Holidays May Be Over for HIV Patients

Nov. 29, 2006— -- HIV patients who take their HIV drugs intermittently are at a greater risk of infections, heart disease, and death compared to those patients who never stop taking their medicine, according to a new study in the New England Journal of Medicine.

This finding could end a long debate on the value of "drug holidays," an approach otherwise known as standardized treatment interruption (STI) and a popular strategy in the war against HIV and AIDS over the past five years.

"This is a very important study," says Dr. Paul Skolnik, director of the Center for HIV/AIDS Care and Research at Boston University Medical Center in Boston, Mass. "It was controversial at the time it was designed, because there were many who fervently believed, despite the lack of data, that drug interruption was the correct way to go."

STI was initially designed to mitigate the serious side effects of HIV medications in patients, including changes in body fat, liver problems, and heart disease. Patients following STI would take a break when their immune systems were strong and start taking the drugs again when their bodies' natural defenses were down.

The Strategies for Management of Antiretroviral Therapy (SMART) study, which looked at nearly 6,000 patients in 33 countries, revealed that patients who stopped and started their drug regimens experienced a 2.6 times greater risk of infectious disease or death.

"Much of HIV treatment over the years has, unfortunately, been based on anecdotal or limited evidence," Skolnik says. "We have learned time and time again that these kinds of decisions can only be wisely made through adequately controlled and designed studies."

Additionally, though it was hoped that occasional breaks in drug regimens would minimize drug side effects, patients in the STI group still had nearly double the chance of having major heart, liver, or kidney problems.