HIV ‘treatment holiday’ may harm

Patients who take a break from their HIV drugs on the instructions of their doctors may risk the condition getting worse, say experts.

Patients who take a break from their HIV drugs on the instructions of their doctors may risk the condition getting worse, say experts. Some studies have suggested that so-called “treatment holidays” could actually improve their health. However, researchers from the University of California say that it could be harmful for a few patients. Tests during a four month trial suggested that the break may speed up the attack on the immune system. Their results, published in the New England Journal of Medicine, will be a disappointment to those experts who hoped that treatment holidays could be a way of tackling HIV which has grown resistant to modern drug cocktails. The theory is that turning off the anti-HIV drugs allows the “repopulation” of the body with strains of the virus which are easier to treat. When the treatment is resumed, it would have a far greater impact, suggest experts. Blood testsThe study compared the health of hundreds of HIV patients, half of whom were given their normal combination of drugs, and half of whom were given a four month break. All of them had HIV which was proving resistant to standard combination therapy. The way of measuring the “health” of an HIV patient is not only to look for physical signs of deterioration, but also to measure the concentration of the virus in their blood, and the level of immune cells called CD4+ T cells – those specifically targeted by the virus. “Our results indicate that this strategy does not work and should be avoided by this group of HIV-infected individuals”Dr Jody Lawrence, UCSF The researchers found that, 12 months after the end of the “holiday”, 22 of 138 patients who took a break had either died, or showed physical signs of disease progression, such as the emergence of one or more Aids-related conditions. This compares with 12 of the 132 people in the “control” group which kept taking the tablets. In addition, the “holiday” patients had persistently lower levels of CD4+ cells, a sure sign that HIV is active. Wrong strategyDr Jody Lawrence, from the Department of Medicine at the University of California, San Francisco, said: “We had hoped that a structured treatment interruption would be beneficial for people experiencing treatment failure due to multidrug-resistant HIV. “However, our results indicate that this strategy does not work and should be avoided by this group of HIV-infected individuals.” The findings will be a blow to patients hoping for a brief respite from the side effects of their medication – a common motive for a “treatment holiday”. However, other experts said that while a break might not be suitable for drug-resistant HIV patients, it might work for other HIV patients. A spokesman for Terrence Higgins Trust told BBC News Online that it was essential that anyone contemplating a “treatment holiday” should make sure that their doctor keeps a close eye on their condition throughout. He said: “Each case is very individual, and will depend on the person’s general health as well as how far their condition has progressed. “We would advise anyone with HIV who is considering taking a treatment holiday to discuss all options with their HIV doctor, and if they do take one, to be prepared to have their health more closely monitored during that time.” (Source: BBC, Wednesday, 27 August, 2003, 23:08 GMT 00:08 UK)