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Fewer pills led to better adherence, virologic suppression in HIV
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A lower pill burden resulted in better adherence and better virologic suppression among patients with HIV, according to data from a recent meta-analysis.
In addition, once-daily dosing was associated with only slightly better adherence and no better virologic suppression compared with twice-daily dosing, the researchers found.
“[Antiretroviral therapy] combinations should be selected based on factors such as tolerability, potential drug interactions, patient preference for dosing frequency and pill burden, as well as structural factors (eg, cost, drug availability, access to care, insurance coverage),” the researchers wrote in Clinical Infectious Diseases. “Efforts to improve and sustain adherence should not be limited to regimen simplification, but consideration should be given to proven evidence-based interventions to improve adherence.”
The researchers conducted a meta-analysis of 19 studies that were open-label, randomized controlled trials comparing once-daily vs. twice-daily ART regimens in which adherence and viral suppression were measured. The studies were published from 2004 to 2011 and included 6,312 patients. Both treatment-naive and treatment-experience patients were included.
There was a negative association between adherence and pill burden for both once-daily and twice-daily regimens, but this association was only significant with twice-daily regimens. There also was a negative association between pill burden and virologic suppression, which was significant for both once-daily and twice-daily regimens.
Overall, adherence was slightly higher among those on a once-daily regimen compared with a twice-daily regimen, but virologic suppression rates were similar with the two regimens. In time, both adherence and virologic suppression decreased, but adherence decreased less with once-daily dosing.
“The non-linear correlation between pill burden and adherence or virological suppression suggests that while ART ‘de-simplification’ from once-daily [single tablet regimens] to once-daily multi-tablet regimens may have adverse effects on virological outcomes, separating out single-tablet regimens and/or fixed-dose combinations into their constituents is not likely to have a major detrimental impact on virological outcomes (provided that the overall pill burden does not increase dramatically),” the researchers wrote.
Disclosure: The researchers report various financial relationships with Abbott, AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Janssen-Cilag, Janssen Therapeutics, Merck Sharp and Dohme, Sangamo BioSciences, Tibotec, Vertex Pharmaceuticals and ViiV.
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