Researchers Testing Whether AIDS Drug Regimens Can Be Taken Only Five Days a Week To Cut Costs, Reduce Side Effects

Researchers in Boston and Uganda are exploring the implications of allowing HIV-positive patients to take a break from their medications every weekend, a strategy that could reduce the cost of treating the disease and improve the quality of life for patients, the Boston Globe reports. Antiretroviral drugs in the U.S. cost about $10,000 to $30,000 per person annually, and side effects of the medications can include fatigue and nausea in the short term, and heart disease, cancer and diabetes in the long term, according to the Globe. If the studies prove successful, intermittent therapy could save nearly 30% of the cost of treating one HIV-positive person. In a 48-week Boston pilot study, scientists from the Community Research Initiative of New England divided patients into three groups, with each group following a different drug regimen. Tests showed that for 23 of the 26 patients who took their drugs five days a week, the virus remained suppressed and the patients reported they felt better. The three patients who experienced a rebound in their viral levels resumed their daily regimens and their levels again were suppressed. The Uganda study includes 157 patients who will be monitored for 18 months. Deputy U.S. Global AIDS Coordinator Mark Dybul, who is overseeing the Uganda study, said about 90 patients already had completed the trial after being on a regimen similar to that used in the Boston study for about 18 months and that researchers are "very encouraged" by the results. The U.S. government is supporting the Uganda study, and the Boston study was supported using government and foundation funds, the Globe reports.

Reaction
The strategy of allowing patients to take a break from their treatment "signals a milestone in the evolution of the epidemic," according to the Globe. Antonio Urbina, an AIDS specialist at St. Vincent's Comprehensive HIV Center in New York City, said, "It's saying: We can keep you alive, and you can be a mother or even a grandmother or a grandfather. But now we want to change the focus to improving the quality of your life." Calvin Cohen, research director at CRINE, said, "The dogma has been, 'You must take your meds every day or else. ... I think we've demonstrated that's not true for all meds, and it's not true for all people." Doctors know that some patients who routinely miss doses of their medications can develop drug-resistant HIV strains that are difficult to treat, and some HIV specialists are concerned about allowing patients to skip doses, saying patients might start skipping doses without consulting a doctor and develop new drug-resistant strains of the virus. "There are real dangers in putting people on intermittent therapy that have to be understood before we begin recommending it to wide numbers of people," Stephen Boswell, president of Fenway Community Health in Boston, said, adding, "Our approach has been to encourage people to miss no doses because there are very good data that show that even when people miss a few doses, the regimens ultimately fail. And the more doses you miss, the more likely you are to fail." Therefore, the studies rely on the weekday-on, weekend-off schedule, which is geared to help patients remember when they should take their medications (Smith, Boston Globe, 10/17).