Why is STI considered a scientifically controversial strategy? Suggest three biological reasons why Structured Treatment Interruptions could be advantageous. Predict what will happen to the virus over time if patients are then allowed to resume their HAART therapy after STI. Propose situations in which the STI approach may not be recommended or effective in some HIV-positive people. How would a physician be able to tell if STI is working?
Sample Answer – Structured Treatment Interruptions
Structured Treatment Interruptions (STI) refers to a planned break from medication in which patients are exempted from taking prescription(Sued et al., 2015). The approach is becoming apparent in the treatment of HIV where patients take planned ‘drug holidays’ from highly active antiretroviral therapy (HAART). Reasons for interrupting therapy range from improving the natural immune response to HIV, reducing drug toxicities, to restoring viral drug susceptibility. While the rationale for this approach is endorsed, it is considered scientifically controversial because of high risks of load rebound, clinical disease progression, and CD4 cell decline. Moreover, there is no consensus about the best time to start, stop, pause, or switch therapy.
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Still, STI could be advantageous in healthcare. Firstly, it allows successful treatment while minimizing toxicity in the body(Sued et al., 2015). Continued drug intake tends to increase toxin levels in the blood. Hence, interruptions reduce toxin levels. Secondly, STI relieves fatigue resulting from constant subjection to treatment. Reduction of treatment fatigue directly relates to the side-effects of the treatment protocol. Thirdly, interruptions stimulate immune system responses. This works by restoring the ability of immune cells to recognize disease-causing organisms. The ability is highly confined when HIV is fully suppressed by antiretroviral drugs.
Patients who resume HAART after STI are likely to have lower viral loads if the drugs continue preventing the creation of viral DNA and synthesis of viral DNA. However, if a mutation occurs, the virus could become resistant to drugs. HIV drug resistance is a potential problem that could impede success in reducing the impact of the disease. Resistance develops when patients receive poor health quality or experience significant treatment interruptions. Indeed, treatment interruptions could give the HIV virus the leverage to transmute and eventually become resistant to medication.
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Structured Treatment Interruptions is not recommended for some HIV patients, especially chronically infected individuals. A majority of studies carried out on chronically infected people show that STI leads to a high replication of the virus just a few weeks after the first intervention. Hence, control of viral replication after administration of STI is not likely to be achieved in populations with chronic HIV infections. A study by Adityanjee et al. (2006)used scheduled STIs to ‘auto-vaccinate’ the host immune system against HIV with the hope of restoring strength in cells and improving immune responses, but the results indicated that patients who received the STI regimen recorded higher incidence of opportunistic infections and death.
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There are various ways to test whether STI is working. They involve taking regular physiological measurements. CD4 cell count and plasma viral load levels are the most common measurements(Memish et al., 2015). CD4 cell count records the concentration of CD4 cells in the blood. These cells comprise a type of white cell that is responsible for fighting infection in the body. The higher the number of CD4 cells, the healthier a person is considered to be. When the CD4 cell count falls below 200, a patient is diagnosed with AIDs. CD4 cells increase when the HIV virus is suppressed by HAART. The plasma viral load level measures how much HIV RNA exists ina certain sample of blood. It is given as “copies per millimeter 9mL)” of blood. The test helps the physician monitor how efficient Structured Treatment Interruptions is in managing HIV.
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