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Taiwo BO, Romdhani H, Lafeuille MH, Bhojwani R, Milbers K, Donga P. Treatment and comorbidity burden among people living with HIV: a review of systematic literature reviews. J Drug Assess 2022; 12:1-11. [PMID: 36582675 PMCID: PMC9793945 DOI: 10.1080/21556660.2022.2149963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background As the human immunodeficiency virus (HIV) treatment landscape continues to evolve, the prolonged life expectancy and long-term exposure to antiretroviral drugs have modified the burden associated with living with HIV. Objective To better understand the current treatment and comorbidity burden in people living with HIV (PLWH). Methods Peer-reviewed systematic literature reviews (SLRs) between 2017 and 2020 that included US studies and examined drug adherence/pill burden, resistance burden, or comorbidities in PLWH were identified. Methods and findings were extracted for the overall studies and examined in the subset of US studies. Results Among 665 publications identified, 47 met the inclusion criteria (drug adherence/pill burden: 5; resistance: 3; comorbidities: 40). While antiretroviral drug adherence levels varied across SLRs, single-tablet regimens (STR) were associated with higher adherence versus multiple-tablet regimens. STRs were also associated with lower risk of treatment discontinuation, higher cost-effectiveness, and lower risk of hospitalization. Longer survival resulted in a high comorbidity burden, with non-AIDS causes accounting for 47% of deaths among PLWH in the US. HIV doubled the risk of cardiovascular disease and was associated with other health problems, including bone and muscle diseases, depression, and cancers. Several antiretroviral regimens were associated with chronic diseases, including cardiometabolic conditions. Lifetime HIV costs are substantially increasing, driven by antiretroviral, adverse event, and comorbidity treatment costs cumulated due to longer survival times. Conclusions There is a considerable burden associated with HIV and antiretroviral treatment, highlighting the benefits of less complex and safer regimens, and the unmet need for effective preventative interventions.
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Affiliation(s)
- Babafemi O. Taiwo
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Marie-Hélène Lafeuille
- Analysis Group, Inc, Montréal, QC, Canada,CONTACT Marie-Hélène Lafeuille Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Montréal, QCH3B 0G7, Canada
| | | | | | - Prina Donga
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
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2
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Tsai HC, Chen IT, Chang HM, Lee SSJ, Chen YS. Trend of HIV Transmitted Drug Resistance After the Introduction of Single-Tablet Regimens in Southern Taiwan. Infect Drug Resist 2022; 15:5495-5507. [PMID: 36158235 PMCID: PMC9507459 DOI: 10.2147/idr.s382568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background The prevalence of transmitted drug resistance (TDR) after the universal implementation of STRs is unknown in Taiwan. Objective This study aimed to investigate the prevalence of TDR in patients with HIV-1 infection, clarify the risk factors for pol resistance, and compare differences in HIV drug resistance before and after the implementation of STRs in Taiwan. Methods Adult patients infected with HIV-1 were enrolled in this study from 2013 to 2021. Mutations associated with drug resistance were identified using the 2019 International Antiviral Society-USA list of drug resistant mutations in HIV, and drug susceptibility was assessed according to the Stanford HIV Drug Resistance Database edition 9. A logistic regression model was used to analyze the risk factors for pol resistance, and the differences in the prevalence of drug resistance from 2013-2016 to 2017-2021 were compared using the Mann-Whitney U-test. General linear regression was used to analyze temporal changes in the annual proportion of TDR overall and by type of antiretroviral drugs. Results A total of 369 patients were included. The prevalence rate of pol resistance was 9.8% (36/369). The resistance rates to nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs) were 3.3%, 6.9%, 0% and 1.8%, respectively. The patients with hepatitis C infection were more likely to have pol resistance (aHR 5.767, CI 1.232-26.991, p=0.026). The prevalence rate of pol resistance did not decrease after the implementation of STRs as first-line therapy in 2017 (11.2% vs 8.7%, aHR 1.329, CI 0.667-2.645, p=0.480), and no significant temporal changes were shown in the annual proportion of TDR overall or by type of antiretroviral drug. Conclusion Our findings showed a stable prevalence rate of transmitted drug resistance despite the implementation of STRs as the first-line therapy in June 2016.
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Affiliation(s)
- Hung-Chin Tsai
- Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Parasitology, Kaohsiung Medical University, Kaohsiung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan.,Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - I-Tzu Chen
- Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hui-Min Chang
- Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Pharmacy and Graduate Institute of Pharmaceutical Technology, Tajen University, Pingtung, Taiwan
| | - Susan Shin-Jung Lee
- Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yao-Shen Chen
- Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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3
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Tsai HC, Chen IT, Chang HM, Lee SSJ, Chen YS. High Prevalence of Doravirine Resistance in HIV-1-Infected Patients with Virological Failure to an NNRTI-Based Single-Tablet Regimen. Infect Drug Resist 2022; 15:3857-3869. [PMID: 35899084 PMCID: PMC9309287 DOI: 10.2147/idr.s361012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to investigate the prevalence of resistance to a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based single-tablet regimen (STR) in Taiwanese patients and clarify the clinical implications of using doravirine in patients who fail NNRTI treatment. Patients and Methods Taiwanese patients infected with HIV-1 who failed NNRTI-based STR treatment were enrolled in this retrospective cohort study from 2015 to 2020. Mutations associated with drug resistance were identified using the 2019 International Antiviral Society-USA list of drug-resistant mutations in HIV, and drug susceptibility was assessed according to the Stanford HIV Drug Resistance Database version 9. Median values of continuous variables were compared between two groups using the Mann-Whitney U-test, and categorical variables were compared using the chi-square test or Fisher's exact test. Results A total of 107 patients were included, of whom 29 were treatment failure to the initial STRs, and 78 failed treatment after switching to an STR. Seventy-four patients failed treatment with TDF/FTC/EFV (Atripla), 30 with TDF/FTC/RPV (Complera) and 3 with TAF/FTC/RPV (Odefsey). The prevalence rates of resistance to nucleoside reverse transcriptase inhibitors (NRTIs), NNRTIs, protease inhibitors (PIs) and integrase strand transfer inhibitors (INSTIs) were 76%, 86%, 3% and 2%, respectively. Among the 29 patients failure to the initial STRs, 62% developed doravirine resistance, compared to 64% of the 78 the patients who failed treatment after switching to an STR. There were no significant differences in the prevalence of specific NNRTI or doravirine resistance-associated mutations between these two groups. The patients with K65R mutations were more likely to have NNRTI resistance (p = 0.037) and doravirine resistance (p < 0.001). Conclusion Our findings showed a high rate of doravirine cross-resistance in patients with NNRTI-based STR treatment failure. Doravirine should be used cautiously as a salvage regimen in patients who fail NNRTI treatment.
