Structured treatment interruptions in chronic HIV management: where next?

Intrapatient Evolutionary Dynamics of Human Immunodeficiency Virus Type 1 in Individuals Undergoing Alternative Treatment Strategies with Reverse Transcriptase Inhibitors

“… 1 STI is applicable to patients in three main scenarios: (1) those initiating therapy during acute infection, (2) those with chronic drug-suppressed infection, and (3) those with advanced infection and undergoing treatment failure from multidrug-resistant virus. 2 It is thought that STI, in those with suppressed viremia, could enhance recovery of the weakened anti-HIV immune response and therefore provide better HIV control 3 while at the same time offering breaks off treatment to reduce side effects and cost. In contrast, in those failing treatment the benefit from interruptions could result from the reversal of the virus population to wild-type, which could potentially enhance success with subsequent salvage therapy.…”

“… 3 , 9 Among patients with chronic HIV infection who are failing due to multidrug-resistant HIV, most studies have found that although STI results in shifts in viral populations from resistant to wild-type (drug-sensitive) virus, CD4 + T cell counts also decline without accompanying virological benefits to subsequent salvage therapy, as resistance quickly reemerges upon resumption of treatment. 2 …”

“…Studies have concentrated on comparisons of STI with CT mostly in terms of the development of clinical events and virological, immunological, and quality of life treatment outcome. 2 , 6 As yet, viral evolutionally dynamics including linkages of emerging mutations at a genome level during the course of treatment are still poorly understood.…”