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.
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.
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
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.
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
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