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Affiliation(s)
- Hung-Chin Tsai
- Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Parasitology, Kaohsiung Medical University, Kaohsiung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan.,Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - I-Tzu Chen
- Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hui-Min Chang
- Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Pharmacy and Graduate Institute of Pharmaceutical Technology, Tajen University, Pingtung, Taiwan
| | - Susan Shin-Jung Lee
- Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yao-Shen Chen
- Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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4
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Ozhmegova EN, Bobkova MR. [HIV drug resistance: past and current trends]. Vopr Virusol 2022; 67:193-205. [PMID: 35831962 DOI: 10.36233/0507-4088-113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
HIV infection is incurable, but effective antiretroviral therapy (ART) makes it possible to achieve an undetectable viral load (VL), to preserve the function of the immune system and to prevent the patient's health. Due to the constant increase in the use of ART and the high variability of HIV, especially in patients receiving so-called suboptimal therapy for various reasons, the incidence of drug resistance (DR) is increasing. In turn, the presence of DR in an HIV-infected patient affects the effectiveness of therapy, which leads to a limited choice and an increase in the cost of treatment regimens, disease progression and, consequently, an increased risk of death, as well as transmission of infection to partners. The main problems of drug resistance, its types and causes, as well as factors associated with its development are considered. The main drug resistance mutations for each of the drug classes are described.
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Affiliation(s)
- E N Ozhmegova
- FSBI «National Research Centre for Epidemiology and Microbiology named after the honorary academician N.F. Gamaleya» of the Ministry of Health of Russia
| | - M R Bobkova
- FSBI «National Research Centre for Epidemiology and Microbiology named after the honorary academician N.F. Gamaleya» of the Ministry of Health of Russia
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5
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Bor J, Kluberg SA, LaValley MP, Evans D, Hirasen K, Maskew M, Long L, Fox MP. One Pill, Once a Day: Simplified Treatment Regimens and Retention in HIV Care. Am J Epidemiol 2022; 191:999-1008. [PMID: 35081613 PMCID: PMC9989337 DOI: 10.1093/aje/kwac006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 10/27/2021] [Accepted: 01/10/2022] [Indexed: 01/04/2023] Open
Abstract
Simplified drug regimens may improve retention in care for persons with chronic diseases. In April 2013, South Africa adopted a once-daily single-pill human immunodeficiency virus (HIV) treatment regimen as the standard of care, replacing a multiple-pill regimen. Because the regimens had similar biological efficacy, the shift to single-pill therapy offered a real-world test of the impact of simplified drug-delivery mechanisms on patient behavior. Using a quasi-experimental regression discontinuity design, we assessed retention in care among patients starting HIV treatment just before and just after the guideline change. The study included 4,484 patients starting treatment at a large public sector clinic in Johannesburg, South Africa. The share of patients prescribed a single-pill regimen increased by over 40 percentage points between March and April 2013. Initiating treatment after the policy change was associated with 11.7-percentage-points' higher retention at 12 months (95% confidence interval: -2.2, 29.4). Findings were robust to different measures of retention, different bandwidths, and different statistical models. Patients starting treatment early in HIV infection-a key population in the test-and-treat era-experienced the greatest improvements in retention from single-pill regimens.
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Affiliation(s)
- Jacob Bor
- Correspondence to Dr. Jacob Bor, Departments of Global Health and Epidemiology, School of Public Health, Boston University, 801 Massachusetts Avenue, Boston, MA 02118 (e-mail: )
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6
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Choudhary MC, Mellors JW. The transformation of HIV therapy: One pill once a day. Antivir Ther 2022; 27:13596535211062396. [DOI: 10.1177/13596535211062396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A co-formulated, one pill once a day antiretroviral regimen (single-tablet regimen), containing efavirenz, emtricitabine, and tenofovir disoproxyl fumarate ( Atripla), revolutionized the antiretroviral therapy landscape. Single-tablet regimens provide not only dosing convenience but help optimize adherence and persistence with antiretroviral therapy to achieve durably suppressed viremia with both individual and societal benefits. Given the many excellent options available now, single-tablet regimens are the preferred choice for initiating antiretroviral therapy in almost all patients with rare exceptions for drug interactions and pregnancy, and for simplification of more complex antiretroviral therapy to a single-tablet regimen. In this special commemorative article, we celebrate this astounding advancement in antiretroviral therapy, championed by John C. Martin while CEO of Gilead Sciences, and its transformative impact on HIV care nationally and globally.
