Trials That Matter: CD4+ T-Lymphocyte Count–Guided Interruption of Antiretroviral Therapy in HIV-Infected Patients

摘要

Advances in antiretroviral chemotherapy have been remarkably successful in suppressing HIV replication, preventing or reversing much of the immunologic damage from HIV infection, reducing the incidence of clinical events and hospitalizations, and prolonging life (1). However, treatment is merely suppressive, not curative (2), and antiretroviral therapy is associated with clinical toxicity, emergence of drug resistance, substantial cost, and burdensome pill-taking. As a result, the concept of structured interruptions to treatment is attractive. Proponents of structured treatment interruption have had several theoretical goals, including providing pulse exposures of viral antigens as an autoimmunization strategy to boost anti-HIV immune responses (3–5); repopulating with drug-sensitive “wild-type” virus in persons with multidrug-resistant HIV (6–9); and reducing drug exposure and its adverse clinical, social, and economic consequences (10–12).