Abstract
The recent development of once-daily antiretroviral agents and fixed-dose combination formulations has been an important development in antiretroviral regimen simplification. Recent studies indicate that once-daily antiretroviral regimens improve adherence, especially in antiretroviral-naïve patients and in difficult-to-treat populations, such as the homeless or marginally housed. However, there are potential risks with the higher peak and lower trough plasma drug concentrations that may result from certain once-daily formulations. Due to the multifactorial and complex nature of adherence behavior, clinicians’ efforts to improve patient adherence should not be limited to prescribing once-daily regimens, but should also consider social support, side effect management, and adherence support tools, such as pillbox organizers and other targeted interventions. Additional research will clarify the benefits of once-daily and fixed-dose combination regimens on clinical and virologic outcomes. Comprehensive cost-benefit analysis of regimen simplification could help facilitate evidence-based decisions regarding antiretroviral regimen choices.
Acknowledgments
JBN receives research supported from the United States National Institutes for Allergy and Infectious Disease, Division of AIDS (K23AI 068582-01), the US PEPFAR Grant Award (T84HA21652-01-00) for Medical Education Partnership Initiative, the European Developing Countries Clinical Trial Partnership Senior Fellowship Award (TA-08-40200-021), and the Wellcome Trust Southern Africa Consortium for Research Excellence (WT087537MA).
Disclosure
In the last 12 months, JBN has received consulting fees or participated in scientific advisory boards for Gilead Sciences and is a speaker bureau member for GlaxoSmithKline, Merck Inc, and Gilead Sciences. PAP declares that he has no competing financial interests. BR declares that he has no competing financial interests. Editorial assistance was provided by José L Walewski of Envision Scientific Solutions, which was contracted by Boehringer Ingelheim Pharmaceuticals Inc, for these services. The authors received no compensation related to the development of the manuscript.