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Author Topic: ARV vacation question  (Read 598 times)

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Offline stuka

  • Member
  • Posts: 44
ARV vacation question
« on: July 07, 2014, 01:23:18 PM »
So I've been reading comments by eric48 regarding ARV treatment. I profusely apologize if I have misunderstood eric's advice on this topic but from what I understand is that eric is suggesting that once the immune system goes to a stable state (> 500 CD4), one has a choice to take a breather from ARVs. He does acknowledge the fact that the CD4 count will likely drop so its not a permanent vacation by any means.

The impression that I got from reading this is that as long as one monitors the labs every three months, its not quite so bad to stop once you are UD and your CD4 count is in the normal range. And when CD4 count drops below a certain threshold one can start again. Its almost like hitting a reset button with no other side effects.

This advice goes contrary to what I have been reading on other websites. I thought the real danger is that if you stop ARVs you will build resistance to your current medication and the virus will indeed become stronger as it now has a chance to mutate and grow wiser so to speak. The other thing that I remember reading is that usually the viral load climbs much faster after stopping ARVs compared to the initial increase.

I would appreciate if someone can shed more light on this topic.

Offline MaxellSmith

  • Member
  • Posts: 14
Re: ARV vacation question
« Reply #1 on: July 07, 2014, 01:51:20 PM »
You can talk your doctors about this, but if you stop your ARV treatment you are likely to develop resistance to your medication.

Planned Long-Term Therapy Interruptions

Planned therapy interruptions have been contemplated in various scenarios, listed below. Research is ongoing in several of the scenarios. Therapy interruptions cannot be recommended at this time outside of controlled clinical trials (AI).
In patients who initiated therapy during acute HIV infection and achieved virologic suppression—the optimal duration of treatment and the consequences of treatment interruption are not known at this time. (See Acute HIV Infection.)

In patients who have had exposure to multiple ARV agents, have experienced ARV treatment failure, and have few treatment options available because of extensive resistance mutations—interruption is not recommended unless done in a clinical trial setting (AI). Several clinical trials, largely yielding negative results, but some with conflicting results, have been conducted to better understand the role of treatment interruption in these patients [1-4]. The largest of these studies showed negative clinical impact of treatment interruption in these patients [1]. The Panel notes that partial virologic suppression from combination therapy has been associated with clinical benefit [5]; therefore, interruption of therapy is not recommended.

In patients on ART who have maintained a CD4 count above the level currently recommended for treatment initiation and irrespective of whether their baseline CD4 counts were either above or below that recommended threshold—interruption is also not recommended unless done in a clinical trial setting (BI). (See discussion below highlighting potential adverse outcomes seen in some treatment interruption trials.)


Source: http://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/18/discontinuation-or-interruption-of-antiretroviral-therapy

There is plenty of information (from official sources) about this topic if you use google, but anyways I would only check this up with a doctor.
« Last Edit: July 07, 2014, 01:54:34 PM by MaxellSmith »

Offline mecch

  • Member
  • Posts: 11,689
  • red pill? or blue pill?
Re: ARV vacation question
« Reply #2 on: July 07, 2014, 02:42:09 PM »
Stuka, nobody is practicing what Eric is "advising".
Once you start HAART, the overwhelming experience and medical opinion is that you stay on it.  Maybe someone might need to quit for a moment under very special circumstances.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline Joe K

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  • Member
  • Posts: 3,661
  • 31 Years Poz
Re: ARV vacation question
« Reply #3 on: July 07, 2014, 02:59:18 PM »
So I've been reading comments by eric48 regarding ARV treatment. I profusely apologize if I have misunderstood eric's advice on this topic but from what I understand is that eric is suggesting that once the immune system goes to a stable state (> 500 CD4), one has a choice to take a breather from ARVs. He does acknowledge the fact that the CD4 count will likely drop so its not a permanent vacation by any means.

The impression that I got from reading this is that as long as one monitors the labs every three months, its not quite so bad to stop once you are UD and your CD4 count is in the normal range. And when CD4 count drops below a certain threshold one can start again. Its almost like hitting a reset button with no other side effects.

This advice goes contrary to what I have been reading on other websites. I thought the real danger is that if you stop ARVs you will build resistance to your current medication and the virus will indeed become stronger as it now has a chance to mutate and grow wiser so to speak. The other thing that I remember reading is that usually the viral load climbs much faster after stopping ARVs compared to the initial increase.

I would appreciate if someone can shed more light on this topic.

Stuka,

The important part is that Eric's advice is nothing more than a cut and paste response and it's WRONG.  You should only follow your doctors advice on maintaining your health and ignore anything you have read by Eric48.

I say this as both a member and Moderator.  Once you start ARVs, you should remain on them, unless directed differently by your doctor.

