Therapieonderbrekingen in de behandeling van HIV: De verrassende optie: Géén geneesmiddelen

Highly active antiretroviral therapy (HAART) has led to substantial reductions in morbidity and mortality in HIV-infections. Recently, structured treatment interruption (STI) of HAART has gained much attention. The application of STI has been investigated for three scenarios: acute HIV infection, chronic HIV infection with anundetectable viral load, and chronic infection with virological failure. The use of one or more cycles of STI in acute infections has led to virological suppression without drug treatment in a small number of patients due to an immunological suppresion of viral replication. This effect has rarely been encountered in patients with a chronic infection, although STI may decrease drug exposure and toxicity. Regarding virological failure, STI has been associated with a repopulation of wild type virus. As a result, the drug-resistant virus may disappear and a higher rate of virological response to a subsequent regimen may occur. The long-term effects of STI in this setting are not known yet. Currently, STI cannot be recommended as part of routine clinical care. It is important to verify the available preliminary findings through prospective, randomised studies to assess and weigh the benefits and risks of this approach carefully.