Bad Breaks

Here's more bad news for HIVers considering a short-term break from their antiretroviral drug regimens: You're more likely to expose others to the virus and to suffer potentially dangerous blood clots if you do, according to two new studies. An analysis of data from the large-scale Strategies for the Management of Antiretroviral Therapy study'which was stopped in 2006 when it showed that even structured treatment interruptions double the risks for serious illness or death'indicates that treatment breaks significantly boost HIV transmission risks, despite rates of risky behaviors remaining constant. Because HIV viral levels in both blood and sexual fluids rose in the absence of anti-HIV medications, the chances of infecting others through unprotected sex, needle sharing, or childbirth also increased, researchers reported in the October 2008 edition of the Journal of Acquired Immune Deficiency Syndromes. A second analysis of the SMART study data reported in the October 21 edition of the journal PLoS Medicine has shown that treatment breaks were linked with increases in three key blood proteins linked with inflammation and blood vessel damage, particularly potentially life-threatening blood clots, even after anti-HIV meds are resumed. The researchers say it's also possible for inflammation to increase risks for diabetes, heart disease, and certain cancers, although their study did not specifically address these ailments. It was thought at one time that STIs ranging from a few days to several months could offer HIVers much-needed breaks from the taxing and toxic side effects of antiretrovirals as well as cut costs for people struggling to pay the five-figure annual costs for treatment. Some AIDS experts even once posited that short drug-free periods could induce one's body to produce more HIV-fighting CD4 cells. But this new disappointing data'particularly in light of the availability of newer medications with fewer adverse side effects'only add to a growing consensus that treatment interruptions should be avoided, experts say. If you are considering a break, it is recommended that you speak with your doctor to evaluate what other alternatives may be available to you. 'I think the bottom line is that treatment interruptions failed. It's just not something that can be tolerated,' says Gordon Dickinson, a professor of medicine and chief of the division of infectious diseases at the University of Miami. 'The desired advantage of being able to stop taking medication for a period of time is not there. In the end, people who did stop therapy showed disease progression.'