1076. Patient Willingness to Reduce Efavirenz Dose Based on Genetic Testing
Session: Poster Abstract Session: HIV: Switching Antiretrovirals
Friday, October 9, 2015
Room: Poster Hall
Background: Many HIV-infected adults have sustained control of HIV-1 replication with once-daily, single-pill efavirenz (EFV) 600 mg/ tenofovir disoproxil fumarate 245 mg/emtricitabine 200 mg. Among these patients, CYP2B6 genotyping can identify that the majority are eligible to reduce EFV to 200 mg or 400 mg. This has the potential to reduce cost and improve tolerability, but would require once-daily 2 or 3 pills, respectively, with 2 prescriptions. We performed a formal survey of clients at a large HIV primary care clinic in the Southeastern US to assess willingness to participate in such dose reduction

Methods: Eligible survey participants were HIV-positive, at least 18 years of age, English speaking, on a one-pill once-daily regimen, and at the clinic for a non-urgent HIV care encounter. Study team members not engaged in patient care performed face-to-face interviews using a scripted set of questions. All but 2 patients participated from June to August 2014.

Results: Of 132 patients surveyed, data were evaluable in 129, of whom 66 (51%) were White, 50 (39%) were Black, 13 (10%) were of other race/ethnicities, 113 (88%) were male, 84 (65%) were on EFV, median age was 49 years, 117 (91%) said that on a typical day they felt pretty good or great, 111 (87%) reported undetectable HIV, and 57 (44%) had copays. When told that switching from 1 pill to 2 or 3 pills “might make you feel a little better”, 60 (47%) said they were “yes” (35, 27%) or “maybe” (25, 19%) willing to switch. When told that switching “might make you feel a little better, but with a small chance it might not control your HIV as well”, only 11 (9%) said “yes” (2, 2%) or “maybe” (9, 7%) willing to switch. There was no association between willingness to switch and age, race, sex, copays, number of other pills or prescriptions, or years on HIV therapy (P>0.05 for each). Genetic testing to “decide what dose of medicine might be best” was acceptable to 117 (91%).

Conclusion: A substantial proportion of patients with control of HIV on long-term EFV may be willing to reduce EFV dose based on genetic testing, even if this requires more pills, but only if this does not compromise virologic control. Clinic and demographic factors did not predict willingness to switch.

Margaret Mitchell, -1, Caroline Wells, BS2, Xuechao Zhang, BS3, Joshua Hughes, MSN4, Je'purde White, PharmD5, Robertson Nash, MA, MBA, MSN1 and David Haas, MD, FIDSA6, (1)Vanderbilt University Medical Center, Nashville, TN, (2)Lipscomb University College of Pharmacy, Nashville, TN, (3)Vanderbilt University School of Medicine, Nashville, TN, (4)Vanderbilt University, Nashville, TN, (5)Lipscomb University, Nashville, TN, (6)Medicine, Vanderbilt University School of Medicine, Nashville, TN

Disclosures:

M. Mitchell, None

C. Wells, None

X. Zhang, None

J. Hughes, None

J. White, None

R. Nash, None

D. Haas, Merck: Consultant , Consulting fee

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