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Breaking: 4 Days On, 3 Days Off HIV Treatment May Still Work

Four Days On, Three Days Off Treatment

For those with undetectable viral loads, missing a couple days of meds may not compromise health; opening the possibility of less than daily treatment schedules.

A new study presented at the International Congress on Drug Therapy in HIV Infection shows that HIV-positive people with undetectable viral loads maintained viral suppression even after missing a few days of treatment.

For treatment-weary poz people, exchanging a daily pill for a four-day on three-day off routine sounds like a huge relief; and it can have a significant impact on reducing HIV treatment costs. That's why a French pilot study set out to determine whether such a weekly treatment routine  would compromise viral suppression. Although some worried that this kind of break in treatment would lead to rising viral loads and more drug resistance; those fears appear unfounded. 

For research purposes, 100 participants — all people living with HIV who had been undetectable for at least four years — were told to take their medication each day either from Monday to Thursday, or Tuesday to Friday. All of them took a three-drug regimen of two nucleoside reverse transcriptase inhibitors (NRTIs) and either a boosted protease inhibitor or an NNRTI, reports NAM's AIDSMap.

After 48 weeks of this routine, 96 out of 100 participants had maintained viral suppression below 50 copies/ml. Three of them experienced a rebound, and another quit the regiment altogether after just four weeks.

While drug levels declined to extremely low detectable levels, viral suppression was maintained overall.

Obviously, a four-day on/three-day off plan cuts down the cost of meds by a large fraction. While it’s been believed that any kind of interruption of your antiretroviral routine would damper progress, this study seems to show otherwise.

The three participants who had viralogic rebounds were taking abacavir-based treatments in combo with a boosted protease inhibitor. These rebounds were noticeable at four, 12, and 40 weeks after the new routine.

A larger follow-up study is being planned, which will involve 640 people undergoing the four-day on/three-day off routine for two years. Researchers are interested in seeing the long-term effects of such a regiment, while also seeing how it impacts one’s quality of life — financially and emotionally. 

It's too early to stop taking your pills or reduce the number of days a week you take them (especially without consulting your doctor): but these findings certainly look promising and we'll be watching the remaining study will great interest.

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David Artavia