Decrease in lipoatrophy in a pilot study using a short-term treatment interruption strategy for 48 weeks in S?o Paulo, Brazil

摘要

Editor: In the absence of a cure for HIV infection, patients must cope with long-term exposure to daily antiretroviral agents, which ultimately leads to pill fatigue and toxicities. Common toxicities include impaired glucose and lipid metabolism and body fat redistribution. Furthermore, for developing countries that need to provide treatment to a large number of infected individuals, the cost of antiretroviral agents is also a limitation. Recent studies investigating treatment interruption and reinitiation guided by CD4~+ T cell count thresholds demonstrated that the reemergence of viremia was associated with a number of events, including higher mortality rates and increased risk of serious non-AIDS diseases. Time-cycled strategies using long-term interruptions of 1 month or more increase the risk of selecting resistant HIV-1 strains. However, it is not clear whether short-term treatment interruptions lead to consistent deleterious viremia among patients. We therefore conducted a pilot study in which patients were treated for 7 days followed by 7 days of treatment interruption for 48 weeks among HIV-1-infected individuals with evidence of lipoatrophy. We hypothesized that toxicities would decrease with minimal loss of the benefits of antiretroviral treatment and minimal risk of the development of antiretroviral resistance.