Limitations of a Simplification Antiretroviral Strategy for HIV-Infected Patients with Decreasing Adherence to a Protease Inhibitor Regimen

Abstract

Purpose: To determine the long-term efficacy of a simplification strategy in the clinical setting when used to improve adherence. Method: Prospective study of 70 patients included in a regimen with ddI plus 3TC plus an NNRTI, after viral suppression with a PI-containing regimen, due to decreasing adherence. Adherence to PI was calculated as the percentage of doses taken last week before inclusion, and patients were stratified as high and low adherents (⩾95% and <95% of doses). Results: Overall, 19 patients (27%) related adherence to PI <95% at inclusion (6 patients [9%], with adherence <80%). Mean adherence improved, with only 8% of patients presenting values <95%. At 104 weeks, 88% of patients on therapy had viral load supression, but only 43% by ITT analysis. The main cause of therapy change or withdrawal was toxicity or drug interactions (26%). Notably, 16% of patients were lost to follow-up or left therapy, especially in the group of initially low adherent (26% vs. 12%, p = .02). Conclusion: The use of a simplification strategy could be associated with long-term high risk of treatment failure, when used to improve adherence in the clinical setting.

Keywords:

• adherence
• nonnucleosides
• simplification