New trend in HIV therapy. Later treatment onset and structured pauses

Clear advantages in HIV therapy can be shown since 5 years. Questions arise concerning possible reductions of drug exposure per unit of time. These questions have become important in the light of possible development of lipodystrophy, hepatotoxicity and other side effects. Eradication at this point is not possible. Control of virus may be possible even when therapy is started later than recommended so far. 200 CD4 cells in asymptomatic patients and 100,000 copies of virus may be new starting points. There is a potential of decreasing drug exposure to 70% or 50% of the actual amount by structured or supervised therapy interruptions. Especially for the largest group of chronically infected patients no clear results concerning immunologic or virologic outcomes can be presented at this moment. If no harm is done, reduced amounts of drug exposure may be considered as an advantage.