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Review
. 2019 Apr 3:13:475-490.
doi: 10.2147/PPA.S192735. eCollection 2019.

Adherence to HIV treatment regimens: systematic literature review and meta-analysis

Frederick Altice  1 , Obaro Evuarherhe  2 , Sophie Shina  2 , Gemma Carter  2 , Anne Christine Beaubrun  3
Affiliations
Review

Adherence to HIV treatment regimens: systematic literature review and meta-analysis

Frederick Altice et al. Patient Prefer Adherence. .

Abstract

Background: Antiretroviral therapy (ART), when taken consistently, reduces morbidity and mortality associated with human immunodeficiency virus and viral transmission. Suboptimal treatment adherence is associated with regimen complexity and high tablet burden. Single-tablet regimens (STRs) provide a complete treatment regimen in a single tablet. This study examined the relationship between STRs (vs multiple-tablet regimens [MTRs]), treatment adherence, and viral suppression.

Methods: A systematic review was conducted to identify studies investigating at least one of the following: (1) STR/MTR use and adherence; (2) levels of adherence and viral suppression; and (3) STR/MTR use and viral suppression. Meta-analysis was performed to assess the relationship between STR vs MTR use and adherence in observational settings at ≥95% and ≥90% adherence thresholds.

Results: In total, 29 studies were identified across the three objectives; two studies were relevant for all objectives. STRs were associated with higher treatment adherence than MTRs in 10/11 observational studies: a 63% greater likelihood of achieving ≥95% adherence (95% CI=1.52-1.74; P<0.001) and a 43% increase in the likelihood of achieving ≥90% adherence (95% CI=1.21-1.69; P<0.001). Higher adherence rates were associated with higher levels of viral suppression in 13/18 studies. Results were mixed in five studies investigating the association between STR or MTR use and viral suppression.

Conclusion: Although the direct effect of STRs vs MTRs on viral suppression remains unclear, this study provided a quantitative estimate of the relationship between STRs and ART adherence, demonstrating that STRs are associated with significantly higher ART adherence levels at 95% and 90% thresholds. Findings from the systematic review showed that improved adherence results in an increased likelihood of achieving viral suppression in observational settings. Future research should utilize similar measures for adherence and evaluate viral suppression to improve assessment of the relationship between pill burden, adherence, and viral suppression.

Keywords: antiretroviral therapy; human immunodeficiency virus; meta-analysis; systematic review; treatment adherence.

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Conflict of interest statement

Disclosure Obaro Evuarherhe, Gemma Carter and Sophie Shina are employees of Oxford PharmaGenesis Ltd, Oxford UK, which was funded by Gilead Sciences. Anne Christine Beaubrun is an employee of Gilead Sciences, Foster City, CA, USA. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
PRISMA diagram. Note: aTwo identified studies were relevant for all three objectives., Abbreviation: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Objective 1 – meta-analysis comparing the effects of STRs and MTRs on optimal (≥95%) adherence levels. Excluding nevirapine-based regimen plus at least two nucleoside reverse transcriptase inhibitors arm in Taneja et al. Abbreviations: MTR, multiple-tablet regimen; STR, single-tablet regimen.
Figure 3
Figure 3
Objective 1 – meta-analysis comparing the effects of STRs and MTRs on adherence levels (≥90% threshold). Abbreviations: MTR, multiple-tablet regimen; STR, single-tablet regimen.
See this image and copyright information in PMC

References

    1. Department of Health and Human Services; [Accessed March 23, 2017]. Panel on Antiretroviral Guidelines for Adults and Adolescents: guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. [updated July 14, 2016]. Available from: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
    1. Astuti N, Maggiolo F. Single-tablet regimens in HIV therapy. Infect Dis Ther. 2014;3:1–17. - PMC - PubMed
    1. Dejesus E, Young B, Morales-Ramirez JO, et al. Simplification of antiretroviral therapy to a single-tablet regimen consisting of efavirenz, emtricitabine, and tenofovir disoproxil fumarate versus unmodified anti-retroviral therapy in virologically suppressed HIV-1-infected patients. J Acquir Immune Defic Syndr. 2009;51:163–174. - PubMed
    1. Glass TR, De Geest S, Hirschel B, et al. Self-reported non-adherence to antiretroviral therapy repeatedly assessed by two questions predicts treatment failure in virologically suppressed patients. Antivir Ther. 2008;13:77–85. - PubMed
    1. 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. - PMC - PubMed