Increase in Single-Tablet Regimen Use and Associated Improvements in Adherence-Related Outcomes in HIV-Infected Women

Abstract

Introduction The use of single-tablet ART regimens and its implications on adherence among HIV-infected women have not been well-described. Methods Participants were enrolled in the Women’s Interagency HIV Study (WIHS), a longitudinal study of HIV infection in U.S. women. We examined semiannual trends in single-tablet regimen use and ART adherence, defined as self-reported 95% adherence in the past 6 months, during 2006–2013. In a nested cohort study, we assessed the comparative effectiveness of a single-tablet versus a multiple-tablet regimen with respect to adherence, virologic suppression, quality of life, and AIDS-defining events, using propensity score matching to account for demographic, behavioral, and clinical confounders. We also examined these outcomes in a subset of women switching from a multiple- to single-tablet regimen, using a case-crossover design. Results 15,523 person-visits, representing 1,727 women (53% black, 29% Hispanic, 25% IDU, median age 47), were included. Use of single-tablet regimens among ART users increased from 7% in 2006 to 27% in 2013; adherence increased from 78% to 85% during the same period (both p<0.001). Single-tablet regimen use was significantly associated with increased adherence (adjusted RR 1.05, 95% CI 1.03–1.08) and virologic suppression (RR 1.06, 95% CI 1.01–1.11), while associations with improved quality of life and fewer AIDS-defining events did not achieve statistical significance. Similar findings were observed among the subset of switchers. Conclusion Single-tablet regimen use was associated with increased adherence and virologic suppression. Despite this, 15% of women prescribed ART were still not optimally adherent; additional interventions are needed to maximize therapeutic benefits.

Simplification of HAART therapy on ambulatory HIV patients in Malaysia: a randomized controlled trial

“…The use of FDC was found to be beneficial compared to FRC despite the short six month duration of follow-up. Most interesting was the increase in adherence in the FDC group which is supported by previous research 43. The significant increase in CD4 from baseline in the FDC group was demonstrated to positively affect patient’s quality of life.…”

Adherence and HIV RNA Suppression in the Current Era of Highly Active Antiretroviral Therapy

“…12 Single-pill use began in 2006, and rose to almost 30% in 2010. The higher adherence observed with the use of single pill regimens conforms with studies contrasting the ease of use of single pill regimens and once-daily formulations with multi-dose regimens 12,13,14,15,16,17 and also with studies of medication use in the general population. 18 Lower toxicity profiles may also have contributed to improved adherence to newer drugs.…”

Barriers to HIV Medication Adherence as a Function of Regimen Simplification

“…If patients with lower anticipated adherence had a higher tendency of being assigned STR, the improvement in adherence brought by STR might have been attenuated. Variations in measures of adherence across studies may also account for discrepancies in the literature [17, 20–22, 24] [16] [26] [18, 19]. Taken together, the inconsistent relationship between STR and adherence obscures inferences that we can draw about the role of treatment simplification on adherence.…”