Managed Care

Too many pills means lower adherence to antiretrovirals in HIV patients

Krishna Rutvij Patel, PharmD

Although adherence rates among HIV/AIDS patients are as low as 50%, anything less than 100% is unacceptable because adherence to antiretroviral therapy (ART) is the primary factor that determines virologic suppression, disease progression, and even death. Therefore, evidence-based interventions to improve adherence have become a focus of formulary decision makers.

One such intervention, known as regimen simplification, was studied in a meta-analysis published in January 2014 in Clinical Infectious Diseases. This meta-analysis of 19 trials evaluated the effect of pill burden (number of pills and other dosage forms) and dosing frequency, two major components of regimen simplification, on adherence in HIV-infected adults. Researchers concluded that while lower pill burden was associated with better adherence, once-daily dosing only slightly improved adherence compared with twice-daily dosing. This suggests that regimen simplification is an important consideration when making formulary decisions.

Slightly higher adherence among patients on once-daily regimen compared to twice-daily regimen

Source: Nachega, et al, Lower Pill Burden and Once-daily Dosing Antiretroviral Treatment Regimens for HIV Infection: A Meta-Analysis of Randomized Controlled Trials. Clin Infect Dis. 2014; 48:383–488

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