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Evidence summaries

Structured Treatment Interruptions (Sti) in Chronic Unsuppressed HIV Infection in Adults

Structured treatment interruptions (STIs) do not improve outcomes in chronic unsuppressed HIV infection. On the contrary, there is evidence of harm due to the associated CD4 cell decline and the increased risk of clinical disease progression. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 8 randomized studies with a total of 1113 subjects with persistent viremia due to multi-drug resistant HIV. Of the seven completed RCTs (n=609), six have reported consistent virologic and immunologic patterns, and found no significant benefit in virologic response to subsequent antiretroviral therapy in the STI arm, compared to the control arm. In addition, the largest completed randomized trial reported greater numbers of clinical disease progression events and evidence of prolonged negative impact on CD4 cell counts in the STI arm.

The single RCT with divergent findings from the others (GigHAART), reporting a significant virologic and immunologic benefit due to STI, was different in prescribing a shorter STI duration and a salvage ART regimen of 8-9 drugs. There were also differences in the patient population characteristics with this study, targeting those with very advanced HIV disease.

STI as a treatment strategy in HIV-infected patients has had various aims, including allowing wild virus to re-emerge and replace the resistant mutant virus, to halt development of drug resistance and to preserve subsequent treatment options, to alleviate treatment fatigue and reduce drug-related adverse effects; and to improve quality of life.

    References

    • Pai NP, Lawrence J, Reingold AL, Tulsky JP. Structured treatment interruptions (STI) in chronic unsuppressed HIV infection in adults. Cochrane Database Syst Rev 2006 Jul 19;3:CD006148. [PubMed]

Primary/Secondary Keywords