Taking a Break? (HIV Treatment Interruptions) en español
Are Treatment Interruptions Ever Necessary?
According to most HIV experts – as well as HIV treatment guidelines published by the U.S. Department for Health and Human Services (DHHS) and the International AIDS Society-USA (IAS-USA) – once anti-HIV treatment becomes necessary, it should be continued indefinitely. However, there are a number of circumstances that can arise while someone is on anti-HIV treatment that may require him or her to temporarily stop therapy. These include:
Side effects and drug toxicities that require treatment to be stopped.
Other illnesses that can increase the risk of side effects or make it difficult for people to swallow or absorb oral medications.
Travel restrictions. For some travelers, packing and taking HIV medications while away from home can be a difficult situation. For example, the U.S. government prohibits the entry of HIV-positive citizens from other countries. If HIV medications are found by U.S. customs agents, entry into the United States can be denied. While it is not recommended, temporarily stopping treatment to avoid being identified as HIV positive while traveling internationally is sometimes necessary.
Surgery that requires nothing be taken by mouth (such as liquids, food, or pills) 12 hours before the procedure, or surgery that may not allow someone to swallow medications after the procedure is completed.
Non availability of drugs, such as running out of medication before a refill prescription can be filled.
When treatment must be stopped immediately, it is best to discontinue all of the drugs at the same time. However, if a necessary treatment interruption can be planned in advance – such as elective surgery or travel restrictions – there are a few important issues to consider:
Are you using Sustiva® (efavirenz) or Viramune® (nevirapine)? (If not, skip to the next question.) If you are considering a treatment interruption and are taking either of these drugs, it is best to plan ahead. This is because these drugs stay in the blood much longer than protease inhibitors (PIs) or nucleoside reverse transcriptase inhibitors (NRTIs). For example, if someone stops their Sustiva and two nucleoside analogues on the same day, the Sustiva will linger in the body longer than the either of the nucleoside analogues. This would be like taking only the Sustiva without the addition of other anti-HIV treatments, which can cause the virus to become resistant to the Sustiva. As a result, people who are taking a break from their Sustiva- or Viramune-based combination should consider stopping the Sustiva or Viramune at least a few days or a week (up to three weeks) before stopping the other anti-HIV drugs they are taking. Unfortunately, research hasn't yet determined the best time to stop either of these drugs if a treatment interruption is necessary.
If you've been off of your Viramune-based regimen for two weeks or longer, you should be careful upon restarting the drug. Like starting Viramune for the first time, it is best to restart the Viramune using half the recommended daily dose (200mg once daily), continue it for 14 days, and then start taking the full daily dose again (200mg twice daily).
Are you taking anti-HIV medications that need to be taken with food? (If not, skip to the next question.) If you are not taking a regimen that contains Sustiva or Viramune but are taking medications that need to be taken with food, it is best to stop all of the medications at the same time. If you are stopping because of surgery, schedule your last dose for 12 hours before the procedure – the last time you will be able to eat anything before the surgery. You should resume taking all of your anti-HIV medications as soon as you're allowed to eat and drink again.
Are you taking anti-HIV medications that do not need to be taken with food? If you are not taking a regimen that contains Sustiva or Viramune but are taking medications that do not need to be taken with food, it is best to stop all of the medications at the same time. Alternatively, take your medications as scheduled with a sip of water. If treatment is interrupted, all drugs should be restarted together.
People who have HIV and hepatitis B must also be careful with treatment interruptions. If you have chronic hepatitis B and are taking Epivir® (lamivudine), Emtriva® (emtricitabine), Viread® (tenofovir), Combivir® (zidovudine/lamivudine), Truvada® (tenofovir/emtricitabine), Epzicom® (abacavir/lamivudine), Trizivir® (abacavir/zidovudine/lamivudine), or Atripla™ (efavirenz/tenofovir/emtricitabine), abruptly stopping any of these drugs may cause a "hepatic flare" – a sudden and sharp increase in liver enzymes and damage to the liver. If you have HIV and hepatitis B and need to temporarily stop any of these drugs, your doctor should monitor your liver enzymes very careful, at least until therapy is restarted.
Above all, a decision to temporarily stop treatment should be made in consultation with a healthcare professional.
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