Resistant HIV? No Long Drug Holidays, Please!

With HIV/AIDS, sometimes the treatments are as likely as the disease to be the cause of feeling bad, and no one can be faulted for wanting to take a long break — a lengthy “holiday” from the drugs. However, a much-anticipated study published in the New England Journal of Medicine last week shows that might be a really bad idea for HIVers with drug-resistant strains of the virus.

“Structured treatment interruptions” are controversial, even when supervised by a physician, and not fully researched. The premise is hopeful: A break will let the body recover for a while from the toxic medications and their serious side effects, and that, meanwhile, troublesome drug-resistant viruses will mutate back to a less-resistant form.

In this study, 138 patients with drug-resistant HIV and a viral load above 5,000 took a four-month STI from meds, then started back on a different combo. The 132 similar control patients switched their cocktail but didn’t take a break.

The good news was that 64% of the holiday group’s viruses did lose some of their drug resistance (reverted to “wild-type” HIV). However, the cost of a four-month break was high: a “precipitous drop” in T4 cells, permitting more AIDS-related diseases. Within a year, almost twice as many STI patients had died or significantly progressed in disease, compared to the non-STI control group.

It appears, then, that for poz people with drug-resistant HIV, lengthy drug holidays — even with physician supervision — are not advisable. The usefulness of shorter breaks is undetermined — study results are very mixed — but long periods without meds allow HIV too much opportunity to rebound and do damage.

Whatever you do, as TV says, do not try this at home! If the HIV cocktail is making someone’s life miserable, any drug holiday should be done under the doctor’s supervision. Unfortunately, it probably should be brief, rather than long.

(For details, see Lawrence et al., NEJM, 28 Aug 2003.)

Sandy Bartlett

Community Education Coordinator, AIDS Services of Austin

This article appears in September 12 • 2003.

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