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Op-Ed

Curious about taking ‘drug holiday’ from ARV

An HIV-positive Filipino was told about “ARV drug holiday” (that is, taking a break from taking his ARV) and wants to know more about this. Dr. Jose Narciso Melchor Sescon provides needed information on this.

Dr. Jose Narciso Melchor Sescon – president of the AIDS Society of the Philippines and current Chief of Clinics of Sta. Ana Hospital – answers all your HIV-related inquiries. For all your questions, email josescon1@gmail.com or info@outragemag.com.

Dear Doc,

My friends from Africa mentioned to me that there are PLHIVs there who go on drug holidays to allow the body to recuperate from the stress caused by the meds. Can I also practice this?

Mr. Holiday

The rule of thumb to keep in mind is that drug therapy regimen is customized to the needs of the patient. Never compare your ARV treatment plan with the other clients since, for all you know, there are other factors that your HIV specialist considered when he/she gave you your specific drug combinations.  Also, you may not have been informed, they may be part of a “new” research protocol or design on ARV treatment (which may not work for you). So never mess up with the instructions given to you by your HIV specialists.

Drug holidays, or otherwise known as “structured treatment interruptions” (also known as STI, though NOT to refer to sexually transmitted infections), is an evolving trend in other developing/developed countries where there have been ARV treatment practice for more than three decades.

The fact remains that antiretroviral (ARV) therapy improves the health of persons with HIV by suppressing the virus and thus slowing the progression of the disease to AIDS condition.

On the other hand, the drugs have side effects, are expensive, and many people find it difficult to take them for long periods without any breaks.

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Some scientists came to think and proposed that it might in fact be a good thing to have “breaks” from antiretroviral treatment in order to stimulate the body’s immune response to HIV. When HIV is suppressed to very low levels in the blood for long periods (as occurs with antiretroviral therapy), a person might lose his/her natural immune response to the virus. Notably, the immune system is a very important body mechanism in controlling the virus, along with antiretroviral treatment.

If treatment is stopped, the virus quickly multiplies and levels in the blood rise. This could serve to “switch on” and strengthen the immune response, in a process that has been called “auto vaccination”.

A small number of scientific studies with people on antiretroviral treatment set out to study what would happen if there were controlled, short treatment breaks, called structured treatment interruptions or “drug holidays”. These studies have shown that there is measurable, increased recognition of the HIV by the immune system following treatment breaks. However, these effects on the immune system are similar to what is found in people before treatment, and do not seem to have long-term benefits in people with established HIV infection.

(There may be more benefit in people who started antiretroviral treatment very soon after they were infected with HIV.)

Another concern is that there is evidence that drug resistance is more likely to occur following structured treatment interruptions, just as it is more likely to occur when people interrupt their treatment for other reasons.

Because at this stage there is no clear answer as to whether structured treatment interruptions is a good thing, and also because of the uncertainty about how often and how long interruptions should be, structured treatment interruptions is not advised for any person on antiretroviral treatment except as part of a properly controlled and monitored scientific study.

Many scientists now believe that it is probably safer to use other ways to stimulate an immune response to HIV in patients on treatment. Such methods could include cytokines (immune messenger molecules) or HIV vaccines, and NOT structured treatment interruptions.

So it is NOT SMART to go drug holidays on your own without the HIV specialists’ recommendations. Otherwise, you are part of a randomized control trial study on drug resistances/and drug holidays efficacy.

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