Single tablet HIV regimens facilitate virologic suppression and retention in care among treatment naïve patients^*

* Meetings: These data were preliminarily presented at the 10th International Conference on HIV Treatment and Prevention Adherence, Miami, 28–30 June 2015.

ABSTRACT

Newer HIV regimens are typically taken once daily but vary in the number of pills required. Whether the number of pills in a once-daily HIV regimen affects clinical outcomes is unknown. We retrospectively compared adherence, retention in care, and virologic outcomes between patients starting a once daily single-tablet regimen (STR) to patients starting a once-daily multi-tablet regimen (MTR) in a publicly funded clinic in the United States. Outcomes were measured in the year after starting ART and included retention in care, virologic suppression, and medication possession ratio of at least 80%. Data from patients initiating therapy from 1 January 2008 to 31 December 2011 were analyzed with both unadjusted and propensity-score adjusted regression. Overall, 622 patients started with an STR (100% efavirenz-based) and 406 with an MTR (65% atazanavir-based and 35% darunavir-based) regimen. Retention in care was achieved in 80.7% of STR patients vs. 72.7% of MTR patients (unadjusted OR 1.57, 95% CI 1.17–2.11; adjusted OR 1.49, 95% CI 1.10–2.02). Virologic suppression occurred among 84.4% of STR patients vs. 77.6% of MTR patients (unadjusted OR 1.56; 95% CI 1.14–2.15; adjusted OR 1.41; 95% CI 1.02–1.96). There was no difference in the proportion of patients achieving at least 80% adherence, as measured by medication possession ratio (33.0% of STR patients and 30.1% of MTR patients; unadjusted OR 1.14; 95% CI 0.87–1.50; adjusted OR 1.04, CI 0.79–1.38). While it is difficult to eliminate confounding in this observational study, retention in care and virologic outcomes were better in patients prescribed STRs.

KEYWORDS:

• Adherence
• pill burden
• retention in care

Author contributions

TZ conceived of the study. TZ and JC collected data. CAF, VH, and TPG developed the data analysis plan. VH performed the statistical analysis. CAF, VH, and TZ wrote the first draft of the manuscript. TPG and TZ contributed to revision of the manuscript. All authors approved the final manuscript prior to submission.

Acknowledgments

Supported in part by the facilities and resources of the Harris Health System. CAF acknowledges support from National Institutes of Health K23MH109358. TPG acknowledges support from the facilities and resources of the Michael E. DeBakey VA Medical Center. The opinions are those of the authors and not necessarily those of the Department of Veterans Affairs. The authors would like to acknowledge William Slaughter for data support.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Charlene A. Flash http://orcid.org/0000-0002-3280-2134

Notes

* Meetings: These data were preliminarily presented at the 10th International Conference on HIV Treatment and Prevention Adherence, Miami, 28–30 June 2015.