Joe

Offline Tonny2

  • Member
  • Posts: 294
Re: ARV vacation question
« Reply #4 on: July 07, 2014, 03:26:59 PM »
So I've been reading comments by eric48 regarding ARV treatment. I profusely apologize if I have misunderstood eric's advice on this topic but from what I understand is that eric is suggesting that once the immune system goes to a stable state (> 500 CD4), one has a choice to take a breather from ARVs. He does acknowledge the fact that the CD4 count will likely drop so its not a permanent vacation by any means.

The impression that I got from reading this is that as long as one monitors the labs every three months, its not quite so bad to stop once you are UD and your CD4 count is in the normal range. And when CD4 count drops below a certain threshold one can start again. Its almost like hitting a reset button with no other side effects.

This advice goes contrary to what I have been reading on other websites. I thought the real danger is that if you stop ARVs you will build resistance to your current medication and the virus will indeed become stronger as it now has a chance to mutate and grow wiser so to speak. The other thing that I remember reading is that usually the viral load climbs much faster after stopping ARVs compared to the initial increase.

I would appreciate if someone can shed more light on this topic.
stuka....what I would do is write down all this sugestions and ask your doctor, if indeed this is possible, as far as I know, you stopping treatment might cause resistance to the treatment you are taking right now (I think is just one pill, coplera), if you were to be resistance to this drug you might hsve yo take more medications, resulting in more out of pocket for you...please stick to your life saving pill and move on, I wish I were taking just one pill a day....good luck   ;p

Offline Jeff G

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  • Member
  • Posts: 11,738
  • How am I doing Beren ?
Re: ARV vacation question
« Reply #5 on: July 07, 2014, 05:06:59 PM »
Eric is known for his questionable advice and scaremongering ... this time he has been very caviler on the topic that any person living with HIV must come to terms with and that is at the current time once you begin HIV treatment its a lifetime commitment and you should never alter your treatment plan without discussing it with a trusted doctor first .

We have wonderful members here and when we get it wrong sometime we can count on our forum mates to call us out on it ... and we all get something wrong evetually .

Eric got it wrong this time and we did what we can as a forum to address ... now you know .

Offline stuka

  • Member
  • Posts: 44
Re: ARV vacation question
« Reply #6 on: July 07, 2014, 05:13:53 PM »
Everyone, thanks for the prompt responses. Please understand that I am absolutely not contemplating getting off ARVs. I have not even started yet. There's no way in hell I'm playing russian roulette with my health anymore. I made a terrible mistake once and do not wish to blow off the second chance (thanks pochas2:)) that I've been given.

Its just that I saw Eric's posts on this topic and thought it was rather odd that he was the only one advocating this approach. I figured that I would get other people's input and it seems that almost everyone is unanimously of the opinion that one should NEVER stop once treatment begins.

I must say that we should respect people's right to post whatever they like, but I also fear that such posts might give the wrong impression, especially to HIV treatments newbies like myself.

Offline Jeff G

  • Administrator
  • Member
  • Posts: 11,738
  • How am I doing Beren ?
Re: ARV vacation question
« Reply #7 on: July 07, 2014, 05:49:15 PM »
I took a drug holiday and ended up relasping and back in chemo therapy for a long while with Kaposi Sarcoma . Im not saying this to scare folks and there are certain times that doctors will advise a brief treatment interuption for a medical procedure or in cases of a med change ... but thats the exception to the rule and should always be done under the supervision of a trusted doctor who know what they are doing and you can trust .

There are a few fundamental things we all need to come to terms with when we are living with HIV and the two biggest I can think of is that HAART is a lifetime commitment and we will die without it . As a LTS I am hard to shock but I have been shocked a bit in the last few days at threads asking if coconut water can treat HIV and can you take med holidays or suggest that its a good idea to do so ... the new people on this forum learning the ropes have every right to post and ask these questions like you did but I find it disheartening when people that should no better by now engage in that kind of misinformation because its confusing and makes the adjustment to living with HIV even more hard and stressful for those members are still reeling from a new HIV diagnosis .

Here is something to read ... and you can google and see where treatment interruptions and alternate dosing has been studied with very specify combos... This is where many people get the idea that you can take drug holidays and skip doses but you would be hard pressed to find an infectious disease doc who would give you the green light to do this on your own or even agree its a good idea to consider it .  .http://clinicaltrials.gov/show/NCT00414635 .

Offline leatherman

  • Member
  • Posts: 6,189
  • Google and HIV meds are Your Friends
Re: ARV vacation question
« Reply #8 on: July 07, 2014, 07:17:33 PM »
As a LTS I am hard to shock but I have been shocked a bit in the last few days at threads asking if coconut water can treat HIV and can you take med holidays or suggest that its a good idea to do so ... the new people on this forum learning the ropes have every right to post and ask these questions like you did but I find it disheartening when people that should no better by now engage in that kind of misinformation because its confusing and makes the adjustment to living with HIV even more hard and stressful for those members are still reeling from a new HIV diagnosis .
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

 


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