Many people with HIV have wondered whether treatment breaks—stopping and starting HIV meds—could lessen long-term med side effects and treatment fatigue. In 2006, the largest med-break study, SMART (Strategies for Management of Anti-Retroviral Therapy), showed that people who stopped meds when their CD4 counts topped 350, then restarted when counts fell below 250, had more drug side effects, non-AIDS related ailments and deaths than those who kept taking their combos. (According to a recent review, results were worst if breakers also had hepatitis B or C.) In December 2008, CASCADE, a large European study, reported that CD4 counts rose progressively slower after breaks.
Two smaller studies found, however, that breaks may work—in these particular conditions:
When people with high current CD4 counts (and never beneath 200) stopped meds at 700 CD4s, starting again at 350 (per the LOTTI study, led by Franco Maggiolo, MD, of Bergamo, Italy).
When people with high CD4 counts (average: 670) took weekend breaks from a Truvada (tenofovir and emtricitabine) plus Sustiva (efavirenz) regimen (per the Five On, Two Off/FOTO study, led by Cal Cohen, MD, of Boston’s Community Research Initiative).
Treatment breaks may get a break after all.