On-Again, Off-Again HIV Treatment May Work
"If you don't treat HIV, it takes over the immune system," Lori tells WebMD. "If you treat it with multiple HIV drugs, you get no immune-system involvement. In between, we think there is a chance of restoring the immune system."
Montaner is optimistic that his team has found a way to do this. Their new clinical trial is enrolling patients whose HIV is controlled by their HIV drug regimen. This regimen cannot include drugs that can't be stopped and started due to risk of resistance (such as Sustiva) or risk of dangerous side effects (such as Ziagen). Each patient then undergoes four progressively longer rounds of treatment interruption (two, four, and six weeks, followed by an open period). Before each new interruption, viral load must be brought back down to undetectable levels by the drugs.
Although not part of the trial, Montaner is monitoring a patient who -- in consultation with his physician -- is undergoing the treatment-interruption schedule being tested in the new clinical trial. With each treatment interruption, the rebound in the amount of virus in the patient's body was smaller than that seen previously. The virus rebounded at first -- and then steadily fell even thought the patient stayed off his HIV drugs. "His immune responses are going through the roof," Montaner says.
Montaner warns that there is no proof that this strategy works, and those patients who try it run considerable potential risk. If patients feel that they must interrupt their treatment, Montaner advises that they do so only under the close supervision of a physician. "We cannot tell a person not to do this," Montaner says. "If you choose to do it, it is your own decision. We are not telling people how to manage their disease. But if people are doing something already, we can follow them."