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JAC Advance Access published online on July 1, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl268
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Leading article

Treatment interruptions in HIV-infected subjects

Marco Bongiovanni 1, Maddalena Casana 1, Camilla Tincati 1, and Antonella d'Arminio Monforte 1 *

1 Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, University of Milan, Italy

* To whom correspondence should be addressed.
Antonella d'Arminio Monforte, E-mail: antonella.darminio{at}unimi.it


  Abstract

Despite a high antiviral efficacy, the use of highly active antiretroviral therapy (HAART) in clinical practice is often impaired by the long-term toxicity of antiretroviral treatment, the increased rate of human immunodeficiency virus-1 (HIV-1) drug resistance in treated patients and the cost of therapies, so that possible interruption of HAART has to be considered as part of the current clinical practice. However, this strategy is usually followed by a rapid viral rebound with a substantial loss of CD4 T lymphocytes because the HIV suppression with HAART does not result in reconstitution of the HIV-specific immune response. Structured treatment interruption (STI) has already been investigated in HIV-infected subjects with well-controlled viral replication (initiating treatment during primary or chronic HIV infection) and in those with multiple treatment failures. A clear benefit of STI in patients with chronic infection remains controversial and these benefits are more often observed in patients starting treatment during primary HIV infection.

Keywords: HIV; HAART; STI.
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