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Affiliation(s)
- Madhu C Choudhary
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John W Mellors
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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7
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Chang HM, Chou CH, Tsai HC. Durability of single tablet regimen for patients with HIV infection in Southern Taiwan: data from a real-world setting. BMC Infect Dis 2022; 22:2. [PMID: 34983388 PMCID: PMC8725531 DOI: 10.1186/s12879-021-06919-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background A single-tablet regimen (STR) has been associated with better drug adherence. However, the durability of different STRs was unknown in the real-world settings. Our aim was to investigate the durability of different initial STR regimens in antiretroviral-naive patients starting STR in southern Taiwan. Method This was a retrospective study of antiretroviral-naive patients that initiated first-line antiretroviral regimens with STRs between May 2016 and December 2017. The primary endpoint was time to virological failure. Secondary endpoints were STR discontinuation due to toxicity/intolerance. Durability was defined as time from the initiation until discontinuation/modification. Kaplan- Meier curves were plotted assessing time to virological suppression, treatment failure and discontinuation for the three STRs and Cox proportional hazards model was used to analyze the factors associated with time to viral suppression, treatment failure or discontinuation. Results Two hundred and twenty-three patients were included: The median follow-up duration (IQR) was 73.9 (48–101.6) weeks, 25 patients (11%) experienced virological failure; the 48 weeks probability of treatment failure was 22.9% (16/70) for Efavirenz/Emtricitabine/Tenofovir Disoproxil Fumarate (EFV/FTC/TDF), 24.1% (13/54) for Emtricitabine/Rilpivirine/Tenofovir Disoproxil Fumarate (FTC/RPV/TDF) and 24.2% (24/99) for Abacavir/Dolutegravir/Lamivudine (ABC/DTG/3TC) (p=0.16). Fifty-six patients (25%) discontinued their STRs owing to toxicity/intolerance. When compared to EFV/FTC/TDF, treatment with FTC/RPV/TDF (aHR 8.39, CI 1.98–35.58, p = 0.004) and ABC/DTG/3TC (aHR 8.40, CI 2.39–29.54, p=0.001) were more likely to have treatment failure. The predictors for treatment failure included age ≦ 30 years old (aHR 3.73, CI 1.25–11.17, p = 0.018), switch between different STR (aHR 2.3, CI 1.18–4.50, p = 0.001) and free of active syphilis infection (aHR 0.24, CI 0.08–0.73, p = 0.012). The risk factor for treatment discontinuation included younger age ≦ 30 years old (aHR 3.82, CI 1.21–12.37, p = 0.023), treatment with EFV/FTC/TDF (aHR 8.65, CI 2.64–28.39, p < 0.001) and free of active syphilis infection (aHR 0.16, CI 0.04–0.62, p = 0.006). Conclusion Younger age was associated with treatment failure and drug discontinuation. Active syphilis infection s/p treatment was associated with free from treatment failure and discontinuation. This probably driven by the more frequently sexual health education and counseling when patients had syphilis infection. Treatment with ABC/DTG/3TC was associated with higher risk of treatment failure. The STR durability was dependent on the drug toxicity/intolerance, age and syphilis infection.
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Affiliation(s)
- Hui-Min Chang
- Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Pharmacy and Master Program, Collage of Pharmacy and Health Care, Tajen University, Pingtung County, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Chen-Hsi Chou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Hung-Chin Tsai
- Section of Infectious Diseases, Kaohsiung Veterans General Hospital, National Yang -Ming Chiao Tung University, Kaohsiung, Taipei, Taiwan. .,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan. .,Department of Parasitology, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan. .,Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, #386 Ta-Chung 1st Road, 813, Kaohsiung, Taiwan.
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8
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Chang HM, Chou PY, Chou CH, Tsai HC. Outcomes After Switching to BIC/FTC/TAF in Patients with Virological Failure to Protease Inhibitors or Non-Nucleoside Reverse Transcriptase Inhibitors: A Real-World Cohort Study. Infect Drug Resist 2021; 14:4877-4886. [PMID: 34853517 PMCID: PMC8628065 DOI: 10.2147/idr.s331647] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/09/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose This study evaluated the real-world tolerability and treatment effectiveness of BIC/FTC/TAF in treatment-experienced patients living with HIV-1 in Taiwan, especially in those with viremia at switch. Patients and Methods This was a retrospective cohort study of adult patients in Taiwan with HIV-1 who received BIC/FTC/TAF from between November 2019 and November 2020. The primary endpoint was the rate of viral suppression (plasma HIV RNA load <50 copies/mL) while on BIC/FTC/TAF. The secondary endpoints included durability of treatment, incidence of and reasons for discontinuation of BIC/FTC/TAF, and changes in weight and lipid profiles. Results A total of 175 patients were switched to BIC/FTC/TAF. Among them, 74 patients (42%) were using INSTI based regimen, 34 patients (19%) NNRTI based regimen and 65 patients (37%) with PI based regimen before switching. Before starting BIC/FTC/TAF, 84.6% of the patients were virologically suppressed, of whom 97.3% maintained suppression while on BIC/FTC/TAF. Overall, 15.4% of the patients (n=27) had a detectable viral load before BIC/FTC/TAF, of whom 81.5% achieved and maintained virologic suppression on BIC/FTC/TAF during follow-up. Only two patients discontinued BIC/FTC/TAF due to adverse events, with rash being the predominant cause. By month 12, the median changes in weight was +4 kg (IQR, −1.8 to 8.2). There were no significant differences from baseline to the end of follow-up in triglycerides (p = 0.07), total cholesterol (p = 0.92), LDL-C (p = 0.12), and HDL-C (p = 0.053). Conclusion The results of this real-world cohort study suggest that switching to BIC/FTC/TAF may be an option to achieve and maintain virological suppression, even in patients with residual viremia at baseline. Our results also demonstrated a low discontinuation rate, a moderate gain in weight, and no significant increases in lipid levels with BIC/FTC/TAF. However, studies with larger sample sizes are warranted to evaluate the clinical implications of our findings.
