The global anti-retroviral therapy (HAART) has resulted in the transformation of HIV infection as an inevitably fatal disease transformed into a chronic course of disease, although incurable; an infection that requires treatment throughout life with the technology we have at the beginning of XXI century.
An increasing number of children infected by transmission from mother to child HIV vertical transmission, that Cuba was the first nation to eradicate, who died in infancy in the pre-HAART era, are now reaching adolescence and about to face the prospect of having to take antiretroviral therapy daily with a better grip for the rest of their lives2,3, 4
InLancet HIVThe study PENTA 16 shows the conclusions of Breather study group report, an open study comparing daily and continuous shots of ART treatments with short cycles allowing 2 days without treatment every week.
One hundred and ninety-nine participants aged 8 and 24 years had suppressed viral load for at least twelve months prior to enrollment and were taking a HAART regimen containing a long-term efavirenz treatment were recruited from 11 countries all around the world. In 48 weeks, six (6%) of 99 children in short-cycle treatment group versus seven (7%) of 100 in the continuous treatment group had virologic rebound (HIV viral load> 50 copies per ml; -1 difference · 2%, 90% CI - 7 3 · the · 4 9), showing that the treatment of short cycle is not inferior to continuous treatment.
There was no statistical difference between groups in the proportion of participants who developed major resistance mutations or proportion of adverse events. This is the first study to show that the controlled switching appears to be safe in terms of maintaining viral suppression as the emergence of drug resistance. In particular, the study was undertaken in geographic locations settings of various configurations reaching an impressive retention rate with only a missing participant throughout follow-up.
Children have an expectation to take antiretroviral therapy for about twenty years longer on average than adults and strategies to a time out of antiretroviral therapy could be an effective way to reduce the organic fatigue due to the treatment.6
Furthermore, reducing the HAART through a short cycle treatment may provide potential cost savings. The short-cycle treatment strategy was highly acceptable to
participants, especially because it allowed that they could socialize in the final weekend, which is opposite the main barrier to taking the drugs. Even patients who are virologically suppressed the intermittent use report with a brief drug-free period and the treatment of short cycle provides no medication regulation time and a legitimate way to miss doses.7
The worry is that such a strategy can give the message that the lost shots are acceptable and that they could not affect the viral load (note of the translator: In conversation with a nurse in married AIDS the default target is 90%, ie you could lose a single outlet in the month). Therefore, appropriate advice is critical to ensure that the results are not misinterpreted and patients understand that there is a maximum limit of rupture in the treatment of specific phase to 2 days a week.
In particular, the findings of this study are usable only for stable patients and well established on ART.
The average time HAART prior to randomization in this study was 6 years children had been deleted viral load for at least twelve months. In addition, the results can not be extrapolated to children who have failed in previous treatment or antiretroviral therapy containing low doses of Efavirenz (equivalent to 400 mg for adults) or even to other HAART regimens long action. The follow-up period was short and was planned a two-year extension of the study that will provide data for the long-term sustainability of this short course treatment strategy. Other questions to be answered before the treatment of short cycle power become a viable option.
The study was conducted under strictly controlled conditions with intense monitoring of viral load. Research is needed to understand whether the study could be implemented safely in resource-limited settings where routine monitoring of viral load is unavailable or infrequent.
More research could also assess whether the treatment of short cycle with the new drug long-acting and become available that have a higher barrier to resistance and are more tolerable, such as tenofovir and dolutegravir alafenamide.8
viral suppression is the ultimate goal of improving health outcomes and reducing transmission of HIV, thereby conferring benefits to individual and public health.9, 10
A Great adherence to antiretroviral therapy is critical to ensure sustained virologic suppression. Adherence to treatment of chronic diseases falls during adolescence and unfortunately HIV is no exception.11Adolescents face several obstacles to membership and our experience is that no intervention will be sufficient to ensure high levels of grip needed to maintain virologic suppression.12So we need several different approaches in our arsenals to support membership in this group.
We now have a new and promising and innovative option on the horizon that could be offered to young people who face the prospect of a HAART learning.
No potential competing interests.
Rashida Ferrand The
- UNAIDS. How AIDS changed everything-ODM6: fifteen years 15 AIDS hope lessons answers. UNAIDS, Geneva; 2015
- Newell, ML, Coovadia H, Cortina-Borja, M, Rollins, N, Gaillard, P and Dabis, F. mortality in infected and uninfected infants born to HIV-infected mothers in Africa: an analysis pool.The Lancet.2004;364Finished
- Hazra, R, Siberry, GK and Mofenson LM. Growing up with HIV: children, adolescents and young adults with HIV infection acquired perinatally.Annu Rev Med. 2010;61Finished
- Foster, C, Judd, A, Tookey, P et al. Young people in the UK and Ireland with HIV perinatally acquired: the legacy services to pediatric adults.AIDS Patient Care STDS. 2009;23: 159-166
- Week-off based on efavirenz antiretroviral therapy in HIV-infected children, adolescents and young adults (Respiro): auction, open, non-inferiority, phase 2 / 3 trial.Lancet HIV.2016; (Published online June 20.)http://dx.doi.org/10.1016/S2352-3018(16)30054-6.
- Lowenthal, ED, Bakeera-Kitaka, S, Marukutira, T Chapman, J, Goldrath, K and Ferrand, RA.adquirido perinatally HIV infection among adolescents in sub-Saharan Africa: A review of emerging challenges.The Lancet infect Dis. 2014;14Finished
- Bernays S, J Seeley, Paparini S, T. Rhodes' I'm afraid to get stuck in my lie: Challenges for self-reported adherence to young people living with HIV.AIDS Impact; Amsterdam, Netherlands; July 28-31, 2015.
- Elliot, E, Amara ,, Jackson, one et al. Elvitegravir and dolutegravir plasma concentrations after cessation of drug intake.J Antimicrob Chemother. 2016;71Finished
- Attia, S, Egger, M, Muller M, Zwahlen, M and low, N. Sexual transmission of HIV according to viral load and antiretroviral therapy: a systematic review and meta-analysis.AIDS. 2009;23Finished
- Mills, EJ, Bakanda C, Birungi, J et al. The life expectancy of people receiving antiretroviral combination therapy in low-income countries: analysis of a Ugandan cohort.Ann Intern Med. 2011;155Finished
- Nachega, JB, Hislop, M, Nguyen, H. et al. Antiretroviral therapy adherence, virologic and immunologic outcomes in adolescents compared with adults in southern Africa.J Immune Defic Syndr Adquiriraâ AOA. 2009;51Finished