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Serious setback in the long-term treatment of HIV infection
October 10, 2002Structured therapeutic interruptions (STI), long hailed as a way of reducing the side effects of long-term AIDS treatment, has been shown to be ineffective, according to a collaborative study between Swiss and British researchers.
Professor Rodney Phillips and colleagues at Oxford University's Peter Medawar Building for Pathogen Research and the Zoology Department collaborated with a Swiss Consortium based in Geneva to study the effect of manipulation of the treatment given to Swiss and Spanish nationals infected with HIV.
The researchers sought evidence for benefit to patients when potent antiretroviral therapy (ART), the standard treatment of people infected with HIV, is interrupted in a controlled way in order to boost the patient's natural immunity to the virus, and perhaps minimise drug side effects. The idea arose from case studies and small trials carried out in Europe and the US.
In this definitive trial, called the `Swiss Spanish Intermittent Therapy Trial`, over 130 patients with chronic HIV infection from both countries were enrolled. The large size of this trial gave it analytic power of a high order. It revealed very clearly that the orderly starting and stopping of drugs did not, on balance, produce a clinically useful or lasting benefit. This finding, which comes only one year after the Peter Medawar Building for Pathogen Research was established, has important implications for the use of these drugs worldwide. In developing countries a particularly attractive extra benefit would have been savings in the costs of medicine but those hopes are dashed by this trial.
However, there may still be some potential for this sort of manipulation to work in the earliest, acute phase of the disease, as Phillips` group in Oxford and his colleagues in Boston have shown.
Professor Rodney Phillips, Professor of Clinical Medicine and Chairman of the Peter Medawar Building for Pathogen Research, said: `The fact that the results of this research are negative is enormously disappointing but this doesn`t take anything away from their importance. As we now know that these treatment interruptions are not beneficial to patients with chronic infection, this throws enormous emphasis on studies which illuminate the fundamental pathology of this extraordinary virus. It continues to outwit us at every turn.`
The study was partly funded by the Wellcome Trust
Oxford, University of
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