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Affiliation(s)
- Hui-Min Chang
- Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Pharmacy and Master Program, Collage of Pharmacy and Health Care, Tajen University, Pingtung, Taiwan
| | - Pei-Yun Chou
- Section of Infectious Diseases, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chen-Hsi Chou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hung-Chin Tsai
- Section of Infectious Diseases, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
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9
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Papot E, Kalampalikis N, Doumergue M, Pilorgé F, Quatremère G, Yazdanpanah Y, Préau M. Can we talk about price with patients when choosing antiretroviral therapy? A survey with people living with HIV and prescribers in France. BMJ Open 2021; 11:e046212. [PMID: 34836895 PMCID: PMC8628338 DOI: 10.1136/bmjopen-2020-046212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate people living with HIV (PLWH) and HIV specialist prescribers' perception of discussing antiretroviral therapy (ART) price in PLWH's care and the acceptability of choosing or switching to various types of less expensive ARTs. DESIGN Cross-sectional surveys (one in a convenience sample of PLWH and one in a voluntary response sample of HIV specialist prescribers). SETTING AND PARTICIPANTS The surveys were conducted among PLHW attending an HIV clinic in the North of Paris (cohort of 4922 PLWH in 2016), and HIV specialists working in French HIV clinics (210 across 12 districts/28), between January and June 2016. METHOD Self-administered questionnaires were constructed using data collected during focus groups with PLWH and prescribers. Pretests were carried out to select the questions and items. Descriptive analyses of the 129 complete questionnaires of PLWH and 79 of prescribers are presented. RESULTS Among PLWH, 128/129 were on ART and 54% (69/128) gave a fair estimation of the price of their current regimen. Among prescribers, 24% (19/79) thought that their patients knew this price. Taking into account the price of ART was not perceived as a negative step in the history of French response to HIV epidemic for 53% (68/129) of PLWH and 82% (65/79) of prescribers. Seventy-seven PLWH (60%) would agree to switch to less expensive antiretroviral regimens (as effective and with similar adverse events) if pills were bigger; 42 (33%) if there were more daily doses, and 37 (29%) if there were more pills per dose; prescribers were more circumspect. CONCLUSION A high proportion of PLWH gave a fair estimate of their ART price and this seemed unexpected by HIV specialists. Consideration of drug prices when choosing ART was perceived as conceivable by PLWH and prescribers if effectiveness and tolerance were also considered.
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Affiliation(s)
- Emmanuelle Papot
- Université de Paris, INSERM, IAME, F-75006, INSERM, Paris, France
- AP-HP, Hôpital Bichat, Infectious and Tropical Diseases Department, F-75018 Paris, France
| | | | | | | | | | - Yazdan Yazdanpanah
- Université de Paris, INSERM, IAME, F-75006, INSERM, Paris, France
- AP-HP, Hôpital Bichat, Infectious and Tropical Diseases Department, F-75018 Paris, France
| | - Marie Préau
- UMR 1296 « Radiations : Défense, Santé, Environnement », Université Lumière Lyon 2, Institut de Psychologie, Bron, France
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10
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Lee C, Sapasap J, LaRochelle J, Smith RO, Badowski ME. Antiretroviral Therapy in Children and Adolescents: A Look Into Modern Single Tablet Regimens. J Pediatr Pharmacol Ther 2021; 26:783-794. [PMID: 34790067 PMCID: PMC8591998 DOI: 10.5863/1551-6776-26.8.783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/20/2021] [Indexed: 11/11/2022]
Abstract
Single tablet regimens (STRs) have simplified antiretroviral therapy (ART) over the years in the adult human immunodeficiency virus (HIV) population. However, there is still a prevalent need to simplify regimens in children and adolescents living with HIV. Finding the optimal regimen requires a multi-factorial approach due to their complex pharmacokinetic profiles throughout childhood and the challenges and limitations of medication non-adherence in the pediatric population. These challenges include pill size, available formulations, palatability, and caregiver health literacy, which can all affect the proper administration of medications. The complexity of this population implies the importance of customizing everyone's antiretroviral regimen so that the patient and family can successfully adhere to the therapy. The current recommendations for ART in the adult and pediatric populations are similar, yet the use of STRs are limited. The goal of this review was to assess current data on available STRs and determine their utility as ART in the pediatric population.
