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Abstract: Research is going on for developing
strategy for long-term treatment of HIV disease known as
“structured interruption of treatment” (STI). A
treatment interruption refers to a time period when
patients of HIV/AIDS stop taking their anti-HIV drugs.
Some people refer to these breaks as a “drug holiday”.
An STI may be defined as “a break in treatment that is
agreed upon, planned and monitored together by HIV
patients and their doctors”. Researchers hypothesize
that this will allow the patient’s own immune system to
control replication of HIV sufficiently without the
continual use of anti-HIV drugs. However, STI is still
theoretic and unproven treatment option. Many HIV
patients and physicians have only recently learned about
STI and more than a few are eager to try it. In real
sense, there is actually nothing new about STI. There
are many patients who do that all the time. Whether
patients called them “drug holidays” or simply “taking a
break from medications,” they have been doing this for
some time, generally despite their doctors’ warnings
that they should not.
Introduction: The enthusiasm over STI began with
reports of the “Berlin patient” in 1998, who was given
didanosine (ddI) and indinavir (IDV) shortly after
becoming HIV-infected. This 29 year old HIV infected man
decided that he would take a break from his medicines on
occasion because the combination of drugs he was taking
had several adverse effects. So, on several different
occasions, he stopped taking all his medicines and
restarted agen when got rebound viral load. After 40
days on his regimen, he decided again to stop as before.
But this time, the result was different. Two years
later, his viral load has still not rebounded. After a
series of unscheduled, random treatment interruptions
and a bout of hepatitis A virus infection, the “Berlin
Patient” was maintaining an undetectable viral load and
stable immunologic parameters despite not taking
anti-HIV drugs. He also developed a “vigorous”
HIV-specific helper-T cell and cytotoxic T-lymphocyte (CTL)
response, which was increased during the 2 years he had
been without anti-HIV drugs. Scientists and researchers
have since labeled him the “Berlin Patient”. His
continued success has sparked several clinical trials to
determine whether STI can be effective strategy in the
treatment of HIV patients. While some studies reported
similar results, other early reports were not as
encouraging. In latter reports, almost all of the
patients who interrupted treatment had a rapid and
significant viral rebound that approached or exceeded
their baseline viral load. Still, the anecdotal reports
of success seemed to support further research on STI,
and this research is slowly gaining momentum.
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