In HIV-Positive Women, Does Single-Pill Antiretroviral Therapy Increase Compliance?

May 19, 2014

Adherence with antiretroviral therapy among HIV-infected women was as low as 50% at the time the first fixed-combination, single-dose tablet was introduced.

Compliance with antiretroviral therapy (ART) is critical to ensure response and obtain the desired health benefits. Lower daily pill burdens have been associated with better adherence and thus better treatment outcomes.1

Several studies have found lower adherence rates in women, possibly related to greater ART toxicity in women or a higher prevalence of depression.2 A recent study published in the Journal of Acquired Immune Deficiency Syndromes assessed the efficacy of single-tablet antiretroviral therapy in women.3 The researchers also looked at outcomes in a subset of women who switched from a multiple- to a single-tablet regimen using an interesting case-crossover design.

The study included 15,523 person-visits, representing 1727 women enrolled in the Women’s Interagency HIV Study. The study found that the use of single-tablet combination regimens increased from 7% in 2006 when the first fixed-dose combination therapy became available, to 27% in 2013. Interestingly, adherence increased from 78% to 85% during the same period (P < .001). The study demonstrated that single-tablet regimens were associated with increased adherence (adjusted risk ratio [RR] = 1.05; 95% confidence interval [CI], 1.03 to 1.08) and virologic suppression (RR = 1.06; 95% CI, 1.01 to 1.11).

In the subset of 163 women who switched from a multiple- to a single-tablet regimen, the single-tablet regimen was associated with increased adherence (from 85% to 90%, RR = 1.08; 95% CI, 1.002 to 1.14) and greater virologic suppression (from 77% to 85%, RR = 1.08; 95% CI, 0.97 to 1.20) compared with corresponding levels while on the prior regimen. Interestingly, the study found that at the time the fixed-dose combination tablets first became available, only 50% of women were adherent at the 100% level.

Primary care physicians should be aware of the evidence supporting the association between single-pill antiretroviral therapy drug regimens and improved treatment compliance in women.

References:

1. Parienti JJ, Bangsberg DR, Verdon R, et al. Better adherence with once-daily antiretroviral regimens: a meta-analysis. Clin Infect Dis. 2009;48:484–488. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2708315/pdf/nihms-116534.pdf

2. Silverberg MJ, Gore ME, French AL, et al. Prevalence of clinical symptoms associated with highly active antiretroviral therapy in the Women's Interagency HIV Study. Clin Infect Dis. 2004;39:717–724. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118991/pdf/nihms299713.pdf

3. Hanna DB, Hessol NA, Golub ET, et al. Increase in single-tablet regimen use and associated improvements in adherence-related outcomes in HIV-infected women. J Acquir Immune Defic Syndr. 2014;65:587-596. doi: 10.1097/QAI.0000000000000082. http://www.ncbi.nlm.nih.gov/pubmed/?term=10.1097%2FQAI.0000000000000082