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11
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Kottlan A, Glasser BJ, Khinast JG. Vibratory mixing of pharmaceutical powders on a single-tablet-scale. POWDER TECHNOL 2021. [DOI: 10.1016/j.powtec.2021.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Tabak F, Zerdali E, Altuntaş O, Gunduz A, Bolukcu S, Mete B, Nakir IY, Kumbasar Karaosmanoglu H, Yildiz DS, Meric Koc M, Dokmetas İ. Efficacy and safety of co-formulated elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide in HIV-positive patients: real-world data. Int J STD AIDS 2021; 32:562-569. [PMID: 33599173 DOI: 10.1177/0956462420983692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF) is a recommended and widely used regimen for HIV infection. In this study, we aimed to determine the efficacy and safety of E/C/F/TAF in people living with HIV (PLWH), who are either treatment-naïve or switched from any tenofovir disoproxil fumarate-containing regimen. For switched patients, we aimed to determine the impact of switching from tenofovir disoproxil fumarate (TDF) to TAF on lipid profile and kidney functions. METHODS ACTHIV-IST Study Group produced a database, and five dedicated HIV centres in Istanbul entered data of PLWH who switched from any TDF-containing regimen to E/C/F/TAF and treatment-naïve patients who were initiated with the E/C/F/TAF regimen between January 2017 and December 2019. Clinical findings, viral parameters, lipid studies, renal function tests, adverse events and adherence to the treatment were recorded in this prospective observational study. RESULTS The study included a total of 614 switched and treatment-naïve patients. Of 430 treatment-experienced patients, 89% (382) were men, and the mean age was 42 ± 12 years. Among them, 47% (181/382) self-identified as men who have sex with men (MSM). The median duration of HIV diagnosis was 54 ± 29 months. The median duration of E/C/F/TAF use was 20 ± 36 months and that of previous treatment was 23 ± 18 months. HIV-RNA was undetectable at baseline and month 12 in 84.1% (360/428) and 86.1% (328/381) of patients, respectively (p > 0.05). Mean CD4 counts were 708 ± 287 cells/µL and 802 ± 305 cells/µL at baseline and month 12, respectively (p < 0.001). Serum creatinine levels remained stable during the treatment period. Mean total cholesterol levels at baseline and month 12 were 172 and 211 mg/dL (p < 0.01), LDL-cholesterol 104 and 138 mg/dL (p < 0.01), HDL-cholesterol 39 and 49 mg/dL (p < 0.01) and triglycerides 134 and 174 mg/dL (p < 0.01), respectively. The treatment was generally well tolerated. Eight patients discontinued the therapy (drug interaction: 3; lost to follow-up: 1; pregnancy: 1; pulmonary tuberculosis: 1; side effect: 1; patient's decision: 1). Of 184 treatment-naïve patients, 88% (162) were men, and the mean age was 36.5± 12 years. Among them, 50% (81/162) self-identified as MSM. The mean duration of HIV infection was 21.6 ± 17.1 months. The mean duration of E/C/F/TAF use was 16 ± 4 months. HIV-RNA was undetectable at baseline and month 12 in 1% and 89.1% of patients, respectively. Mean CD4 counts at baseline and month 12 were 469 ± 223 cells/µL and 740 ± 298 cells/µL, respectively. During the treatment period, creatinine levels remained stable. Total cholesterol, LDL-cholesterol, triglyceride and also HDL-cholesterol levels increased. Mean total cholesterol levels at baseline and month 12 were 167 and 211 mg/dL (p < 0.01), LDL-cholesterol 108 and 143 mg/dL (p < 0.01), HDL-cholesterol 41 and 47 mg/dL (p < 0.01) and triglycerides 136 and 172 mg/dL, respectively (p < 0.01). The treatment was generally well tolerated. Three patients discontinued the therapy (drug interaction: 1; non-responder: 1; patient's decision: 1). CONCLUSION Starting with or switching to E/C/F/TAF in PLWH effectively suppresses HIV infection, is associated with an increase in CD4 cell count and is well tolerated in a real-life setting. Renal functions remained stable during the treatment. E/C/F/TAF use was associated with an increase in LDL-cholesterol and triglyceride levels along with an increase in HDL-cholesterol levels.
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Affiliation(s)
- Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa School of Medicine, 532719Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Esra Zerdali
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ozlem Altuntaş
- Department of Infectious Diseases and Clinical Microbiology, Bakirkoy Dr.Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Alper Gunduz
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sibel Bolukcu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, 221265Bezmialem Vakıf University, Istanbul, Turkey
| | - Bilgul Mete
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa School of Medicine, 532719Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Inci Y Nakir
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hayat Kumbasar Karaosmanoglu
- Department of Infectious Diseases and Clinical Microbiology, Bakirkoy Dr.Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Dilek S Yildiz
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Meliha Meric Koc
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, 221265Bezmialem Vakıf University, Istanbul, Turkey
| | - İlyas Dokmetas
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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13
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Sutton SS, Magagnoli J, H Cummings T, Hardin JW. Adherence after treatment switch from a multiple tablet antiretroviral regimen to a single tablet antiretroviral regimen. Therapie 2021; 76:567-576. [PMID: 33589316 DOI: 10.1016/j.therap.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/01/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate adherence after treatment switch from a multiple-tablet regimen (MTR) to a single-tablet regimen (STR) in a national cohort of human immunodeficiency virus (HIV) patients. METHODS This retrospective observational cohort, with data spanning January 1, 2000 to March 1, 2019, consisted of HIV infected patients receiving treatment from the Veterans Affairs (VA) health system. Patients were required to have a complete MTR regimen after January 1, 2006 and before December 31, 2018 with at least 60 days of treatment. Medical and pharmacy data were analyzed from the Veterans Affairs Informatics and Computing Infrastructure (VINCI) database. Statistical analyses examined differences in adherence when patients switched to a STR. Patients who switched to a STR were propensity score matched to those who never switched. Descriptive statistics and multivariable linear mixed effects models were utilized to evaluate differences in adherence between MTR and STR treatment in both the matched and unmatched samples. RESULTS A total of 5021 patients met the study criteria, 3906 patients in the MTR only cohort and 1115 patients in the switch to STR cohort. The unmatched cohorts were similar in terms of sex, index year, drug/alcohol abuse, and viral load but differed in terms of race, Charlson comorbidity and mental health conditions. The one to one propensity score matched cohort included 2230 patients, 1115 patients in each cohort. Among patients that switched from a MTR to STR, adherence increased on average from 65.9% to 78.12%. We find overall adherence is higher with STRs than with MTR HIV regimens in both the matched and unmatched sample and adherence declines with time for both STR and MTR regimens. CONCLUSIONS Switching to a STR is associated with higher adherence compared to MTR among patients with HIV treated with antiretrovirals. However, adherence declines over time with both STR and MTR regimens.
