1st International AIDS Society Conference on HIV Pathogenesis and Treatment


Buenos Aires, Argentina - July 8-11, 2001

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[TITLE:] STRUCTURED TREATMENT INTERRUPTIONS (STIS)

[AUTHOR(S):] Diane V. Havlir
University of California, San Diego, CA, USA

IAS Conf HIV Pathog Treat 2001 Jul 8-11;1st: Abstract No. 29

[ABSTRACT:] STIs are undergoing evaluation in 3 settings of the HIV therapy arena. Each application is associated with a distinct rationale, unique risks and benefits. In patients responding to antiretroviral (ARV) therapy, a STI may boost host immune responses and ultimately contribute to control of HIV replication. This rationale makes most sense for acute HIV infection when ARV is initiated prior to the deletion of host HIV CTL responses. Promising observational data report attenuated rises of HIV RNA levels observed after repeated STIs in acute HIV infection. Important insights into determinants of protective host immune responses may result from studies of these patients.

In patients failing ARV therapy with multiply drug resistant virus, STIs may permit re-population of drug sensitive virus. Response to a subsequent "salvage" ARV regimen with a proceeding STI may be superior to current practice of regimen modification without interruption. This hypothesis is being tested in randomized clinical trials. STIs may put patients with low CD4 cell counts at increased risk for serious HIV complications; for this reason, STIs should be considered experimental.

STIs are also being evaluated as a means to reduce pill burden and drug toxicity. In areas with limited resources, such strategies offer the possibility of increasing ARV access. The optimal timing and duration of STIs in these patients are not known. "Flexible" schedules which trigger re-institution of therapy for either a CD4 , an HIV RNA threshold or both represent one strategy. "Fixed" schedules designating duration of STI represent an alternate approach. Risks of STIs for these patients include drug resistance, repopoulation of HIV reservoirs that were gradually diminishing, and subtle effects on quality of life including cognitive function.

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