Latest study offers new hope for HIV treatment interruption
Patients with HIV undergoing CD4-guided treatment interruption saw substantial drug savings and no evidence of increased treatment resistance compared with those on continuous highly active antiretroviral therapy, researchers claim (Lancet 2006;368:459).
The findings differ from those of the SMART
study published earlier in the year (PJ, 28 January, p98), which saw an increased risk of clinical
AIDS or death in patients receiving intermittent HAART.
The latest trial randomised 430 patients to receive continuous or interrupted
therapy. A similar proportion of patients in the treatment interruption
group reached a viral load of less than 50 copies per ml as in the continuous
treatment group (90.5 per cent versus 91.8 per cent). There was no significant
difference in the emergence of resistance between the two groups. Unlike
SMART, the new trial was not powered to detect differences in clinical
endpoints. However, no AIDS-defining events and only one death were observed
in the trial, a finding that the authors say is a “striking discrepancy
[to SMART] unlikely to be due to chance and requires explanation”.
The CD4-guided approach in the latest trial involved restarting HAART
at 350 cells per µl, whereas SMART recommenced treatment at 250
cells per µl. The authors suggest that minimising the time spent
with low CD4 counts could potentially abolish the differences between
the continuous and intermittent treatment groups and conclude that ritonavir-boosted
protease inhibitor-based HAART can be interrupted provided that CD4 counts
are monitored and maintained. |
The
Pharmaceutical Journal
Acrobat
Reader