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Affiliation(s)
- Scott S Sutton
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, College of Pharmacy, 715 Sumter Street, Columbia, SC 29208, USA
| | - Joseph Magagnoli
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, College of Pharmacy, 715 Sumter Street, Columbia, SC 29208, USA.
| | - Tammy H Cummings
- Dorn Research Institute, Columbia VA Health Care System , 29209, Columbia, SC, USA
| | - James W Hardin
- Department of Epidemiology & Biostatistics, University of South Carolina, 29208, Columbia, SC, USA
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14
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Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide in the Treatment of HIV-Infected Patients: Experience with the First 100 Patients from Qatar. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2020; 2020:1597839. [PMID: 32849932 PMCID: PMC7441451 DOI: 10.1155/2020/1597839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/21/2020] [Indexed: 01/04/2023]
Abstract
Background To describe our experience with the use of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (EVG/COBI/FTC/TAF) in the treatment of HIV-infected patients in Qatar including both naïve and treatment experienced. We also report the reasons for switching to EVG/COBI/FTC/TAF in treatment-experienced patients, response to treatment, and tolerability. Method Review of the medical records of the first 100 HIV-infected patients treated with EVG/COBI/FTC/TAF. Results Among the 100 HIV-infected patients who were treated with EVG/COBI/FTC/TAF, 64 were Qatari and the rest were from other nationalities. 80 patients were males and 20 were females. 29 were treatment naïve, and 71 were treatment experienced. Among treatment-experienced patients, the most common reasons for switch to EVG/COBI/FTC/TAF were safety concerns, followed by regimen simplification and adverse drug reaction of the previous regimen (40%, 14%, and 13%, respectively). Treatment response to EVG/COBI/FTC/TAF leading to undetectable viral load in naïve patients was 69%, and in treatment-experienced patients, it was 83% with an overall response among all patients of 79%. Excluding those who left the country and whose data were not available, the response rate will be 86%. Tolerability was excellent with mild side effects and no discontinuation due to side effects. Conclusion Experience with the use of EVG/COBI/FTC/TAF in 100 patients with HIV infection in Qatar was favourable both in treatment naïve patients and in those who were treatment experienced with an excellent tolerability.
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15
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Fusco J, Henegar C, Quinlivan EB, Vannappagari V, Aboud M, Smith K, Fusco G. Integrase Inhibitor-Based Antiretroviral Therapy Among Women Living with HIV: Data from the OPERA Cohort. Curr HIV Res 2020; 17:266-276. [PMID: 31560291 DOI: 10.2174/1570162x17666190927161537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Women face unique complexities in HIV treatment yet are underrepresented in antiretroviral therapy (ART) studies. OBJECTIVE This analysis assessed the one-year durability of the first integrase strand transfer inhibitor (INSTI)-based regimens prescribed to women in a large cohort of patients living with HIV in care. METHODS Women with HIV who initiated their first INSTI-containing regimen between 08/12/2013 and 11/30/2015 were identified in the OPERA cohort, a collaboration of 79 US outpatient clinics. Discontinuation within the first year of treatment with an INSTI was compared between dolutegravir (DTG), raltegravir (RAL) and elvitegravir (EVG), using multivariable Cox regression and Kaplan- Meier estimates. Virologic response and regimen modifications were described and compared across INSTIs. RESULTS A total of 537 treatment-naïve (DTG: 39%, EVG: 48%, RAL: 13%) and 878 treatmentexperienced (DTG: 57%, EVG: 29%, RAL: 13%) women were analyzed. In the first twelve months after initiation, women taking EVG or RAL were more likely to discontinue their initial INSTI than those taking DTG among both treatment-naïve (adjusted hazard ratio EVG vs. DTG: 1.59 (95% CI: 1.09, 2.39); RAL vs. DTG: 2.46 (1.49, 4.05)) and treatment-experienced women (EVG vs. DTG: 1.39 (1.02, 1.88); RAL vs. DTG: 2.17 (1.51, 3.12)). Following discontinuation of the initial INSTI, women commonly switched to a regimen containing a different drug from the INSTI class (treatment-naïve DTG: 34%, RAL: 33% EVG: 41%; treatment-experienced DTG: 23%, RAL: 19% EVG: 41%). CONCLUSION In treatment-naïve and treatment-experienced women living with HIV, women taking DTG had the lowest risk for early (≤1 year) discontinuation.
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Affiliation(s)
| | | | | | | | | | - Kimberly Smith
- ViiV Healthcare, Research Triangle Park, NC, United States
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16
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Benoit AC, Burchell AN, O'Brien KK, Raboud J, Gardner S, Light L, Beaver K, Cotnam J, Conway T, Price C, Rourke SB, Rueda S, Hart TA, Loutfy M. Examining the association between stress and antiretroviral therapy adherence among women living with HIV in Toronto, Ontario. HIV Res Clin Pract 2020; 21:45-55. [PMID: 32419657 DOI: 10.1080/25787489.2020.1763711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND We aimed to identify the association between stress and antiretroviral therapy (ART) adherence among women in HIV care in Toronto, Ontario participating in the Ontario HIV Treatment Network Cohort Study (OCS) between 2007 and 2012. MATERIALS AND METHODS We conducted cross-sectional analyses with women on ART completing the AIDS Clinical Trial Group (ACTG) Adherence Questionnaire. Data closest to, or at the last completed interview, were collected from medical charts, through record linkage with Public Health Ontario Laboratories, and from a standardized self-reported questionnaire comprised of socio-demographic and psycho-socio-behavioral measures (Center for Epidemiologic Studies Depression Scale (CES-D), Alcohol Use Disorders Identification Test (AUDIT)), and stress measures (National Population Health Survey). Logistic regression was used to quantify associations with optimal adherence (≥95% adherence defined as missing ≤ one dose of ART in the past 4 weeks). RESULTS Among 307 women, 65.5% had optimal adherence. Women with suboptimal compared to optimal adherence had higher median total stress scores (6.0 [interquartile range (IQR): 3.0-8.1] vs. 4.1 [IQR: 2.0-7.1], p = 0.001), CES-D scores (16 [IQR: 6-28] vs. 12 [IQR: 3-22], p = 0.008) and reports of hazardous and harmful alcohol use (31.1% vs. 17.9%, p = 0.008). In our multivariable model, we found an increased likelihood of optimal adherence with the absence of hazardous and harmful alcohol use (Adjusted Odds Ratio (AOR)=2.20, 95% confidence interval (CI): 1.12-4.32) and a decreased likelihood of optimal adherence with more self-reported stress (AOR = 0.56, 95% CI: 0.33-0.94). CONCLUSIONS Interventions supporting optimal ART adherence should address stress and include strategies to reduce or eliminate hazardous and harmful alcohol use for women living with HIV.
