"In general, once highly active antiretroviral therapy [HAART] is started, it should not be stopped," lead author Dr. Daniel J. Skiest told Reuters Health. "There may be selected patients who can interrupt therapy with a low risk of adverse outcomes."

"This would apply to patients who never had a low CD4 cell count or any HIV-related complications and are currently virologically suppressed on HAART," he added.

Dr. Skiest, of the Baystate Medical Center, Springfield, Massachusetts, and colleagues prospectively studied treatment interruption in 167 HIV-infected patients receiving HAART who had CD4+ cell counts below 350 cells per cubic millimeter.

After 96 weeks, of the patients who completed follow-up, 17 had CD4+ cell counts at or below 350 cells per cubic millimeter. At this point, 46 other patients had resumed ART and 5 had died from causes not related to HIV or AIDS.

Overall, a higher nadir in CD4+ cell count, a lower HIV load before ART, and an HIV load of 50 copies/mL at the time of treatment interruption predicted a longer interval before any adverse findings.

Although the approach was successful in some patients, Dr. Skiest stressed that "therapy interruption should only be undertaken with the guidance of the patient's HIV clinician, and careful monitoring is important."

J Infect Dis 2007;195:1426-1436.

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