Chronic HIV Infection: Can Anyone Afford a Drug Holiday?

Managing chronic conditions with medication has always been challenging for patients and physicians alike. The reasons for imperfect adherence to, or compliance with, medication regimens are numerous; these reasons can be complex and or as straightforward as “I forgot.” Compliance research shows that the nature of the condition and the consequences are not always compelling enough to motivate patients because low adherence rates have been documented in such settings as posttransplantation, epilepsy, and HIV–AIDS.

Although the virologic, immunologic, and clinical benefits of potent antiretroviral therapy consisting of three or more antiretroviral drugs have been extolled by clinical researchers and the U.S. Centers for Disease Control and Prevention, questions have arisen about early use of aggressive therapy and the possibility of intermittent therapy or other types of sanctioned drug holidays. Some HIV-infected patients who feel well but are tired of taking antiretroviral medications daily are eager to learn the consequences of temporarily or permanently stopping therapy.

Preliminary investigations into the feasibility of interrupting antiretroviral therapy in chronic or established HIV infection—in the setting of successful antiretroviral–induced viral suppression and in cases of treatment failure—have been unable to answer critical questions because of limitations in study design, sample size, or duration of follow-up. Nevertheless, the data from these studies have provided some insights. Furthermore, several large controlled trials are currently enrolling patients or are just under way; findings will not be available for 2 to 3 years. Experts agree that until then, clinicians should not interrupt treatment or try to replicate the on–off treatment schedules reported from clinical trials as an alternative to currently recommended management strategies for their patients with HIV infection.