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Affiliation(s)
- Anita C Benoit
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Sandra Gardner
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Baycrest Health Sciences, Kunin-Lunenfeld Centre for Applied Research and Evaluation (KL-CARE), Toronto, ON, Canada
| | - Lucia Light
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | - Kerrigan Beaver
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Jasmine Cotnam
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Tracey Conway
- Project Community Advisory Committee, Ontario HIV Treatment Network Cohort Study, Ontario, Canada
| | - Colleen Price
- Project Community Advisory Committee, Ontario HIV Treatment Network Cohort Study, Ontario, Canada
| | - Sean B Rourke
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sergio Rueda
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
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17
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Does the Polypill Improve Patient Adherence Compared to Its Individual Formulations? A Systematic Review. Pharmaceutics 2020; 12:pharmaceutics12020190. [PMID: 32098393 PMCID: PMC7076630 DOI: 10.3390/pharmaceutics12020190] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/17/2022] Open
Abstract
Many patients, especially those with a high pill burden and multiple chronic illnesses, are less adherent to medication. In medication treatments utilizing polypills, this problem might be diminished since multiple drugs are fused into one formulation and, therefore, the therapy regimen is simplified. This systematic review summarized evidence to assess the effect of polypills on medication adherence. The following databases were searched for articles published between 1 January 2000, and 14 May 2019: PubMed, Web of Science, Cochrane Library, and Scopus. Medication adherence was the only outcome assessed, regardless of the method of measuring it. Sixty-seven original peer-reviewed articles were selected. Adherence to polypill regimens was significantly higher in 56 articles (84%) compared to multiple pill regimens. This finding was also supported by the results of 13 out of 17 selected previously published systematic reviews and meta-analyses dealing with this topic. Adherence can be improved through the formulation of polypills, which is probably why the interest in researching them is growing. There are many polypills on the market, but the adherence studies so far focused mainly on a small range of medical conditions.
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18
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Step MM, McMillen Smith J, Kratz J, Briggs J, Avery A. "Positive Peers": Function and Content Development of a Mobile App for Engaging and Retaining Young Adults in HIV Care. JMIR Form Res 2020; 4:e13495. [PMID: 32012035 PMCID: PMC7055772 DOI: 10.2196/13495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 07/23/2019] [Accepted: 09/26/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although treatment for HIV infection is widely available and well tolerated, less than 30% of adolescents and young adults living with HIV infection achieve stable viral suppression. Mobile technology affords increased opportunities for young people living with HIV to engage with information, health management tools, and social connections that can support adherence to treatment recommendations and medication. Although mobile apps are increasingly prevalent, few are informed by the target population. OBJECTIVE The objective of this study was to describe the "Positive Peers" app, a mobile app currently being evaluated in a public hospital in the Midwestern United States. Formative development, key development strategies, user recruitment, and lessons learned are discussed in this paper. METHODS "Positive Peers" was developed in collaboration with a community advisory board (CAB) comprising in-care young adults living with HIV and a multidisciplinary project team. Mobile app functions and features were developed over iterative collaborative sessions that were tailored to the CAB members. In turn, the CAB built rapport with the project team and revealed unique information that was used in app development. RESULTS The study was funded on September 1, 2015; approved by the MetroHealth Institutional Review Board on August 31, 2016; and implemented from October 11, 2016, to May 31, 2019. The "Positive Peers" mobile app study has enrolled 128 users who reflect priority disparity population subgroups. The app administrator had frequent contact with users across app administration and study-related activities. Key lessons learned from the study include changing privacy concerns, data tracking reliability, and user barriers. Intermediate and outcome variable evaluation is expected in October 2019. CONCLUSIONS Successful development of the "Positive Peers" mobile app was supported by multidisciplinary expertise, an enthusiastic CAB, and a multifaceted, proactive administrator.
