Stopping ARV Therapy
- Patient's inability to tolerate all available ARV medications
- Patient's request to stop, after appropriate counselling
- Non-adherence despite counselling: Treatment should be stopped to avoid continued toxicity and continued evolution of drug resistance.
- Continue failing ART regimen unless toxicities or drug interactions make the clinical situation worse for the patient.
- ART likely to have residual antiviral activity despite treatment failure.
- Stopping therapy in setting of virologic failure can be associated with rapid falls in CD4 counts and development of opportunistic complications.
- May be needed because of serious drug toxicity, intervening illness or surgery that precludes oral intake, or ARV non-availability
- Stop ALL the drugs when discontinuing therapy
- NNRTIs (EFV, NVP) have longer half-lives and may be detected at significant levels for up to 3 wks after last dose; If all components of an NNRTI-based regimen are stopped at the same time, patient will be on functional monotherapy for a period of time and at increased risk for resistance.
- Consider discontinuing EFV or NVP and continue the NRTIs for 1 additional week, if feasible. (Has demonstrated value in the PMTCT settings, but its benefits in treatment programmes is unclear.)