Treatment timeouts dangerous in HIV care

BOSTON, Nov 30 (Reuters) Doctors seeking to reduce the dangerous side effects of long-term HIV therapy have discovered that taking a breather is not better.

People infected with the HIV virus and who have treatment timeouts are more than twice as likely to die or suffer other serious consequences than those kept on a steady diet of drugs, a study published in this week's New England Journal of Medicine shows.

The study was supposed to follow patients for six years, but it was called off after about 16 months because the dangers of intermittent treatment are so high.

And while doctors expected the risk of heart, liver and kidney disease to decline with intermittent drug use, primarily because those were regarded as side effects of the newest HIV medicines, the likelihood of those problems actually increased.

''Treatment may increase the risk, but the absence of treatment appears to increase the risk even more,'' James Neaton of the University of Minnesota told Reuters.

Under the rules of the study, 2,720 volunteers from 33 countries were given holidays of various lengths from their drug therapy once their CD4+ counts, a measure of the health of the immune system, hit 350. Drug treatment resumed if their counts dropped below 250.

But those patients were 2-1/2 times more likely to die or be hit by an AIDS-related infection than the 2,752 volunteers who were told to keep taking their medicine, regardless of their CD4+ count.

Also, the people who received intermittent drug treatment were 70 percent more likely to develop heart, kidney or liver problems.

''This was a big surprise,'' Neaton said.

Fifty-five of those who had intermittent treatment died from various causes, while 30 who had continual treatment died, the study said.

AGGRESSIVE THERAPIES Doctors had thought that kidney, liver and heart disease were caused by the aggressive therapies that have allowed HIV patients to live longer.

Among patients who received the drugs only when they seemed to be needed, ''we expected the rate of cardiovascular disease to be 15 percent lower,'' the researchers said.

The new findings suggest that those health problems may instead be the result of long-term infection with the HIV virus, Neaton said.

Doctors involved in the Strategies for Management of Anti-Retroviral Therapies (SMART) study had hoped that patients could take a break from the treatments because the therapy is difficult and expensive.

''The prospect of lifelong treatment is difficult for people with HIV,'' said David Cooper of the University of New South Wales in Australia. ''We are gratified that the SMART study has so clearly delineated the risk and benefits of these two strategies.'' At a conference on AIDS, Dr Anthony Fauci, head of the U S ational Institute for Allergy and Infectious Diseases, said he did not believe any doctor should now offer patients treatment breaks, at least not breaks monitored by watching their CD4 immune cells.

''I think for practical purposes, it is the end,'' Fauci told reporters. He said doctors might still try the treatment holiday approach if they monitor viral load -- how much virus is circulating in the patient's blood.

Reuters AKJ DB1015