Nachega, Jean B., Parienti, Jean-Jacques, Uthman, Olalekan A., Gross, Robert, Dowdy, David W., Sax, Paul E., Gallant, Joel E., Mugavero, Michael J., Mills, Edward and Giordano, Thomas P. (2014) Lower pill burden and once-daily antiretroviral treatment regimens for HIV infection : a meta-analysis of randomized controlled trials. Clinical Infectious Diseases, Volume 58 (Number 9). pp. 1297-1307. doi:10.1093/cid/ciu046 ISSN 1058-4838.

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Abstract

Background. Contemporary antiretroviral treatment regimens are simpler than in the past, with lower pill burden and once-daily dosing frequency common. We performed a meta-analysis of randomized controlled trials (RCTs) to investigate the impact of pill burden and once-daily vs twice-daily dosing on ART adherence and virological outcomes.

Methods. A literature search of 4 electronic databases through 31 March 2013 was used. RCTs comparing once-daily vs twice-daily ART regimens that also reported on adherence and virological suppression were included. Study design, study population characteristics, intervention, outcome measures, and study quality were extracted. Study quality was rated using the Cochrane risk-of-bias tool.

Results. Nineteen studies met our inclusion criteria (N = 6312 adult patients). Higher pill burden was associated with both lower adherence rates (P = .004) and worse virological suppression (P < .0001) in both once-daily and twice-daily subgroups, although the association with adherence in the once-daily subgroup was not statistically significant. The average adherence was modestly higher in once-daily regimens than twice-daily regimens (weighted mean difference = 2.55%; 95% confidence interval [CI], 1.23 to 3.87; P = .0002). Patients on once-daily regimens did not achieve virological suppression more frequently than patients on twice-daily regimens (relative risk [RR] = 1.01; 95% CI, 0.99 to 1.03; P = .50). Both adherence and viral load suppression decreased over time, but adherence decreased less with once-daily dosing than with twice-daily dosing.

Conclusions. Lower pill burden was associated with both better adherence and virological suppression. Adherence, but not virological suppression, was slightly better with once- vs twice-daily regimens.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Antiretroviral agents, Patient compliance, HIV infections -- Treatment
Journal or Publication Title:	Clinical Infectious Diseases
Publisher:	University of Chicago Press
ISSN:	1058-4838
Official Date:	22 January 2014
Dates:	Date Event 22 January 2014 Available 14 January 2014 Accepted 20 October 2013 Submitted
Volume:	Volume 58
Number:	Number 9
Page Range:	pp. 1297-1307
DOI:	10.1093/cid/ciu046
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	27 December 2015
Date of first compliant Open Access:	27 December 2015
Funder:	National Institute of Allergy and Infectious Diseases (U.S.) (NIAID), National Institutes of Health (U.S.) (NIH), Stellenbosch University, Fogarty International Center, United States. Health Resources and Services Administration (HRSA), United States. President's Emergency Plan for AIDS Relief (PEPFAR), European Developing Countries Clinical Trial Partnership (EDCTP), Wellcome Trust (London, England), National Institutes of Mental Health (U.S.) (NIMH), Forskningsrådet för arbetsliv och socialvetenskap (Sweden) (FAS), United States. Department of Veterans Affairs. Health Services Research and Development Service, Agence nationale de recherches sur le SIDA (France) (ANRS), Institut national de la santé et de la recherche médicale (France) (INSERM)
Grant number:	2UM1AI069521-08 (SU), T84HA21652-01-00 (US), TA-08-40200-021 (EDCTP), WT087537MA (SACORE), R34 MH083592-01A1 (NIMH), 2012-0064 (FAS), P30 AI 045008 (NIH), CIN 13-413 (DVA), 2012-YY1137 (INSERM), UM1AI069412 (NIAID)

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