Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Study shows interruption of antiretroviral therapy increases risk of disease and death

04.12.2006
Does not reduce risk of serious side effects from continual ART

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 professor of clinical Medicine and Epidemiology, "Interruption of antiretroviral therapy has been generally advocated as a potential treatment strategy to enhance the quality of life, limit side effects, and allow for the emergence of the predominant wild-type virus in patients infected with multidrug-resistant HIV. However, our data clearly demonstrate that continuous use of anti-retroviral therapy is superior to its episodic use."

In the SMART Study, researchers from more than 30 countries around the world randomly assigned 5,472 participants infected with HIV with a CD4+ cell count of more than 350 per cubic millimeter to the continuous use of antiretroviral therapy or to the episodic use of antiretroviral therapy. The participants—2,720 in the episodic therapy group and 2,752 in the continuous therapy group—were followed for an average of 16 months. Episodic therapy involved only using antiretroviral therapy when the CD4+ count decreased to less than 250 per cubic millimeter and then stopping therapy when the CD4+ count increased to more than 350 per cubic millimeter. The primary end point was the development of an opportunistic disease or death from any cause. An important secondary end point was major cardiovascular, renal, or hepatic disease.

There were 120 participants in the episodic therapy group and 47 in the continuous therapy group who had an opportunistic disease or died from any cause. Analysis of study data showed that those on episodic therapy had more than twice the risk of developing these endpoints compared to those in the continuous therapy group. In addition, participants in the episodic group experienced significantly more cardiac, renal, and hepatic complications. Observes Dr. El Sadr, "The latter finding is surprising considering that cardiac complications have been associated in other studies with such events and liver and kidney complications have been linked to such treatment."

According to Dr. El-Sadr, "Our findings provide clear and compelling evidence that the episodic antiretroviral strategy, guided by the CD4+ count, should not be recommended." Dr. El-Sadr also stated that further research is needed to evaluate the effect of interrupting antiretroviral therapy on immune function, inflammation, and other markers.

Stephanie Berger | EurekAlert!
Further information:
http://www.columbia.edu

More articles from Studies and Analyses:

nachricht New study: How does Europe become a leading player for software and IT services?
03.04.2017 | Fraunhofer-Institut für System- und Innovationsforschung (ISI)

nachricht Reusable carbon nanotubes could be the water filter of the future, says RIT study
30.03.2017 | Rochester Institute of Technology

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

Im Focus: Quantum-physical Model System

Computer-assisted methods aid Heidelberg physicists in reproducing experiment with ultracold atoms

Two researchers at Heidelberg University have developed a model system that enables a better understanding of the processes in a quantum-physical experiment...

Im Focus: Glacier bacteria’s contribution to carbon cycling

Glaciers might seem rather inhospitable environments. However, they are home to a diverse and vibrant microbial community. It’s becoming increasingly clear that they play a bigger role in the carbon cycle than previously thought.

A new study, now published in the journal Nature Geoscience, shows how microbial communities in melting glaciers contribute to the Earth’s carbon cycle, a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

7th International Conference on Crystalline Silicon Photovoltaics in Freiburg on April 3-5, 2017

03.04.2017 | Event News

 
Latest News

New quantum liquid crystals may play role in future of computers

21.04.2017 | Physics and Astronomy

A promising target for kidney fibrosis

21.04.2017 | Health and Medicine

Light rays from a supernova bent by the curvature of space-time around a galaxy

21.04.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>