HIV study advises drug continuity

LOS ANGELES -- Taking HIV patients off medications during periods when the disease appears to be under control is a risky and sometimes fatal treatment strategy, according to a large international study published today.

Patients who cycled on and off drugs were 2.6 times more likely to die or develop symptoms associated with AIDS compared with patients on continuous therapy, the study found. They were also 1.8 times more likely to develop serious heart, kidney, or liver diseases.

Interrupted treatment was once seen as a way to reduce the toxic side effects of AIDS medications and to stretch the supply of drugs. But small studies over the past few years suggested it might do more harm than good.

The new report, published in the New England Journal of Medicine, appears to be the definitive word on this strategy.

"I think, for practical purposes, this is the end," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, which funded the $73 million study.

HIV, or human immunodeficiency virus, attacks a class of immune cells called T-cells. Anti-retroviral drugs work by preventing the virus from replicating in the body.

The rationale for interrupted treatment has been undermined in the past five years as AIDS treatments have become much less toxic, said Dr. Eric S. Daar, chief of HIV medicine at Harbor/UCLA Medical Center in Torrance, Calif. Fears that patients would become resistant to AIDS antiviral drugs also have been alleviated by recent studies showing only a 5 percent rate of resistance, he said.

Stretching a limited drug supply is still important for the developing world, but less critical in the United States, Daar said.