Better adherence with once-daily antiretroviral regimens: a meta-analysis

Abstract

Once-daily regimens of antiretroviral therapy are simpler than other regimens, but whether such regimens are associated with better adherence to treatment is controversial. We performed a meta-analysis of 11 randomized, controlled trials (total number of subjects, 3029), which revealed that the adherence rate was better with once-daily regimens (+2.9%; 95% confidence interval, 1.0%-4.8%; P < .003) than with twice-daily regimens. This modest effect was more pronounced at the time of treatment initiation and for regimens for which all medications were taken once per day.

Figure 1

Forrest plot of the effect of once-daily versus twice-daily antiretroviral regimens on the rate of adherence. Adherence rate was defined as follows: (no. of taken doses/no. prescribed doses)×100. Cochrane Q test for heterogeneity: χ²=29.7; degrees of freedom, 10; P=<.001; I²=66.4%. Test for overall random effect: Z=2.98; P=<.003.

Figure 2

Forrest plot of the effect of once-daily versus twice-daily antiretroviral regimens on viral suppression. Viral suppression was defined as a plasma RNA HIV level <50 copies/mL in the intent-to-treat analysis, with missing equals failure. In the study by Gathe et al. [18], data represent week 12 results among subjects with Medication Event Monitoring System evaluation (Dr. Rode, personal communication, December 2008). Week 48 results are 77% and 76% for once-daily and twice-daily regimens, respectively. Cochrane Q test for heterogeneity: χ²=8.2; degrees of freedom, 9; P=.43; I²=0.0%. Test for overall random effect: Z=1.25; P=.21. n, No. of subjects with viral suppression; N, total sample size.