HIV infection and AIDS: Edited by Martin FisherTreatment interruption strategies: how great are the risks?Paton, Nicholas IAuthor Information Medical Research Council Clinical Trials Unit, London, UK Correspondence to Dr Nicholas Paton, Senior Clinical Scientist, MRC Clinical Trials Unit, 222 Euston Road, London NW1 2DA, UK Tel: +44 (0)207 670 4808; e-mail: [email protected] Current Opinion in Infectious Diseases: February 2008 - Volume 21 - Issue 1 - p 25-30 doi: 10.1097/QCO.0b013e3282f4069d Buy Metrics Abstract Purpose of review This review brings together the results of recent definitive trials of treatment interruption strategies in order to evaluate the risks and to examine whether there is evidence to support this approach in clinical practice. Recent findings Recent studies confirm that there is no clear benefit of treatment interruption in the settings of virological failure or acute infection. The most important recent data relate to the use of structured treatment interruption in the setting of chronic HIV disease. The SMART and Trivacan trials found that a CD4+ lymphocyte count guided interruption strategy was clearly inferior to continuous therapy, but Staccato (using a higher threshold for treatment re-initiation) did not. The largest fixed-schedule treatment interruption trial also reported inferior clinical outcomes with interruption, although the evidence of harm was less clear in other smaller studies. A broad spectrum of clinical effects of treatment interruption was highlighted by this research. Summary Overall, recent studies indicate that treatment interruption is associated with a variable degree of net harm. Continuous treatment should remain the strongly preferred approach, although, if it is carefully managed, there may be some clinical situations in which the benefits of a short period of interruption may potentially outweigh the risks. © 2008 Lippincott Williams & Wilkins, Inc.