Findings from one of the largest HIV/AIDS therapy studies conducted to date show that a specific strategy of interrupting antiretroviral therapy more than doubles the risk of AIDS or death from any cause. Researchers affiliated with the Mailman School of Public Health and Harlem Hospital Hospital led a large multi-center international study, known as Strategies for Management of Anti-Retroviral Therapies, or SMART, comparing two treatment strategies for people with human immunodeficiency virus (HIV). Findings from the study, published in the November 30 New England Journal of Medicine, demonstrate the value of continuous antiretroviral therapy.
As HIV/AIDS has evolved into a chronic disease without a cure, lifelong antiretroviral therapy has become the norm. Lifelong therapy, however, can be difficult to adhere to as well as expensive. For these reasons, there has been a concerted research effort to test treatment interruption strategies that may enhance patients' quality of life and limit adverse drug effects.
The strategies evaluated in the SMART Study compared the recommended continuous use of antiretroviral therapy (anti-HIV medicines) with use of antiretroviral therapy in an episodic (interrupted) manner. The study found that the use of episodic antiretroviral therapy was inferior to continuous therapy as episodic therapy significantly increased the risk of opportunistic diseases or death from any cause. Further, episodic antiretroviral therapy did not reduce the risk of serious complications, including those related to the heart, kidneys, and liver.
Antiretroviral therapy in people with HIV is associated with remarkable benefits including longer survival and less illness. However, life-long treatment is difficult and can be associated with both short- and long-term risks, such as major metabolic and cardiovascular complications and built-up resistance to treatment. According to Wafaa El-Sadr, MD, MPH, co-chair of the SMART Study and profess
Contact: Stephanie Berger
Columbia University's Mailman School of Public Health