Structured intermittent therapy with seven-day cycles of HAART for chronic HIV infection: A pilot study in Sao Paulo, Brazil

In the last 6 years, an impressive impact of the highly active antiretroviral therapy (HAART) on survival and morbidity in HIV-1-infected individuals has been attained. However, their prolonged use may induce metabolic adverse effects such as lipodistrophy, hypertension, diabetes mellitus, osteopenia and hyperlipidemia. Recently, new strategies such as short-cycle structured intermittent therapy (SIT; 7 days without therapy followed by 7 days with HAART) have been suggested. We tested this strategy in seven (four women and three men; mean of age 39 of years) HIV-positive individuals, all of whom had CD4(+) T cell counts greater than 500 cells/mm(3) and undetectable plasma viral load for at least 2 years. Our results indicated no opportunistic diseases or CD4 cell count decrease over a mean follow-up of 26 months. No plasma viral replication was detected in five of seven cases. There was a decrease in triglyceride levels to normal range (not statistically significant), but no modification of cholesterol levels. Thus, we recommend a larger clinical trial to determine if SIT is cost effective in developing countries.