For HIV-positive people with few remaining treatment options and compromised immune systems, remaining on an antiretroviral regimen that is no longer keeping viral load undetectable continues to protect against new AIDS-related illnesses, according to a study published in the January 15 issue of Clinical Infectious Diseases. The new data confirm the results of earlier studies suggesting that the benefit of remaining on a failing treatment regimen is greater than the benefit of temporarily stopping treatment to prevent worsening drug resistance.
Some health care providers temporarily stop antiretroviral therapy in their patients with multiple-drug-resistant HIV, to guard against the accumulation of additional drug-resistance mutations until new treatment options come along. To address the safety of this strategy, Isabelle Kousignian, MD, of the Institut National de la Santé et de la Recherche Médicale (INSERM) in Paris, and her colleagues compared HIV-positive people who stopped treatment for at least three months to people who remained on a failing drug regimen and those who remained on a regimen that was still working. The medical records of 12,764 patients with CD4 counts below 200 cells were included in the comparison.
Kousignian’s team found that people who took a drug holiday had a 28 percent greater chance of developing a new AIDS-related illness than people who remained on a failing treatment regimen. Though the team was unable to determine whether people who stayed on a failing regimen had a greater risk of developing new drug resistance, they concluded that it is safer for a person on a failing regimen—and who can’t construct a new regimen—to remain on the failing regimen rather than interrupting treatment.
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