It might seem counterintuitive for a person living with HIV to stop their treatments.
However, a new study in PLOS Pathogens has examined the effects of treatment interruptions and made a groundbreaking discovery.
The ultimate goal of such a treatment strategy is to eventually find a cure for HIV as well as the syndrome that can develop from it, AIDS.
The research and the notion of temporarily stopping treatments, though, does have its ethical concerns.
Antiretroviral therapy (ART) is beneficial for people who are living with HIV.
ART can result in a near-normal lifespan. Starting this therapy as soon as possible after infection is also associated with both improved immune recovery and a lower HIV burden.
HIV suppression results in a lower risk of transmitting HIV to others.
Many HIV-positive individuals will interrupt ART for various reasons.
These unplanned ART interruptions often occur due to things such as treatment fatigue, toxicity, and when the treatment of another infection (such as tuberculosis) could jeopardize the effectiveness of both treatments.
For example, people with hepatitis B who stopped ART were more likely to experience a flare-up of their hepatitis than those who continued treatment.
The results of HIV treatment trials conducted in 2006 (the SMART trial) indicated that a strategy of interrupting ART could more than double the risk of AIDS or death from any cause.
Treatment interruption was also believed to increase the risk of developing an AIDS-related infection.
Risky road to a possible cure
More than 1.1 million people in the United States are living with HIV. Of those people, one in seven doesn’t know they have the disease.
While the rate of new HIV diagnosis has been steadily dropping over the past 10 years, it’s still critical that research for better treatment options continues.
Once HIV levels drop below a certain point, accurate measurement becomes impossible. So the only way to detect the presence of HIV is to take people off ART. This is known as an analytical treatment interruption (ATI).
However, this also can cause virus levels to rebound.
But if a cure for HIV is ever to be found, there must be people living with HIV willing to interrupt their antiretroviral therapy. While risky, this is an essential step to test whether an experimental treatment can effectively fight the infection.
The new study concludes that the risks of treatment interruption may not be so serious after all.
“For the first time, definitive research has been done looking at the potential negative effects of withdrawing ART for a limited period to confirm if an intervention has been effective in reducing HIV reservoir levels,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID).
“We’ve discovered conclusively that there is no negative effect from interrupting ART, which will have exciting implications for HIV research going forward.”
Data from this study indicates for the first time that ART interruption won’t increase the amount of HIV that can lay dormant in cells after therapy is resumed.
Interrupting therapy also won’t cause the immune system damage that was previously feared, researchers concluded.
“Researchers shouldn’t worry about the HIV rebound in the course of attempting to discover new, effective interventions because this study conclusively shows that there is no lasting increase in HIV reservoirs once the patient is placed back on antiretroviral therapy,” Fauci told Healthline.
There are those in the field who have some qualms about interrupting treatments.
“I have worked with numerous clients both at-risk for and diagnosed with HIV. In my clinical experience, I have witnessed clients thrive the most psychologically when they maintain their ARV regimens as prescribed by their doctors,” Dr. Kim Chronister, a licensed clinical psychologist in Los Angeles, told Healthline.
“It seems particularly important for clients with a history of impulsivity, drug abuse, and high-risk behaviors to maintain a regimen/routine of psychotherapy in combination with pharmacology (medications) and exercise. When one of these variables is not in place, it can feel like one’s life is a bit out of whack to someone with a profile of mood instability or impulsivity.”
Chronister said anyone embarking on this treatment plan should work closely with their care providers.
“Interrupting ART is a very personal decision made between a provider and a client, and for some it may be so important to them that the pros outweigh the cons,” she said.
“Observing one’s virus levels rebound is a very real downside to interrupting ART. I would highly recommend, from a psychological standpoint, working with a therapist as well as bringing in a partner or close family member to fully process the decision as it can impact a person’s mood and interpersonal relations.”
When asked about the effects this study should have on future research, Fauci focused on the ethical concerns that may have held back progress.
“These findings will finally give researchers the confidence to withdraw ART for limited periods,” he said.
“They can find out what treatments show promise and learn about the individual differences there are in virus rebound to discover the factors that make some patients go for much longer periods than average without showing HIV rebound. This information should open up exciting, new possibilities for future HIV treatments.”