Single Tablet Regimen Usage and Efficacy in the Treatment of HIV Infection in Australia.

B Armstrong,M J Stewart,D Smith,D J Chan,D Fagan

doi:10.1155/2015/570316

Abstract

Single tablet regimens (STRs) for HIV infection improve patient satisfaction, quality of life, medication adherence, and virological suppression compared to multitablet regimens (MTRs). This is the first study assessing STR uptake and durability in Australia. This retrospective audit of all patients receiving an STR (n = 299) at a large Sydney HIV clinic (January 2012–December 2013) assessed patient demographics, treatment prior to STR, HIV RNA load and CD4 during MTR and STR dosing, and reasons for STR switch. 206 patients switched from previous antiretroviral treatment to an STR, of which 88% switched from an MTR. Reasons for switching included desire to simplify treatment (57%), reduced side effects or toxicity (18%), and cost-saving for the patient. There was no switching for virological failure. Compared to when on an MTR, patients switching to an STR had significantly lower HIV RNA counts (p < 0.001) and significantly higher CD4 counts (p < 0.001). The discontinuation rate from STR was very low and all patients who switched to an STR maintained virological suppression throughout the study duration, although the study is limited by the absence of a control group.

Highlights

Advances in the development of antiretroviral agents (ARVs) for the treatment of HIV have reduced morbidity and mortality from AIDS [1]
The majority (88%, 182 patients) had switched from an multitablet regimens (MTRs), 11% (23 patients) switched from an single tablet regimens (STRs), and 1 patient, who had received an MTR but stopped treatment prior to the study period, was commenced on an STR
STRs are an integral option in the treatment of HIV; the initiation of a particular STR, or decision to switch to one, may depend on factors such as persistence of early ARV combinations, improved awareness of cumulative toxicities associated with specific ARVs, the relative strength of the genetic barrier to resistance in poorly adherent patients, and other factors, such as socioeconomic disadvantage, comorbidities, and interactions with prescribed and illicit drugs

Summary

Introduction

Advances in the development of antiretroviral agents (ARVs) for the treatment of HIV have reduced morbidity and mortality from AIDS [1]. Over the past 2 decades, more potent, less toxic ARVs have been developed and treatment regimens of some 20 pills per day are reduced to oncedaily, single tablet regimens (STRs) incorporating 3 ARVs. STRs may improve adherence by reducing pill burden and prevent the development of drug-resistance mutations to individual ARVs in multitablet regimens (MTRs) [2]. Cohen et al [3] note that patients receiving an STR had significantly better rates of adherence compared to those receiving MTRs, and this translated to lower rates of hospitalisation. A recent Italian study concluded that the STR resulted in better adherence, but added C4541.00 lower cost-effectiveness ratio per QALY in comparison with the MTR with a 17% lower cost in favour of the STR [4]

Methods

Results

Discussion

Conclusion