Abstract
PurposeA lower daily pill burden may improve adherence to antiretroviral treatment (ART) and clinical outcomes in patients with human immunodeficiency virus (HIV). This study assessed differences in adherence using the number of pills taken per day, and evaluated how adherence correlated with hospitalization.MethodologyCommercially insured patients in the LifeLink database with an HIV diagnosis (International Classification of Diseases, 9th Revision, Clinical Modification code 042.xx) between 6/1/2006 and 12/31/2008 and receipt of a complete ART regimen were selected for inclusion. Patients were grouped according to their daily pill count and remained on ART for at least 60 days. Outcomes included adherence and rates of hospitalization. Adherence was measured as the proportion of days between the start and end of the regimen in which the patient maintained supply of all initiated ART components. Logistic regressions assessed the relationship between pills per day, adherence, and hospitalization, controlling for demographics, comorbidities, and ART-naïve (vs. experienced) status.Results7,073 patients met the study inclusion criteria, and 33.4%, 5.8%, and 60.8% received an ART regimen comprising one, two, or three or more pills per day, respectively. Regression analysis showed patients receiving a single pill per day were significantly more likely to reach a 95% adherence threshold versus patients receiving three or more pills per day (odds ratio [OR] = 1.59; P<0.001). Regardless of the number of pills received per day, patients were over 40% less likely to have a hospitalization if they were adherent to therapy (OR = 0.57; P<0.001). Patients receiving a single pill per day were 24% less likely to have a hospitalization versus patients receiving three or more pills per day (OR = 0.76; P = 0.003).ConclusionsART consisting of a single pill per day was associated with significantly better adherence and lower risk of hospitalization in patients with HIV compared to patients receiving three or more pills per day.
Highlights
Adherence to antiretroviral therapy (ART) is important for achieving optimal clinical outcomes in individuals with human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS)
ART consisting of a single pill per day was associated with significantly better adherence and lower risk of hospitalization in patients with HIV compared to patients receiving three or more pills per day
Clinical trials and cohort studies suggest that an ART regimen composed of a single pill per day may significantly improve adherence, patient satisfaction, and virological outcomes [8,9,10,11]
Summary
Adherence to antiretroviral therapy (ART) is important for achieving optimal clinical outcomes in individuals with human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS). Clinical trials and cohort studies suggest that an ART regimen composed of a single pill per day may significantly improve adherence, patient satisfaction, and virological outcomes [8,9,10,11]. Among homeless or marginally housed patients, those receiving an ART regimen composed of a single pill per day had better virologic outcomes and a 26% increase in adherence, compared with patients receiving other multi-pill per day regimens [11]. These studies support the adherence benefit of an ART regimen composed of a single pill per day, limited data exist on individuals with HIV or AIDS receiving this regimen in clinical practice.
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