Lower pill burden is associated with higher rates of adherence to HIV treatment and better virological outcomes, according to the results of a meta-analysis published in the online edition of Clinical Infectious Diseases. The research also showed that adherence was better with once-daily regimens compared to twice-daily treatment, but once-daily therapy did not have any advantages in terms of virological suppression.
“Higher pill burden was associated with both lower adherence and worse virologic suppression in both twice-daily and once-daily subgroups,” comment the authors. “Adherence was higher with once-daily ART [antiretroviral therapy] regimens than twice-daily regimens…however, this difference was minimal and did not translate into better treatment outcomes.”
The past decade has witnessed important improvements in antiretroviral treatment. Overall, drugs are now less toxic and better tolerated than in the past. Pill burden has also been reduced and dosing schedules simplified. Two fixed-dose pills (Atripla and Stribild) are now available, providing potent HIV therapy in a single tablet.
A meta-analysis of randomised trials published in 2009 showed that once-daily treatment was associated with higher rates of adherence compared to twice-daily therapy, but that rates of virologic suppression did not differ greatly between the treatment strategies.
More randomised trials have been published since then. An international team of investigators therefore re-visited the questions of whether pill burden and dosing schedule have an impact on adherence and virologic suppression.