One-a-day ART pill best for poor HIV+

Combination ART given once daily as a single pill improves treatment compliance among homeless HIV patients, a new study from San Francisco shows. The treatment adherence rates with the efavirenz, emtricitabine, and tenofovir (EFV/FTC/TDF) combination pill was 86%, the researchers report in the journal AIDS.

"Despite the fact that we enrolled a group of patients who had all of the classic risk factors for non-adherence, most patients did well," Dr Steven Deeks, co-author from the University of California, San Francisco, said. "The cost is comparable to other regimens."

The researchers examined the adherence rates among 47 homeless HIV patients who were started on the EFV/FTC/TDF single-pill/once-daily regimen. They were followed for six months, and treatment compliance was checked by unannounced home visits and pill counts every three to six weeks.

The results

The results were compared with those from their previous studies, which included 57 patients on r-PI (ritonavir-boosted protease inhibitor and two nucleoside reverse transcriptase inhibitors) and 14 on NNRTI (non-nucleoside reverse transcriptase inhibitor) regimens. Both of these were multiple-pill regimens given one or more times daily.

The treatment adherence rates were significantly greater in the EFV/FTC/TDF single-pill regimen. Specifically, 86% of patients in the EFV/FTC/TDF single-tablet regimen, 73% in the r-Pi and NNRTI multi-pill once-daily regimens, and 75% in the r-Pi and 68% in the NNRTI multi-dose regimens adhered to the treatment.

Virologic suppression - defined as HIV RNA load below 50 copies/ml - was also highest (69%), though not significantly, in the EFV/FTC/TDF single-tablet regimen. In comparison, the suppression rates were 43%-47% in the other regimens.

Efficacy of treatment

"This speaks to the incredible efficacy of treatment in general and argues that clinician perceptions regarding non-adherence should not be a reason to deny someone access to these drugs," Dr Deeks pointed out.

Non-randomisation was a major drawback of their study, the researchers admit. Nevertheless, "we found that a one-pill-per-day regimen was associated with good adherence and viral suppression in a challenging population," the authors emphasise.

"For many years HIV treatment was limited by the complexity of the existing therapies. It required a large pill burden, several dosages a day, and some with specific food and water requirements. The single tablet regimen (contains three drugs in one tablet) resolved many of those handicaps," Dr Edwin DeJesus, Medical Director, Orlando Immunology Centre, Florida, said. Dr DeJesus was not connected with the study.

"Simplification of therapy represents an important step forward in supporting adherence and treatment success," the researchers conclude. (Reuters Health/ November 2010)

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