Improving Outcomes in HIV: Single Tablet or Multi-Tablet Regimen?

New research investigates whether reducing the pill burden in HIV treatment regimens could improve patient adherence, retention in care, and virologic outcomes.

A single-tablet HIV treatment regimen may produce better patient outcomes than multi-tablet regimens, according to new research published in AIDS Care.

Once-daily regimens have become the standard of care for patients with HIV, but they often include a multi-tablet regimen. The researchers sought to determine whether reducing the pill burden to only a single daily pill could further improve adherence, retention in care, and virologic outcomes among patients.

To determine which treatment approach had better outcomes, the researchers studied more than 1000 patients at a non-VA Texas clinic who were just beginning HIV treatment from January 2008 to December 2011. Of these patients, 622 took a single once-daily pill and 406 were on a once-daily multi-tablet regimen.

The regimens contained different combinations of medications, although both groups were based around the drug tenofovir. For the study, the single-tablet group was 100% efavirenz-based, whereas the multi-tablet regimen was 65% atazanavir-based and 35% darunavir-based.

According to the findings, retention in care was achieved in 80.7% of patients treated with a single-tablet regimen compared with 72.7% of patients on a multi-tablet regimen. The researchers evaluated retention in care based on patient visits to their physicians for viral load measurements at least twice, a minimum of 3 months apart, in the first year.

HIV suppression was observed in 84% of patients in the single-tablet group after the first year compared with 78% in the multi-tablet group. However, there were no differences in the proportion of patients achieving at least 80% adherence.

“There were no differences in adherence as we could measure it via pharmacy refill dates, which suggests that maybe the single-tablet regimens are more efficacious,” Thomas P Giordano, MD, study author, said in a press release. “It could also be that the persons who got the multi-tablet regimens had more barriers to care and that is why they did more poorly.”

To gain a better understanding, more studies will be needed to account for the differences in types of medications being used versus the effect of pill burden. Additionally, future research should also focus on the cost-effectiveness of the treatments, the researchers concluded.

References

Hemmige V, Flash CA, Carter J, et al. Single tablets HIV regimens facilitate virologic suppression and retention in care among treatment naïve patients. AIDS Care. 2018. https://doi.org/10.1080/09540121.2018.1442554