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Pacientes con VIH sufren efectos duraderos a la interrupción de la terapia antiretroviral

HIV Patients Suffer Lasting Effects From Interruption of Antiretroviral Therapy

February 6, 2008 -- HIV patients can suffer long-lasting health effects after their drug treatment is interrupted, according to results of a study presented at the Conference on Retroviruses and Opportunistic Infections in Boston. Participants in the study, Strategies for Management of Anti- Retroviral Therapy (SMART), whose treatment was temporarily halted, still had a higher risk of death and infections 18 months after they resumed taking the drugs on a continuous basis. The recently completed SMART study was the largest HIV treatment study ever conducted.
Based on early findings from the SMART Study, researchers established in 2006 that HIV patients who stop and start treatment, even under medical supervision, have a higher risk of death and infections. Based on these findings, study participants who were on the intermittent treatment arm were advised to start treatment and remain on it. “While restarting continuous therapy lowered the risk of infections and death, the increased risk from intermittent treatment was not completely eliminated,” said Wafaa El- Sadr, MD, MPH, co-chair of the SMART Study and professor of Medicine and Epidemiology at Columbia University Mailman School of Public Health and director of the International Center for Care and Treatment Programs (ICAP), who presented the findings. ``We are not sure why there is this lasting effect, and need to continue with our research to fully understand this finding.”

More than 33 million people worldwide are infected with HIV, the virus that causes AIDS. Taking antiviral drugs for long periods is inconvenient, can lead to side effects as well as being costly. This has inspired an interest in trying to find out if stopping antiviral drugs intermittently would maintain their benefits while minimizing their risks.

The findings from the SMART study show that treatment interruption should not be recommended. Earlier findings from SMART published in the New England Journal of Medicine showed an increased risk of death, infections, as well as major heart, liver and kidney diseases. SMART results headlined the 2006 Conference on Retroviruses, when Dr. El-Sadr and colleagues reported that CD4-guided drug holidays at certain levels increased the risk of opportunistic disease or death more than 2.5 fold. People who interrupted antiretroviral therapy had an 80% increased risk of death from any cause, and a 70% increased risk of major heart, kidney and liver disease.

At this week’s 2008 Conference, Dr. El-Sadr explained that while restarting treatment in those who had interrupted it showed benefit, it did not completely reverse processes that had increased the risk of these complications. “The message is clear,” Dr. El-Sadr noted, “for the foreseeable future, patients with HIV around the world who start therapy should remain on it.” Support for patients to stay on these medications was recognized by conference attendees as an important programmatic priority.

The Strategies for Management of Antiretroviral Therapy (SMART) Study was designed and initiated by the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA) and implemented in collaboration with regional coordinating centers in Copenhagen, London, and Sydney. Harlem Hospital Center participated in the SMART study among more than 300 sites from 33 countries around the world. The study is funded by the Division of AIDS of the National Institute of Allergy and Infectious Diseases (NIAID).

About the Mailman School of Public Health

The only accredited school of public health in New York City, and among the first in the nation, Columbia University's Mailman School of Public Health provides instruction and research opportunities to more than 1000 graduate students in pursuit of masters and doctoral degrees. Its students and more than 300 multi-disciplinary faculty engage in research and service in the city, nation, and around the world, concentrating on biostatistics, environmental health sciences, epidemiology, health policy and management, population and family health, and sociomedical sciences. www.mailman.hs.columbia.edu

Contact: Stephanie Berger 212-305-4372 sb2247@columbia.edu

Courtesy: Columbia University Medical Center

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