (my major concern with such strategies). A major challenge to interpreting such data and strategies is how to minimize this risk-- particularly with treatments whose component drugs have differing intracellular half-lives.
For your patient, if his or her CD4 count remains stable and above contemporary thresholds for initiating therapy, I'd see little pressure to resume therapy (provided that the patient remains symptom-free). I'd certainly continue to monitor the patient's clinical and laboratory status closely.
I hope this helps, thanks for reading and posting. BY
