Structured treatment interruption in HIV infection.
Structured (and unstructured) treatment interruptions have been evaluated during well-controlled acute and chronic HIV infection and before multidrug salvage therapy. In the first 2 instances, the rationale for this strategy is to stimulate or preserve HIV-specific CD4 T cells and broadly directed cytotoxic T-lymphocyte responses. Before salvage therapy, treatment interruptions have led to the reemergence of drug-susceptible virus, at least in blood plasma. Although some evidence suggests beneficial immune stimulation with successive interruptions of therapy begun during acute infection, the long-term benefits of this strategy remain unproved in any clinical setting. The potential dangers of interrupting treatment--recrudescent acute retroviral syndrome, emergence of drug-resistant virus, substantial declines in CD4 T cells, and new or recurrent opportunistic infections--are not theoretic.
Division of Infectious Diseases, University of Colorado Health Sciences Center, Denver, USA.
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Benson
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D004334:Drug Administration Schedule; D004351:Drug Resistance; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D012008:Recurrence; D016879:Salvage Therapy / Q000379:methods*; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D019562:Viral Load