Stopping HAART temporarily in the absence of virus rebound: exploring new HIV treatment options.

PURPOSE OF REVIEW: To examine the literature in search of data supporting (stopping highly active antiretroviral therapy (HAART) temporarily in the absence of virus rebound) to expand HIV treatment options.

RECENT FINDINGS: We proposed investigating HAART interruptions after the 'Berlin patient' had discontinued HAART while keeping HIV suppressed. The idea of inducing immune control of HIV by treatment interruptions has been largely abandoned and with clinicians have mainly investigated whether treatment withdrawal can reduce toxicity, improve the quality of patients' lives, and save costs. Some data suggest that treatment interruptions remain a feasible strategy and the benefits outweigh the costs; others warn against several pitfalls: onset of resistance, HIV transmission and increased toxicity. Researchers have also found, however, that the viral set point can be lowered by treatment interruptions during chronic infection, similar to (but to a lesser extent than) acute infection. Preliminary studies suggest that immunomodulators and therapeutic vaccines may further improve immune control of HIV replication.

SUMMARY: Exposure to HIV leads to excessive immune activation and exhaustion. Viral rebounds should be contained to obtain therapeutic benefits and decrease virus transmission. Temporary interruptions of HAART in combination with therapeutic vaccinations and immune modulators, such as antiproliferative drugs, may suppress HIV for extended periods of time.