Treatment interruption in advanced failing patients.
OBJECTIVE
To discuss the rationale and results of clinical trials examining treatment interruption in HIV-positive patients with advanced disease who are experiencing therapy failure.


RESULTS
In the past it was thought that treatment interruptions in patients experiencing therapy failure might bring about an improved virologic response to treatment via drug re-sensitization. All of the major international clinical trials, with the exception of the Giga-HAART trial, however, have found no benefit of treatment interruption in this group of patients. Moreover, most of the trials have shown an increased risk for disease progression or death. It has also been shown that even patients with no or few treatment options, staying on a failing regimen may have some clinical benefit relative to treatment interruption.


CONCLUSIONS
Treatment interruption in advanced failing patients may be a dangerous course of action due to the increased risk of clinical disease progression and decline in CD4 cell count. Staying on therapy, even a failing therapy, may have some benefit, at least until new drugs become available.
Staszewski
Schlomo
S
HIVCENTER, Medical HIV Treatment & Research Unit, Hospital of the Johann Wolfgang Goethe University Frankfurt, 60590 Frankfurt, Germany. schlomo.staszewski@hivcenter.de