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Clinical Trial
. 2003 Jan 24;17(2):195-9.
doi: 10.1097/00002030-200301240-00009.

HIV RNA in plasma rebounds within days during structured treatment interruptions

Marek Fischer  1 , Roland Hafner, Christine Schneider, Alexandra Trkola, Beda Joos, Helen Joller, Bernard Hirschel, Rainer Weber, Huldrych F Günthard; Swiss HIV Cohort Study
Affiliations
Clinical Trial

HIV RNA in plasma rebounds within days during structured treatment interruptions

Marek Fischer et al. AIDS. .

Abstract

Objective: To evaluate time to viral rebound in patients undergoing repeated structured treatment interruptions (STI).

Method: Fourteen chronically HIV-infected patients enrolled in the Swiss-Spanish Intermittent Treatment Trial (SSITT) underwent frequent blood sampling. Patients underwent four cycles of 2-week STI, followed by 8-week retreatment with the identical antiretroviral treatment (HAART) used before STI. At the fifth cycle, treatment was stopped for a longer period. Before each new STI, plasma viral load (VL) had to reach < 50 copies/ml. VL was measured during day 0 (last day on HAART) and on days 4, 8 and 14 during all five STI.

Results: During the first cycle, plasma HIV RNA increased to > 50 copies/ml (range, 67-88) in five patients at day 4, in eight patients (> 100 copies/ml) at day 8 and in 12 patients (> 100 copies/ml) at day 14. Cumulative analysis of the frequency of detectable HIV RNA at days 4, 8 and 14 compared with day 0 for all five cycles revealed nine patients with VL > 50 copies/ml [13 of 54 samples tested (24.1%); = 0.14] at day 4, 11 patients [33 of 58 samples tested (56.9%); < 0.0001] at day 8 and 12 patients [53 of 65 samples tested (81.5%); < 0.0001] at day 14.

Conclusions: Significant viral replication can be induced during 1 week STI, and this may increase the risk of the emergence of drug resistance during long-term cycling. Therefore, short-term cycling strategies such as 1-week-on, 1-week-off treatment, although conceptually intriguing, should still be regarded as investigational and should be restricted to rigorously controlled clinical trials ideally involving patients who have never failed treatment before.

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