Question:

I have been taking Combivir and Viramune for about 5 years now. My viral load is undetectable and my CD4 is above 400. I am considerng taking a break from the meds. Have others done this successfully and are there other things I can do to strenghten by immune system if I stop the drugs?

Answer provided by:

Peter Shalit, M.D.
Internal Medicine

There are many people who have taken a break from treating their HIV. Although I don't know your personal situation and your reasons for considering taking a break, if I were you I would not do it. Your numbers are great, and you are on an easy (two pills twice a day) and relatively non-toxic cocktail. There are risks to quitting, and in my mind any benefit is questionable.

Here are some risks. During the course of 5 years on medication, your immune system has had time to recover from the damage done by HIV. When you stop treatment, your CD4 and viral load tend to return to where they were before you started. If your CD4 was below 300 and/or your viral load was high (over 100,000) before you started treatment, it probably wouldn't be long before your numbers would be back to where you'd need to resume treatment again. Also, if you stop Combivir and Viramune at once, your virus may become resistant to the Viramune and then that drug would not work for you in the future. You will need to work with your doctor to discuss ways to reduce this risk.

Personally I am a cynic regarding strengthening your immune system without anti-HIV drugs. I practiced HIV care for many years before we had these drugs, and my patients and I tried many things to support their immune systems and maintain their health. I was never convinced that anything (vitamins, supplements, exercise, healthy eating) did any good. There are some studies that involve getting a vaccine against HIV while you are on the drugs, and then stopping the drugs to see if the vaccine helps you control the virus yourself. If you are interested in a study, you should talk to your doctor, and/or contact a local site of a national study group such as the ACTU (AIDS Clinical Trials Unit) or AVEU (AIDS Vaccine Evaluation Unit).

Good luck,
Peter Shalit

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