Important note: Information in this article was accurate in August 2003. The state of the art may have changed since the publication date. |
AIDSWEEKLY Plus; Monday, August 11, 2003
Michael Greer, Senior Medical Writer
Mark Dybul and colleagues working at the National Institutes of Health in Bethesda, Maryland, and Tibotec-Virco in Mechelen, Belgium "evaluated the effect of long-cycle structured intermittent therapy (SIT; 4 weeks without highly active antiretroviral therapy [HAART] followed by 8 weeks with HAART) versus continuous HAART" in a recent study.
Use of the SIT regimen had little effect on the safety and efficacy of HAART, and the only noticeable changes were negative, Dybul and coauthors found.
After almost 1 year of therapy, lipid levels and liver function were comparable in patients who underwent SIT and those treated with standard HAART, they noted. In addition, levels of the inflammatory C-reactive protein - a known risk factor for cardiovascular disease - were similarly high in both treatment cohorts.
An elevated percentage of CD38+ and HLA-DR+ cytotoxic T cells was seen in SIT-treated patients compared to those in the continuous HAART group, according to the report. High levels of these cells are associated with a poor prognosis in HIV patients.
Although structured treatment interruptions have been hypothesized to stimulate antiviral immune activity, SIT-treated patients did not demonstrate autoimmunization effects (Long-cycle structured intermittent versus continuous highly active antiretroviral therapy for the treatment of chronic infection with human immunodeficiency virus: effects on drug toxicity and on immunologic and virologic parameters. J Infect Dis. 2003 Aug 1;188(3):388-96.
"There was no benefit to long-cycle SIT versus continuous HAART with regard to certain toxicity, immunologic, or virologic parameters," Dybul and colleagues concluded.
The corresponding author for this report is Mark Dybul, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA. E-mail: mdybul@nih.gov.
Key points reported in this study include:
Intermittent antiretroviral therapy is inferior to continuous treatment for HIV patients
Toxicity was similar between both treatment groups, as were immunological and virological parameters
However, patients treated with intermittent therapy had higher levels of CD38+ and HLA-DR+ cytotoxic T cells, linked to poor outcome
This article was prepared by AIDS Weekly editors from staff and other reports.
Reference
Dybul M, Nies-Kraske E, Daucher M, et al., "Long-cycle structured intermittent versus continuous highly active antiretroviral therapy for the treatment of chronic infection with human immunodeficiency virus: effects on drug toxicity and on immunologic and virologic parameters", J Infect Dis. 2003 Aug 1;188(3):388-96
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