Episodic HIV Treatment: Not a SMART Idea

An episodic CD4-count–guided treatment strategy was associated with higher morbidity and mortality than was continuous antiretroviral therapy in HIV-infected patients.

Continuous antiretroviral therapy (ART) markedly reduces morbidity and mortality in HIV-infected patients, but it has potential adverse effects, is expensive, and poses difficulties with long-term adherence. Does episodic CD4-count–guided treatment offer a solution to these problems?

In the Strategies for Management of Antiretroviral Therapy (SMART) study, researchers randomized more than 5400 HIV-infected subjects with CD4 counts >350 cells/mm³ to receive either continuous ART or episodic ART guided by CD4-cell count (therapy was given when the CD4 count fell to <250 cells/mm³ and was stopped when the CD4 count increased to >350 cells/mm³). Although the median baseline CD4 count was >500 cells/mm³, the median CD4 nadir at baseline was only …

Reviewing Author

Rajesh T. Gandhi, MD

Episodic HIV Treatment: Not a SMART Idea

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Reviewing Author