1) Define compliance. Draw a curve of what the virus load profile would look like if a patient is not compliant. Label the X-axis with time and the Y-axis with virus load.

2) Why is STI considered a scientifically controversial strategy? Suggest three biological reasons why STI 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?

Answer:

1. Compliance is adherence to a regulation or a treatment.

2.  Structured Treatment Interruptions (STI) refers to a planned break from medication in which patients are exempted from taking prescriptions. 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.