December 18, 2001
This is a good follow-up to Dr. Gallant's oral presentation yesterday looking at stopping HIV medications. This is a prospective non-randomized controlled trial of treatment for 18 months. Outcomes measured were CD4, viral load, lipids and AIDS events. There were 115 treatment interruption (TI) patients and 186 controls.
There were no differences found in baseline CD4 viral load or percentage of patients with viral load <50. Mean duration of the first treatment interruption was 5.4 weeks. Twenty-nine percent of the patients had more than one treatment interruption. After one month of treatment interruption a mean change of CD4 of -72 and mean viral load increase of +2.1 log were observed with highly significant statistics, as expected.
When the drugs stop, HIV levels go up and CD4 cells go down. But, interestingly enough, so do other things! Cholesterol declined by 54 and triglycerides by 236, which were both quite significant!
After 18 months, CD4 cells did not change significantly. In patients with undetectable viral load, 66 percent remained undetectable 18 months later, compared to 73 percent of the control patients. Antiretroviral therapy was changed in 47 percent vs. 40 percent, respectively. There was no change in AIDS events.
It appears that stopping medications has a small chance of failing to control the virus again at pre-stopping levels, but these odds are not huge and the cholesterol and triglycerides benefit from some stopping. This is something that clearly needs further study, but stopping medications clearly does not seem to do irreparable harm!
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