Treatment interruption strategies: how great are the risks?
OBJECTIVE
This review brings together the results of recent definitive trials of treatment interruption strategies in order to evaluate the risks and to examine whether there is evidence to support this approach in clinical practice.


RESULTS
Recent studies confirm that there is no clear benefit of treatment interruption in the settings of virological failure or acute infection. The most important recent data relate to the use of structured treatment interruption in the setting of chronic HIV disease. The SMART and Trivacan trials found that a CD4 lymphocyte count guided interruption strategy was clearly inferior to continuous therapy, but Staccato (using a higher threshold for treatment re-initiation) did not. The largest fixed-schedule treatment interruption trial also reported inferior clinical outcomes with interruption, although the evidence of harm was less clear in other smaller studies. A broad spectrum of clinical effects of treatment interruption was highlighted by this research.


CONCLUSIONS
Overall, recent studies indicate that treatment interruption is associated with a variable degree of net harm. Continuous treatment should remain the strongly preferred approach, although, if it is carefully managed, there may be some clinical situations in which the benefits of a short period of interruption may potentially outweigh the risks.
Paton
Nicholas I
NI
Medical Research Council Clinical Trials Unit, London, UK. nick.paton@ctu.mrc.ac.uk
D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D016896:Treatment Outcome; D028761:Withholding Treatment