Single-tablet HIV treatment shows better outcomes over multi-tablet regimen

May 18, 2018, Veterans Affairs Research Communications
Taking one tablet per day, versus multiple tablets, appears to result in better outcomes for HIV patients. Credit: Mitch Mirkin

HIV patients on a single-tablet daily regimen had better treatment retention and viral suppression than patients taking multiple pills, in a study by a Michael E. DeBakey Veterans Affairs Medical Center researcher and his colleagues.

The results were published in the Feb. 25, 2018, issue of AIDS Care.

HIV, or human immunodeficiency virus, weakens the human immune system. It increases the risk of catching other common infections and conditions that don't usually affect people with stronger immune systems. As the infection progresses, it can lead to AIDS (acquired immunodeficiency syndrome). If untreated, the average survival time with HIV is 9 to 11 years.

In 2016, more than 28,000 veterans with HIV received care from VA.

HIV care has come a long way in recent years. Combination antiretroviral therapy was introduced in the 1990s. This led to significant reductions in deaths due to HIV infection. However, these early treatments were not without their downsides. Early therapy involved complex regimens involving up to a dozen pills each day.

Newer treatment regimens are typically taken only once per day. Once-daily regimens are the new standard for HIV care. Having to take medicine only once per day decreases pill burden, which could improve patients' quality of life and treatment adherence. Some of the newest regimens require only a single daily pill.

While studies have shown that patients prefer a single-tablet regimen, not much research has been done on whether a single pill results in better treatment outcomes than a multiple-tablet regimen. Some of the common multiple-tablet regimens are becoming available in generic versions, meaning they will be less expensive. Insurance companies may insist on these regimens if they are cheaper than a single tablet.

To test whether one treatment approach was better, the research team studied more than 1,000 patients at a non-VA Texas clinic who were just beginning HIV treatment. They looked at 622 patients on a single-tablet regimen and 406 on a multi-tablet regimen, all taken once daily.

While both regimens were based around the drug teofovir, they did not include the exact same combination of medicines. The multi-tablet regimen also contained an antiretroviral HIV drug class called boosted protease inhibitors, and the single-tablet regimen contained a different class called non-nucleoside reverse transcriptase inhibitors.

After following the patients for a year, the researchers found that the single-tablet regimen compared favorably with the multi-tablet regimen. They measured three aspects of treatment: adherence, retention, and HIV suppression.

Treatment adherence means that patients took their medicine more than 80 percent of the time, based on prescription fills. Interestingly, the two regimens had similar rates of adherence. So that factor alone would not explain the apparent edge for the single-tablet group.

To show retention in care, had to visit their doctors for viral load measurements at least twice, at least three months apart, during the first year. Eighty-one percent of the single-tablet group showed retention, compared with 73 percent of the multi-tablet group.

HIV suppression was defined as a viral load in the blood of less than 400 copies per milliliter. In the single-tablet group, 84 percent had viral suppression after the first year. In the multi-tablet group, 78 percent showed suppression.

While the results suggest that single-tablet regimens may lead to better clinical outcomes, more research is needed. Dr. Thomas P. Giordano, a researcher at the Michael E. DeBakey VA Medical Center in Houston and corresponding author on the study, explained that it is not yet entirely clear why the single-pill regimen appears to work better.

"There were not differences in adherence as we could measure it via pharmacy refill dates, which suggests that maybe the single-tablet regimens are more efficacious," he said. "It could also be that the persons who got the multi-tablet regimens had more barriers to care and that is why they did more poorly." He says more studies will be needed to help tease out the differences in the types of medications being used versus the effect of pill burden.

Future research will also need to focus on which treatment is more cost-effective, since single-pill regimens may prove to be more expensive.

Explore further: New once-daily 'Quad' pill for HIV is safe, effective alternative to traditional antiretroviral regimens

Related Stories

New once-daily 'Quad' pill for HIV is safe, effective alternative to traditional antiretroviral regimens

June 28, 2012
A new once-daily pill combining three antiretrovirals and a booster molecule is a safe and effective alternative to two widely used drug regimens for newly diagnosed HIV-positive adults who have had no previous treatment. ...

New pill-only regimens cure patients with hardest-to-treat hepatitis C infection

October 17, 2014
Two new pill-only regimens that rapidly cure most patients with genotype 1 hepatitis C (HCV) infection could soon be widely prescribed across Europe. Two recently-published studies1,2 confirmed the efficacy and safety of ...

Study shows shorter hepatitis C regimen effective in black patients

March 15, 2018
A study by the Harvard Pilgrim Health Care Institute found that contrary to current hepatitis C treatment guidelines, an eight-week treatment regimen may be just as effective as 12 weeks in black patients.

For HIV-infected, number of daily pills decreasing

January 6, 2016
(HealthDay)—For HIV-infected patients, the number of pills and doses of antiretrovirals has decreased over the past seven years, according to a study published online Dec. 30 in the Journal of Clinical Pharmacy and Therapeutics.

Case study shows importance of single-pill HIV-1 treatment

July 17, 2014
(HealthDay)—A single-pill combination HIV-1 treatment may be appropriate in certain cases, according to a case vignette published in the July 17 issue of the New England Journal of Medicine.

HPTN 067 demonstrates high-risk populations adhere well to daily PrEP regimen

July 20, 2015
Results from HPTN 067, a Phase II, randomized, open-label study, demonstrate most study participants had higher coverage of sex events and better adherence when they were assigned to the daily dosing arm, investigators from ...

Recommended for you

Long-acting injectable implant shows promise for HIV treatment and prevention

October 9, 2018
A persistent challenge in HIV/AIDS treatment and prevention is medication adherence – getting patients to take their medication as required to get the best results.

Scientists develop rapid test for diagnosing tuberculosis in people with HIV

October 8, 2018
An international team that includes Rutgers scientists has made significant progress in developing a urine diagnostic test that can quickly, easily and inexpensively identify tuberculosis infection in people also infected ...

Researchers uncover new role of TIP60 protein in controlling tumour formation

October 8, 2018
Scientists from the Cancer Science Institute of Singapore (CSI Singapore) at the National University of Singapore (NUS) have discovered a new molecular pathway that controls colorectal cancer development, and their exciting ...

Combination therapy targets latent reservoir of HIV

October 3, 2018
With more than 35 million people worldwide living with the virus and nearly 2 million new cases each year, the human immunodeficiency virus (HIV) remains a major global epidemic. Existing antiretroviral drugs do not cure ...

Anti-integrin therapy effect on intestinal immune system in HIV-infected patients

October 3, 2018
In a study published today in Science Translational Medicine, Mount Sinai researchers describe for the first time a mechanism that may shrink collections of immune cells in the gastrointestinal (GI) tract, called lymphoid ...

No 'reservoir': Detectable HIV-1 in treated human liver cells found to be inert

October 1, 2018
In a proof-of-principle study, researchers at Johns Hopkins report that a certain liver immune cell called a macrophage contains only defective or inert HIV-1 copies, and aren't likely to restart infection on their own in ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.