Five days On Two days Off (FOTO) A Case report from Imphal, Manipur

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Five days On Two days Off (FOTO) A Case report

Dr.D.S.Hidangmayum (Medical Officer, JNH, Consultant of SASO, Imphal ):

Dr.P.Narendra (WHO Consultant):Dr.S.Ibomcha (HOD, Sr.Physician

JNH):Dr.Sh.Shurchandra (Sr. Pathologist): Dr.JoyTh (Physician JNH):

Dr.N.Dwijamani (Physician JNH):Dr.Kh.Lokeshwor (Physician JNH): Dr.Ksh.Achouba

(Physician JNH): Dr.T.Ginzaning (Physician JNH)

A 36 years old HIV positive widow whose CD4 count was 257 and viral load 91700

copies/ml as base line took ART (d4T+3TC+EFV) and could manage to control the

viral load <20: CD4 count 466.

The client was monitored closely (systemic examination as well as clinical lab

investigations) with the timely intervention of adverse effects. She could

maintain viral load<20 for another 24 weeks.

After taking consent, she was put on FOTO (Five days On Two days Off). At the

end of 24 weeks on FOTO she could still maintain viral load<20 and the CD4 count

increased from 432 to 750.

For monitoring Viral Load and CD4 count, the blood samples (whole blood) were

sent to SRL Ranbaxy, Mumbai (HIV-1 ULTRAQUANT COBAS AMPLICOR for Viral Load and

PCR/FLOW CYTOMETRY for CD4 count testing). The details are given bellow:-

Before the initiation of FOTO:

Sl. No. Clinical ref. Lab. Date CD4 count Viral load

1 SRL Ranbaxy, Mumbai 30th Apr. 2002 257 cells/cu.mm 91700 copies/ml

2 SRL Ranbaxy, Mumbai 31st Jan. 2003 527 cells/cu.mm 25050 copies/ml

3 SRL Ranbaxy, Mumbai 27th Mar. 2004 466 cells/cu.mm <20 copies/ml

4 SRL Ranbaxy, Mumbai 5th Aug. 2004 432 cells/cu.mm <20 copies/ml

After the initiation of FOTO:

Sl. No. Clinical ref. Lab. Date CD4 count Viral load

1. SRL Ranbaxy, Mumbai 10th Feb. 2005 750 cells/cu.mm <20 copies/ml

Conclusion: -If the above regime works, it will minimize the cost, adverse

effect, pill burden and certainly a break through for all who were virologically

well suppressed.

At present, EFV based regimen appear very likely to maintain viral suppression

on FOTO (due to the long half-life of EFV)1. So in terms of patient preference,

this regimen deserves more study2. The study needs fund to initiate with.

1 Cohen CJ, A, Bazner S and others. The FOTO study: A pilot study of

short-cycle treatment

interruption, taking antiretroviral medications for five days on, two days off

(FOTO), for those with viral

load suppression on either PI or EFV-based regimens. Xv International AIDS

Conference, Bangkok,

Thailand, July 11-16, 2004 [abstract #TuPeB4575]. Note: This abstract is

available at

http://www.iasociety.org/ejias/search.asp? (search for FOTO in the “Abstract

title” field (you might have to

click the Search button twice), then click the title to get the full abstract).

2 Weekend Treatment Interruption for Certain Well-Controlled Patients: Interview

With Cal Cohen, M.D.

By S. : from http://www.thebodypro.com/atn/atnpage.html