Drug Holiday

[bagavat]

I was just wondering if anyone else has been taking drug holidays similar to mine.  Several years ago I started having unacceptable side effects, the worst being a large buffalo hump that was growing larger by the day and becoming noticeable by friends and co-workers.  It was also interfering with normal activities including sitting at the computer and holding my head up without straining, etc.  I was also having quite severe abdominal pain and constant low grade nausea, etc.  I started using marijuana again to treat that even though I didnt like the high it was giving me.  I baked brownies instead of smoking it because of damaged lungs caused by PCP.

So I decided to try a one week on, one week off regime, which I continued for three years.  (It has always been my contention that these drugs are very toxic and the doses are over-prescribed.)  My viral load again dropped to undetectable and my CD4s actually rose to about 5-600 from 350.  It was my second set of HIV drugs.  The first lasted for three years before I had to change due to dropping CD4s and rising viral load, etc.  The second regimen also lasted for about three years.  I have never told any of my docs about doing my on/off regimes.  Then about seven years ago when I started my latest drug regimen I decided to change from a one week on, one week off to a weekday on, weekend off regime.  That lasted for a couple of years without any adverse effects.  The last five years I have been on a Sat and Wed off schedule.  So I basically have more or less three days on and one day off, etc. 

I have done this on the basis that the drugs I am using have half lives of approximately 48 hours.  (Read the inserts, you will find out stuff the docs dont both to tell you or dont know.)  Thus my reasoning goes that after 24 hours I still have plenty of the drugs in my system.  I also feel that this system prepares my body for the rare case when I actually do miss a dose.  My body is used to not having these doses on a totally regular schedule.  And guess what?  My CD4s have consistently been around 600 and my viral load has always been undetectable.  And from the very beginning my side effects reversed including losing the buffalo hump in just a few months.  And the other common bad side effects that most people have also were lessened quite a bit.

Recently a friend of mine told me that Metformin (diabetes drug) can cause stomach pain and upset.  I had that very bad.  I was overweight for a several years (I believe that was the main cause of my diabetes) and after my third heart attack and fifth stent I finally decided it was time to lose all that fat.  So I went on a serious diet and lost 75 pounds.  I am now a very healthy 165, my 'fighting weight' from high school days.  So I really didnt need the Metformin anymore.  My stomach problems cleared up in a few days.  What a relief. 

So that is my story.  Any comments?

[bGeek107]

The HIV drugs can affect just about everything. I have never had a good set of drugs. I kept changing drugs. For the last six year or so I take holidays all of the time. It was the only thing I could until my viral load was down and I had more T-cells. Each time I lowered my dose for the last three sets of drugs I got a lower viral load and more T-cells and less pain. By watching my numbers I was able to get to no pain or side effects. My viral has stayed near undetectable and I have over 400 T-cells. I take Travada in the morning and a half dose of Kaletra at night each weekday. I am off on weekends. My Doctors know what I am doing and they are OK with me. My numbers tell them I am doing great and I fell good.

[aztecan]

I wouldn't do what either of you are doing. But, if it is working for you, then I guess you have your answer.

I would be careful to watch for viral breakthroughs, though.

I have been on meds for 14 years and can  honestly say I haven't missed too many doses during that time, even when I took Crixivan, AZT and Epivir.

I have never changed meds because I developed resistance. I have changed because of side effects, including the buffalo hump, chipmunk cheeks and horse collar neck.

My CD4s range between 900 and 1,400, and I've been undetectable since July of 1996. I know this is purely anecdotal, but then, all of the statements in this thread are.

As I said, if its working for you, that's great. But please be vigilant regarding changes.

HUGS,

Mark

[kelly42]

i have been positive since age 19. i am 42 now and i think it is because of the holidays. when my body says stop i stop. i also tell my doctor when i am on holiday and for how long. sometimes a week sometimes a month  sometimes more. i DO NOT advise anyone taking holidays, because everyone is dfifferent. some say it's a dangerous game to play. if you need a break talk to your doctor first. good luck

[nychope1]

At the risk of getting reprimanded for posting here cause I am a "newbie".....

