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Proposed structured treatment interruption (STI) schedules have ranged from stopping treatment for several months at a time to week-on, week-off schedules. The theory behind the rapid-cycling approach is that shorter intervals will curtail viral rebounds and eliminate the CD4-cell count declines that often accompany longer treatment interruptions.
An international group of investigators configured a randomized study (called the Staccato trial) to compare two STI schedules with continuous antiretroviral use. Enrollment started in Thailand and Switzerland in 2002. In one STI group, participants took antiretrovirals only when their CD4 counts fell below 350 cells/mm3, whereas in the other, they were assigned to a 1-week-on, 1-week-off schedule.…