Would you substitute enfuvirtide with an integrase inhibitor as one becomes available for [a virologically suppressed] patient?
Dr Gulick: In a patient who is virologically suppressed on an enfuvirtide-containing regimen, but who wants to change the enfuvirtide (eg, because of intolerance to injection site reactions or problems giving twice-daily injections), one could consider substituting another potent agent such as an investigational or expanded access drug (ie, integrase inhibitor, CCR5 inhibitor). Although there are no study results to support this recommendation, it seems a reasonable option if the substituted agent is fully active. • You said there was no place for a structured treatment interruption (STI). There is one: For persons who were started on potent antiretroviral therapy with a high CD4+cell count (>500/mL) and were asymptomatic, and who remain suppressed. Dr Gulick: Given recent results showing an increased (albeit low) risk of clinical events (HIV-related, death, and surprisingly, non-HIV-related) in patients who stopped antiretroviral therapy, an STI cannot be routinely recommended in any
