1512. The Impact of Antiretroviral Tablet Burden and Polypharmacy on Viral Suppression in Treatment Naïve Patients
Session: Poster Abstract Session: HIV: Antiretroviral Therapy
Friday, October 28, 2016
Room: Poster Hall
Posters
  • IDWeek Poster #4 Layout Revised Final.pdf (462.4 kB)
  • Background:

    Studies have suggested that the tablet burden associated with antiretroviral therapy (ART) and non-ART related polypharmacy may negatively influence adherence to treatment and subsequently virologic outcomes. 

    Methods:

    HIV+ patients (pts) initiating either single (STR) or multiple (MTR) tablet ART between 1/1/2007 and 3/31/2015 were identified from OPERA, a collaboration of 79 HIV clinics in 15 states. Pts were followed from treatment start until regimen change, death, loss to follow-up, or study end. Viral suppression was defined as a plasma HIV-1 RNA (VL) <50 copies/mL.  Rebound was defined as 1 VL >200 after suppression plus regimen discontinuation or 2 VL>200 copies/mL. Non-HIV pill burden was categorized as 0-4, 5-9 and 10 + chronic medications per day. Cox proportional hazards regression modeled the impact of demographics, ART and non-ART pill burden, and other baseline HIV and non-HIV characteristics separately on virologic suppression and rebound.

    Results:

     Of 9190 treatment-naïve pts, 60% initiated an STR. Median (IQR) follow-up was 18.8 (12.0-31.3) and 13.7 (6.6-26.7) months in STR and MTR initiators respectively. Pts initiating STR were significantly more likely (vs MTR initiators) to be male, age 13-25, Hispanic and significantly less likely to have comorbidity, MSM, to have baseline viral load >100,000 copies/mL or AIDS. Seventy percent of STR initiators (54.4% MTR) achieved virologic suppression during the initial regimen (p<0.0001) with 12.1% and 20.0% subsequently experiencing a virologic rebound. Cox model results suggest that STR initiators were both significantly (p<0.001) more likely to achieve suppression [HR (95% CI) 1.38 (1.30, 1.46)], and significantly (p<0.001) less likely to experience virologic rebound [0.55 (0.47, 0.62)] while on their initial regimen. The extent of non-HIV pill burden did not significantly impact the probability of suppression or virologic rebound. Figure 1 depicts model results

    Conclusion:

    Naïve patients initiating on a STR were more likely to achieve viral suppression and less likely to experience virologic rebound than patients initiating on a MTR. The extent of non-HIV pill burden at initiation did not have a significant impact in either suppression or rebound models.

    Anthony Mills, MD1, Jennifer Fusco, BS2, Kathy Schulman, MA3, Cassidy Henegar, PhD, MSPH2, Susan Zelt, DrPH, MBA4, Ronald D' Amico, DO, MSc5 and Felix Carpio, MD, MPH6, (1)Southern California Men's Health Group, Palm Springs, CA, (2)Epividian, Inc., Durham, NC, (3)Outcomes Research Solutions, Inc., Waltham, MA, (4)ViiV Healthcare, Inc., Research Triangle Park, NC, (5)ViiV Healthcare, Research Triangle Park, NC, (6)AltaMed Health Services, Los Angeles, CA

    Disclosures:

    A. Mills, ViiV Healthcare: Consultant , Grant Investigator and Speaker's Bureau , Consulting fee , Grant recipient and Speaker honorarium
    Gilead Sciences: Consultant , Grant Investigator and Speaker's Bureau , Consulting fee , Grant recipient and Speaker honorarium
    Merck: Consultant , Grant Investigator and Speaker's Bureau , Consulting fee , Grant recipient and Speaker honorarium
    Serono: Consultant , Consulting fee

    J. Fusco, ViiV Healthcare: Research Contractor , Research support

    K. Schulman, ViiV Healthcare: Consultant and Research Contractor , Consulting fee and Research grant

    C. Henegar, ViiV Healthcare: Research Contractor , Research support

    S. Zelt, Viiv Healthcare: Employee , Salary and Stock options

    R. D' Amico, ViiV Healthcare: Employee , Salary and stock options

    F. Carpio, None

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