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4 Days a Week of Antiretroviral Treatment Enough?

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Jim Allen:
Reminds me a bit of the Atripla Taken Every Other Day study Or the FOTO study.
(5 days on, 2 days off)

FOTO: https://www.poz.com/article/hiv-efavirenz-intermittent-16959-8019
Every Other Day: https://forums.poz.com/index.php?topic=72189.msg

Is 4 Days a Week of Antiretroviral Treatment Enough?
Full Poz.com write-up:
https://www.poz.com/article/4-days-week-antiretroviral-treatment-enough

In Short:


--- Quote ---Prior studies have clearly shown that “drug holidays” that involve interrupting treatment for weeks or months are dangerous. This allows the virus to come surging back, damaging the immune system and triggering inflammation that can contribute to a host of non-AIDS conditions—even if therapy is resumed before the CD4 count drops. It can also lead to drug resistance. But less is known about treatment breaks lasting a few days in the era of more potent drugs with a higher barrier to resistance.

Roland Landman, MD, of Université Paris Diderot, and fellow investigators with the QUATUOR study asked whether intermittent maintenance therapy could improve the convenience and tolerability and lower the cost of antiretroviral treatment for people who have achieved viral suppression on a standard regimen.

This open-label randomized Phase III trial included 636 participants from multiple centers in France who enrolled between September 2017 and January 2018.

At the start of the study they had undetectable viral load (below 50 copies) on a three-drug regimen containing an integrase inhibitor (48%), non-nucleoside reverse transcriptase inhibitor (NNRTI; 47%) or protease inhibitor (6%). More than 70% paired this with tenofovir disoproxil fumarate/emtricitabine (the drugs in Truvada) or tenofovir alafenamide/emtricitabine (the drugs in Descovy). They had been on antiretroviral therapy for a median of seven years, with viral suppression for six years, and they had no evidence of drug resistance.

Participants were randomly assigned to either stay on their daily regimen or take the same medications for four consecutive days followed by three days off.

At 48 weeks, both groups had a high rate of continued viral suppression: 95.6% in the four-day group and 97.2% in the daily group. This difference was not statistically significant, meaning it could have been driven by chance. There was also no significant difference in the occurrence of viral “blips,” or single detectable viral load measurements, in the two groups. These findings demonstrate that the four-days-on/three-days-off schedule was noninferior to, or as good as, the seven-day schedule.

Just six people (1.9%) in the four-day group and four of those (1.3%) in the daily group experienced virological treatment failure. Of these, three and one, respectively, developed resistance mutations. No one taking a protease inhibitor had virological failure, while three people taking NNRTIs in both treatment groups did so. Among those taking integrase inhibitors, there were three virological failures in the four-day group and one in the daily group. Treatment failure was not associated with lowest-ever CD4 count, CD4/CD8 ratio, duration of viral suppression or a history of past virological failure..
--- End quote ---

harleymc:
I'm going to discuss this with my ID doctor.

beanstalk:
I feel like taking it everyday is better anyway since it becomes a habit. Having "off days" might increase the chance of you forgetting to take the medication, at least it would for me.

leatherman:

--- Quote from: beanstalk on July 28, 2019, 07:44:53 am ---since it becomes a habit

--- End quote ---
taking meds mon-thurs would become a habit after a while. ;) People don't accidentally go to work on the weekend when they have a habit of working monday thru friday. :D Besides if you forgot to take your meds one day, you could count that as one of the "off" days, since there are 3 of those per week.

I think if people in the "old days" could learn and remember to take some meds every 4 hrs and some meds 2 hrs before food and some meds 2 hrs after food (I used to have a chart on my frig to keep track of all that when I was taking about two dozen pills a day) then people can remember to take meds 4 times a week.

I also remember in the "old days" taking 4 AZT pills every 4 hours 24 hours a day 7 days a week. Many people were very sick on that regimen. These days AZT is still used but not in that original dosage because we now know that that dosage was a serious overdose. This study showing that meds are only needed 4 times a week also shows that current dosing schedules are overdoses.

and to be honest, the incredible money savings is worth it. Ryan White programs and federally qualified health centers spend billions on ARVs. That savings in pharmaceuticals could become funding to help PLWH with other issues (housing, food, transportation, mental health, dental). Some funding could even be used to help "train" patients to remain adherent to the 4/3 plan

Loa111:
Do you think then that with further studies, sometime in the nearer future, that 4 days a week will become that norm?

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