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Structured Treatment Interruptions 4 to6-month interrupt safe>400-500??

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Structured Treatment Interruptions

Data from SMART, the largest trial of structured treatment interruptions (STI) conducted to date, were reported earlier this year at CROI.[5] The premature discontinuation of this study has been a major obstacle to enthusiasm around further study of STIs in the context of HIV. The results of 2 other trials, Trivacan[6] and DART,[7] have confirmed the SMART results, with an excess of morbidity and mortality in STI arms compared with control arms. In contrast, the results of the Staccato and Windows[8,9] studies have shown significant cost savings using STI without deleterious adverse outcomes, as shown in Table 2.
Table 2. Outcome in Major Studies Assessing Structured Treatment Interruptions (STI)

AIDS & Deaths per 100 Patient-Years
(5472)   SMART
(326)   rivacan
(813)   DART
(430)   Staccato
(390)  Windows
STI arm      3.1   17.6   8.3   0.2   0.4
Control arm   1.4   6.7   3.2   0.4   0

These apparent contradictory results could be somewhat reconciled if we consider that short (4- to 6-month) treatment interruptions may be safe only in patients with CD4+ cell counts > 400-500 cells/mcL.[9] Also of note, one of the indirect messages of the SMART trial data is that plasma HIV-RNA does matter clinically, because AIDS/death events in the trial were more frequent in patients off therapy across all different CD4 strata.

my laymans interpretation... short interupts have low danger of adverse effects, long interupts have some danger of adverse effects but haart does such a good job that the some danger is very very low??
please comment on your experiences with treatment interupts?????
how many have you had how long?

my nurse was talking today again about going on meds, but explained that i would go on meds for about 2 years and if things were ok to come off meds, she says she has other patients who did this and some of them have been off meds for 6 to 7 years. i mentioned the smart study to the nurse. the nurse explained that whilst the smart study generally concluded that there was no benefit for treatment breaks and the virus came back worse, there is a category of persons the study does not fit with. she explained that seroconverters who were only infected recently (say ~1yr) who go on meds quickly can come off them in about 2 years if their bloods are good and as explained above can go for 6-7yrs+ off treatment. i'm in the UK, and my nurse is organising for me to be referred to mortimer market clinic in London as she said they are more experienced in dealing with this particular type of seroconverter (other reasons for referral-> the visiting doctor also is at mortimer, nhs funding problems, ease for me to travel to mortimer clinic).

hussy thanks for your reply, i do not fall into the 1 year group as you do, but have been exposed 2 years ago, but 500tcells and med vl of 22k.  i wish i could ask your nurse what she thought, i would go on meds now if i thought i could go off of them for 5 years, seems weird because the clinical practice is so different from city to city,
what are your numbers, i am planning to wait till i get to 350tcells or vl spikes up, what are your thoughts

one big question is, we know that a small to medium pc of hiv are suffering with alcolohism or drug use or even abuse, say up to 20% but did these staccato and other Structured Treatment Interruptions take this into account.

in other words if the adverse effects were seen mostly or only in  those suffering with alcolohism or drug use or even drug abuse perhaps the  Structured Treatment Interruptions are safer than the stats show

it just seems unscientific to group everone together, what about by age, or alcolohism or drug use or even abuse etc

Will there ever be a day in our lives where we can stop taking meds? Is that possible?


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