Is intermittent antiretroviral therapy a satisfactory strategy for the management of patients living with HIV?

Abstract

Many innovations, such as long-acting agents, new delivery modalities (injectable and nanoparticles), and novel paradigms (immunotherapy or dual therapy), have been introduced to facilitate the administration of antiretroviral treatment (ART) to patients infected with HIV and improve their adherence and quality of life without altering the drugs' effectiveness. Studies have investigated the use of intermittent treatment, especially weekends-off ART in HIV-suppressed patients. In this review, we analyzed data concerning intermittent ART to help determine if this strategy is reasonable for the management of patients living with HIV. The results of early studies, in 2007-2015, were encouraging, but the studies were flawed because of the small number of patients included, the absence of a control arm, and random designs with variable patterns of ART administration. From 2016, studies have included more patients, and some are prospective, randomized controlled studies. While non-nucleoside reverse transcriptase inhibitors have been most studied, treatment with integrase inhibitors also has been reported, with the findings that viral resistance did not appear when treatment failed with dolutegravir but not with raltegravir. The most recent study, QUATUOR, found that a 4-day on, 3-day off pattern was non-inferior to the continuous pattern (7 days on). Better-quality studies with long-term follow-up (96 weeks or more) are needed to determine the validity of intermittent treatment and the optimal regimens and monitoring to be used in the management of viro-logically suppressed patients living with HIV.