Single-Pill Treatment Is Associated With Better Treatment Adherence In People With HIV

Single-Pill Treatment Is Associated With Better Treatment Adherence In People With HIV

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Published: Apr 18, 2012 10:23 am

Results from a recent study suggest that people with HIV whose antiretroviral regimen is taken as a single pill per day have better treatment adherence and a lower risk of hospitalization compared with people whose regimens consist of three or more pills per day.

“This study found that patients who receive [antiretroviral therapy] as a single pill per day are significantly more likely to be highly adherent to therapy. Furthermore, receiving a single pill per day was associated with a lower risk of hospitalization when compared with receiving multiple pills per day,” wrote the study authors.

“Although this study could not assess causality, it did show that receiving [antiretroviral therapy] as a single pill per day was associated with potential clinical and economic benefits,” they added.

According to the study investigators, high, sustained treatment adherence is necessary throughout a patient’s lifetime for optimal treatment outcomes. Studies in patients receiving older antiretroviral regimens suggest that an adherence rate of at least 95 percent is necessary to reduce risk of treatment failure, hospitalization, and death in people with HIV.

Older combination antiretroviral therapy regimens involve several pills and multiple doses per day. However, more recent regimens with fixed-dose combinations have allowed for simpler dosage schedules, often one pill per day.

Previous studies have suggested that single-pill treatments improve adherence, with adherence levels of up to 98 percent. For example, in a study among homeless people, those receiving an antiretroviral regimen consisting of a single pill per day had lower amounts of HIV virus in their blood and a 26 percent increase in adherence compared with participants who received multi-pill per day regimens.

In this study, researchers sought to confirm whether fewer antiretroviral pills taken per day improve the adherence of people with HIV. They also evaluated how adherence and number of pills per day related to the likelihood of being hospitalized.

The researchers examined medical records from 7,073 adults with HIV who took antiretroviral drugs between mid-2006 and late 2008. The researchers grouped participants according to how many pills they took per day: one pill per day (33 percent of participants), two pills per day (6 percent), or three or more pills per day (61 percent). All study participants remained on antiretroviral therapy for at least 60 days.

The average participant age was 45 years old, and about 80 percent were male.

About 42 percent of participants in the single pill per day group were previously untreated (treatment naïve), compared to 25 percent of participants in the two pills per day group and 20 percent of participants in the three or more pills per day group.

Results showed that 47 percent of single pill per day participants achieved 95 percent adherence or greater, compared with 41 percent of participants in the two pills per day group and 34 percent of participants in the three or more pills per day group.

Treatment-naïve patients and patients who received treatment in 2008 versus 2006 were more likely to achieve 95 percent adherence. Participants with alcohol or drug abuse problems and female participants were less likely to reach 95 percent adherence.

Results also showed that participants were over 40 percent less likely to be hospitalized if they were adherent to therapy.

Among patients who received a single pill per day, 6.6 percent of those who achieved 95 percent adherence were hospitalized at least once, versus 11.4 percent of participants who were not as adherent.

For participants in the two pills per day and three or more pills per day groups, 6.6 percent and 7.8 percent of patients, respectively, who achieved 95 percent adherence were hospitalized at least once, compared with 15.2 percent and 12.1 percent of patients in each group, respectively, who did not achieve 95 percent adherence.

Overall, participants who received a single pill per day were 24 percent less likely to be hospitalized than participants who received three or more pills per day.

In addition, study participants with mental disorders, drug or alcohol abuse problems, and female participants were more likely to be hospitalized, as were those covered by Medicare or who were self-insured versus those covered by private health insurance.

For more information, please see the study in PLoS One.