H-O-L-I-D-A-Y?? Is there a Final word on Drug Holidays and HOW TO DO IT

[BlkRedBonenla]

I have some confusion about drug holidays. If I took an anecdotal check of my HIV plus peers, there would be no consensus from their doctors whether it is proper or not proper to go off meds. No one is arguing to STOP THE MEDS [another topic altogether], but the idea that there are times - toxicity illnesses or good numbers - when stopping the meds has been prescribed.

What think you all?

When you've done this - those that have - is there any special consideration?

Thanks!

[allopathicholistic]

HI BRBLA,

I'll state something worth repeating - Every body is different, literally. Care to share what your doctor told you about treatment interruption??   

Many here including me will tell you (1) "Never go it alone! Not with something like this, it's much too serious and perilous" and (2) any type of treatment interruption should be formally approved and planned with precision by your healthcare provider

Here is an AIDSmeds discussion from last year about STI's

http://forums.poz.com/index.php?topic=593.0

[J.R.E.]

Hello,


I have never done a treatment break. My doctor informed me when I started on meds, that a treatment break was highly unlikely.( Actually I had asked him about a break ) I also started treatment with a 16 t-cell count, in 2003. So, I figure a break somewhere down the road was not being logical. My liver function tests are all still very good, along with kidney and, amylase / lipase tests. I am not having any problem so far. But if the time comes, then I guess I will have to take some sort of break from the meds, if/when the tests show otherwise.

Heres a couple past news articles from this site ;

http://www.aidsmeds.com/articles/1667_10943.shtml

http://www.aidsmeds.com/news/am20060214croi01.html


Take care of yourself-----Ray

[BlkRedBonenla]

HI BRBLA,

 Care to share what your doctor told you about treatment interruption??   

Well, Allopath, the topic has not come up with my doctor regarding ME, but I know she is one that believes once you go on meds you stay on meds, whether those meds change due to intolerance or whatever is a different matter. You stay on meds.

But other doctors believe otherwise.

[allopathicholistic]

she is one that believes once you go on meds you stay on meds, whether those meds change due to intolerance or whatever is a different matter. You stay on meds.

My doctor told me the same thing. But if I gain lots of CD4's I'm gonna pester him with the issue again-- just for fun LOL 

Just kidding, but we do have a superb doctor-patient relationship

[BlkRedBonenla]

Heres a couple past news articles from this site ;

http://www.aidsmeds.com/articles/1667_10943.shtml

http://www.aidsmeds.com/news/am20060214croi01.html

The NOT SO SMART article is spun in an interesting way, which begs discussion. It features ONE study but cites two. In the featured study, 120 are said to fall ill with treatment interruption. The Lancet study, mentioned later in the article had favorable results with treatment interruption. The difference that should be the headline is the Lancet study used 350 cd-4 count as the threshold, while the featured one used 250.

The headline should have been stop treatment until you drop below 350. Remember, the reason for these studies is to avoid the unavoidable toxicties these treatments impose on the body. The featured study can't help but ignore the 47 who stayed on treatment and got HIV-defining illnesses.

Thanks.

[risred1]

While the SMART study certainly had to be suspended, it may have been the parameters of the study that made it untenable in the end.

This is a tough issue, filled with many many variables.

But here are the key elements that I understand as of today.

Starting meds at the 350 mark and not 200 provides two possible benefits. The first is that your CD4 count is expected to improve more dramatically than if you start at 200. The second and also very important, those who start at this demarcation point also tolerate the meds better. If one is tolerating the meds well, treatment break may not be needed. If however toxicity becomes an issue, and a break is desired, the expectation is that the CD4 will drop fairly quickly to the point  one was at prior to taking meds, where, hopefully, a more gradual decline begins. If it is at the 350 mark, one would have to suppose to go back on a regimen at that point.

The interesting thing is that some people tolerate meds so well, that break is not an issue, additionally, there are those who do better on a different combo if the one they are on is the problem. So to take a break or to change meds really seems to be the issue, and to which is better in the long term seems to be what the debate is about. I have no opinion at this time as to choosing Break vs. Changing Meds.

[megasept]

...I have some confusion about drug holidays. If I took an anecdotal check of my HIV plus peers, there would be no consensus from their doctors whether it is proper or not proper to go off meds. No one is arguing to STOP THE MEDS [another topic altogether], but the idea that there are times - toxicity illnesses or good numbers - when stopping the meds has been prescribed.

