Intermittent Antiretroviral Therapy Does Not Improve Quality of Life

　　Quality of life declines in HIV-infected patients on CD4-guided intermittent antiretroviral therapy (ART) compared with those who continue on ART without interruptions, according to a substudy of the Strategies of Management of Antiretroviral Therapy (SMART), which was halted in January 2006 after it became clear that patients in the intermittent arm had higher mortality and morbidity rates.
　　"I think intermittent antiretroviral therapy failed because it results in a lower CD4 cell count and active HIV replication, both of which appear to increase the risk of both classic HIV-related illnesses and serious events, such as heart attacks, kidney disease and liver disease that had not been previously associated with HIV infection," lead author Dr. William J. Burman of the University of Colorado Health Science Center in Denver told Reuters Health.
　　Dr. Burman and colleagues evaluated 1225 patients who were enrolled in the SMART study for a mean of 2.4 years, to assess quality of life and disease progression. The patients had been randomized to continuous ART or intermittent ART directed by CD4 cell count.
　　Most patients (76%) were on antiretroviral therapy at enrollment. At baseline, the median CD4 lymphocyte count was 575 cells per microliter and half of the patients reported having very good or excellent general health.
　　Quality of life measures were lower throughout the trial in patients receiving intermittent ART compared with the quality of life in patients on continuous treatment. Quality of life was assessed on a number of measures, including current health, Physical Health Component Score, general health perceptions, physical functioning, and energy.
　　Once ART was suspended, marked declines in quality of life occurred, as did HIV disease progression. An exception was among patients without disease progress for whom episodic treatment "had minimal effect on quality of life comparisons," the authors report in the February 1st issue of the Journal of Acquired Immunodeficiency Syndrome.
　　"I don't know whether decreased quality of life is a reliable sign of a failing immune system," Dr. Burman told Reuters Health. "The importance of this analysis is that many patients and investigators had assumed that being able to be off antiretroviral drugs would improve quality of life. On the contrary, being off antiretroviral therapy was associated with a decrease in quality of life."
　　J Acquir Immune Defic Syndr 2008;47:185-193.