OPTIMA: Options in Management with Antiretrovirals

Stop anti-HIV drugs for 12 weeks, then restart with up to four drugs

Another idea is to stop all drugs for up to 12 weeks, then restart with up to four drugs. The choice of drugs for the new regimen will be guided by the results of the resistance test. The thinking behind this is that changes to the virus, which make it less resistant to drugs, have been seen when HIV drugs are not taken for around 12 weeks. The changes to the virus make the virus easier to kill by the anti-HIV drugs that had almost stopped working before. Twelve weeks is chosen because in tests most of the changes in the virus happen around 10 weeks after stopping drugs.

People are carefully monitored during the drug-free period for early detection of any dangerous drop in CD4 counts or opportunistic infections, and if this occurs you will be able to restart treatment immediately.

Pros
	A harder hit to the virus when drugs are restarted.
	The HIV drug-free period gives you and your body a rest from the side effects of anti-HIV drugs.
	Gives a chance for the resistant virus to reduce.

Cons
	You may worry about not being treated when on the HIV-drug-free period.
	Your CD4 count may fall and may not come back to the same level when drugs are restarted.
	Viral load is expected to rise and may take time to (or may never) fall again once drugs have been restarted.
	Increased risk of opportunistic infections and the need to take drugs to prevent them.
	Unknown how long the hard hit (the effect of the drug-free period) will last for and whether this makes a difference in the long run.


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