Actually I have, and am arguing for many to "STOP THE MEDS."  The SMART study had a structural problem; it took people back and forth, on and off drugs, for as little as a few weeks. This is the worst of both worlds. Can you imagine medical success battling a disease this way? Dr. Juddith Currier, UCLA, and others have been quoted in the media as endorsing the study's findings. I believe she has been quoted out of context (I cannot be sure, because I have never spoken directly with her). She and her colleagues at UCLA continue to keep as many patients as possible off meds for as long as medically reasonable. No treatment is their favored approach. A few years waiting, a few years of treatment, and then even longer off treatment. They are trying to save our heart and other vital organs from the effects of treatment. Now if that sounds Draconian, look at it this way. We have an immune disorder. If our immune system still works on its own. that's a whole lot better than substituting for it "early" in the life of a disease. Sports analogy: Take your best player off the field when he's all beat up, not when he's still scoring.

Most treatment-naive hiv poz (unless they have additional problems like Hep, or KS) need not be on meds until CD4s <300/350 and/or VL > 100k.  It may also be proper to stop taking meds after successful treatment until the same threshold is passed (slow growth of VL, gradual decline of CD4s. . This is an STI (Scheduled Treatment Interruption), much longer than a "holiday"---mine is 6 years, and both my MD and I agree it was the right decision.

An STI is not a Holiday.

Holidays are easy----just stop taking the meds. Whether to take a Holiday is an important discussion with your specialist. Holidays might be required for a medical procedure, such as some surgeries. Of course there are negative reasons to stop a treatment, ie failure, toxicity. I strongly urge anyone who does this to not do so secretly---tell your MD.  -megasept

[J.R.E.]

Here's a few more topics (questions ) on the subject :'

http://qa.hopkins-aids.org/forum/list_questions.html?section_id=61&category_id=701&category=+Treatment+Interruption




Ray

[bimazek]

basically for me if you look at the study results the data, stattacto etc, yes there is twice as much disease and death in the group that went on and off meds than the group that stayed on meds, but it was ten times less than those who never went on meds...  i think the numbers work like this...

of 4000 people...
8 people died who took a treatment interuption
4 people died who did not take a treatment interuption

but if you look at it if no one would have taken meds then 2000 of 4000 would have died by 10 years approx.

so

the difference between 2000 and 8 or 2000 and 4 is the big difference to me

i am not exact with these numbers but it is close

also

they do not talk about the fact that huge numbers of gay or hiv are on drugs, alcohol or cigs.

these could have been huge issues doubleing the death

maybe they were just testing and proved that drug users die and lie 2x as often as sober people

i would beieve these results if they did random drug tests of all participants

so many drug users are in denial and it is impossible to tell if someone is a user many times

as far as disease it was like this...

of 4000 people...
50 people had a bad disease event who took a treatment interuption
25 people had a bad disease event who did not take a treatment interuption

same thing

are we just measuring that alcoholics and smokers and drug users get sick more often

something is wrong with this study

show me a drug alcohol and smoker free study with random weekly pee tests

[megasept]

basically for me if you look at the study results the data, stattacto etc, yes there is twice as much disease and death in the group that went on and off meds than the group that stayed on meds, but it was ten times less than those who never went on meds... also

...they do not talk about the fact that huge numbers of gay or hiv are on drugs, alcohol or cigs.

these could have been huge issues doubleing the death

maybe they were just testing and proved that drug users die and lie 2x as often as sober people

i would believe these results if they did random drug tests of all participants

so many drug users are in denial and it is impossible to tell if someone is a user many times

as far as disease it was like this...

...are we just measuring that alcoholics and smokers and drug users get sick more often

something is wrong with this study

show me a drug alcohol and smoker free study with random weekly pee tests

Good point. How did or do they control for the variable of drug use/alcohol abuse? That the treatment the Holiday folks were given is unacceptable is the more fundamental problem, but this is another legitimate criticism/challenge to the "last word on the subject" results.
   -megasept

[LiveWithIt]

I've been on drug studies where I have gone off the meds.  My viral load has been as high as 1 million.   Now it is undetectable.  While it is nice to stop taking the meds, 4 pills once a day is not bad at all.  I don't think I would do it again,  I may get resistance to a drug if I do.

[thunter34]

it lives.  another zombie thread resurrected

[Miss Philicia]