Atripla Users May Be Able to Take Weekend Treatment Breaks

http://www.hivandhepatitis.com/2008icr/hiv9/docs/111808_a.html

In an effort to alleviate the inconvenience and other drawbacks of life-long daily treatment, many patients with HIV wish to take "drug holidays," or periodic breaks from antiretroviral therapy.

Several studies -- including the large SMART treatment interruption trial -- have shown that CD4-guided treatment interruption is a potentially hazardous strategy, leading to an increased risk of both opportunistic infections and serious non-AIDS-defining disease.

But a different type of treatment interruption -- a short-cycle strategy alternating periods of 5 days on and 2 days off drugs -- may be feasible for some people, according to a study presented at the 9th International Congress on Drug Therapy in HIV Infection (HIV9) last week in Glasgow, Scotland.

The FOTO study ("Five On, Two Off") included 60 U.S. patients taking tenofovir, emtricitabine, and efavirenz -- the 3 drugs in the Atripla fixed-dose combination pill -- who had a CD4 count above 200 cells/mm3 (mean about 670 cells/mm3) and sustained viral suppression. Most (83%) were men, three-quarters were white, and the mean age was about 45 years.

Participants were randomly assigned to either continue daily therapy or switch to alternating 5 consecutive days on treatment (typically Monday-Friday) followed by 2 days off. HIV RNA levels were assessed at weeks 4, 12, and 24; in the FOTO arm, viral load was measured at the end of a 2-day interruption.

The primary endpoint was the proportion in each arm with virological suppression < 50 copies/mL at week 24. Data on adverse events (AEs), adherence, and quality of life were also collected.

Results

    • 53 participants completed 24 weeks in the study (25 in the FOTO arm and 28 in the daily treatment arm).

    • All 7 patients who stopped the study prior to week 24 had HIV RNA < 50 copies/mL at the time of discontinuation.

    • 10 viral load "blips" (transient increases to 50-500 copies/mL) were detected in the FOTO arm compared with 8 in the daily therapy arm.

    • No participants in either arm experienced virological failure (confirmed HIV RNA > 400 copies/mL) through week 24.

    • In an intent-to-treat (drop out = failure) analysis, 83% of participants in the FOTO arm and 80% in the daily therapy arm had HIV RNA < 50 copies/mL at week 24 (not a statistically significant difference).

    • In an as-treated analysis, 100% in the FOTO arm and 85% in the daily treatment had undetectable viral load at week 24.

    • Week 24 viral suppression rates were deemed equivalent in the 2 arms, with the study powered to detect a 15% difference

    • CD4 cell counts remained high, and were similar in both arms.

    • No AIDS-related events occurred in either arm.

    • 3 mild neuropsychiatric AEs were reported, 2 in the FOTO arm and 1 in the daily therapy arm.

"These data confirm the success of a Five-day On/Two-day Off strategy for maintaining virologic suppression for at least 24 weeks on [efavirenz/tenofovir/emtricitabine]," the investigators continued.

In addition to improved convenience for patients in wealthy countries, they noted, "This treatment strategy could significantly reduce antiretroviral drug costs, which is especially important in resource-scarce areas."

Continued follow-up is ongoing to further assess the durability of this strategy over a longer term.

[David Evans]

nychope1

There's a reason that we ask only long term survivors to post in this forum. It's the same reason that we ask people who are HIV-negative or uncertain of their status to refrain from posting in any of the forums for people living with HIV. It's the same reason that we ask men not to post in the forum for women. There are unique experiences related to living with HIV for a long time, and especially having survived the earlier days of the epidemic.

You may not agree with the rule, but I ask you to respect it by not posting here again. If you do, you'll be given a time out.

David
Moderator