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Affiliation(s)
- Mary M Step
- College of Public Health, Kent State University, Kent, OH, United States
| | | | | | | | - Ann Avery
- Metrohealth Medical Center, Cleveland, OH, United States.,Case Western Reserve University, School of Medicine, Cleveland, OH, United States
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19
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Shen Y, Liu T, Chen J, Li X, Liu L, Shen J, Wang J, Zhang R, Sun M, Wang Z, Song W, Qi T, Tang Y, Meng X, Zhang L, Ho D, Ho C, Ding X, Lu H. Harnessing Artificial Intelligence to Optimize Long‐Term Maintenance Dosing for Antiretroviral‐Naive Adults with HIV‐1 Infection. ADVANCED THERAPEUTICS 2019. [DOI: 10.1002/adtp.201900114] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Yinzhong Shen
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Tingyi Liu
- Department of Mechanical and Industrial EngineeringUniversity of Massachusetts Amherst MA 01003 USA
- Department of Mechanical and Industrial EngineeringInstitute for Applied Life Sciences (IALS)University of Massachusetts Amherst Amherst MA 01003 USA
| | - Jun Chen
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Xin Li
- Institute for Personalized MedicineState Key Laboratory of Oncogenes and Related GenesSchool of Biomedical EngineeringShanghai Jiao Tong University Shanghai 200030 China
| | - Li Liu
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Jiayin Shen
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Jiangrong Wang
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Renfang Zhang
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Meiyan Sun
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Zhenyan Wang
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Wei Song
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Tangkai Qi
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Yang Tang
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Xianmin Meng
- Department of PharmacyShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Lijun Zhang
- Department of Scientific ResearchShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
| | - Dean Ho
- The N.1 Institute for Health (N.1)National University of Singapore Singapore 117456
- Department of Biomedical Engineering, NUS EngineeringNational University of Singapore Singapore 117583
- Department of PharmacologyYong Loo Lin School of MedicineNational University of Singapore Singapore 117600
| | - Chih‐Ming Ho
- Mechanical and Aerospace Engineering DepartmentBioengineering DepartmentUniversity of California California LA 90095 USA
| | - Xianting Ding
- Institute for Personalized MedicineState Key Laboratory of Oncogenes and Related GenesSchool of Biomedical EngineeringShanghai Jiao Tong University Shanghai 200030 China
| | - Hong‐Zhou Lu
- Department of Infection and ImmunityShanghai Public Health Clinical CenterFudan University Shanghai 201508 China
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20
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Subramaniam S, Getty CA, Holtyn AF, Rodewald A, Katz B, Jarvis BP, Leoutsakos JMS, Fingerhood M, Silverman K. Evaluation of a Computer-Based HIV Education Program for Adults Living with HIV. AIDS Behav 2019; 23:3152-3164. [PMID: 30929150 PMCID: PMC6768760 DOI: 10.1007/s10461-019-02474-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study evaluated a computer-delivered HIV and antiretroviral treatment education program in adults (N = 102) living with detectable HIV viral loads (> 200 copies/mL). The self-paced program provided immediate feedback for responses and financial incentives for responding correctly. The program was divided into three courses and a test of content from all three courses was delivered before and after participants completed each course. Test scores on the content delivered in Courses 1, 2 and 3 improved only after participants completed training on the relevant course. Initial test scores were positively correlated with health literacy and academic achievement; were negatively correlated with viral load; and were lowest for participants living in poverty. Education, academic achievement, and health literacy were related to how much participants learned following each course. Computer-based education is a convenient, effective approach to promoting an understanding of HIV and its treatment.
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Affiliation(s)
- Shrinidhi Subramaniam
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
- California State University, Stanislaus, Turlock, CA, USA
| | - Carol-Ann Getty
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
- Psychology Department, Ulster University, Coleraine, Northern Ireland, UK
- King's College London, London, UK
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Andrew Rodewald
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Brian Katz
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
- West Virginia University, Morgantown, WV, USA
| | - Brantley P Jarvis
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
- Knowesis, LLC, Fairfax, VA, USA
| | - Jeannie-Marie S Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Michael Fingerhood
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA.
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21
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A Longitudinal Analysis of Daily Pill Burden and Likelihood of Optimal Adherence to Antiretroviral Therapy Among People Living With HIV Who Use Drugs. J Addict Med 2019. [PMID: 29521670 DOI: 10.1097/adm.0000000000000403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Among people living with HIV (PLWH), high levels of adherence to prescribed antiretroviral therapy (ART) is required to achieve optimal treatment outcomes. However, little is known about the effects of daily pill burden on adherence amongst PLWH who use drugs. We sought to investigate the association between daily pill burden and adherence to ART among members of this key population in Vancouver, Canada. METHODS We used data from the AIDS Care Cohort to Evaluate Exposure to Survival Services study, a long-running community-recruited cohort of PLWH who use illicit drugs linked to comprehensive HIV clinical records. The longitudinal relationship between daily pill burden and the odds of ≥95% adherence to ART among ART-exposed individuals was analyzed using multivariable generalized linear mixed-effects modeling, adjusting for sociodemographic, behavioural, and structural factors linked to adherence. RESULTS Between December 2005 and May 2014, the study enrolled 770 ART-exposed participants, including 257 (34%) women, with a median age of 43 years. At baseline, 437 (56.7%) participants achieved ≥95% adherence in the previous 180 days. Among all interview periods, the median adherence was 100% (interquartile range 71%-100%). In a multivariable model, a greater number of pills per day was negatively associated with ≥95% adherence (adjusted odds ratio [AOR] 0.87 per pill, 95% confidence interval [CI] 0.84-0.91). Further analysis showed that once-a-day ART regimens were positively associated with optimal adherence (AOR 1.39, 95% CI 1.07-1.80). CONCLUSIONS In conclusion, simpler dosing demands (ie, fewer pills and once-a-day single tablet regimens) promoted optimal adherence among PLWH who use drugs. Our findings highlight the need for simpler dosing to be encouraged explicitly for PWUD with multiple adherence barriers.
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Camargo CC, Cavassan NRV, Tasca KI, Meneguin S, Miot HA, Souza LR. Depression and Coping Are Associated with Failure of Adherence to Antiretroviral Therapy Among People Living with HIV/AIDS. AIDS Res Hum Retroviruses 2019; 35:1181-1188. [PMID: 31592722 DOI: 10.1089/aid.2019.0050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Sustained adherence to antiretroviral therapy (ART) is critical in the prevention of drug resistance, disease progression, and death. We aimed to assess the level of ART adherence among 112 people living with HIV/AIDS (PLWHA) and to determine associated factors with that. The socioeconomic aspects were evaluated by medical records; the adherence, depression, and coping by specific questionnaires. Although most patients have undetectable viral load (79%) and CD4+ T count >500 cells/mm3 (65%), two-third (66%) of them exhibited a lower adherence, which was directly associated with some signs of depression (p = .006) presented by 65% of them. Some risk factors to presence of depression were female gender (p = .008) and low income (p = .013). In addition, most participants who reported tobacco (33%) and alcohol (29%) consumption had a low or intermediate adherence score. Among the coping strategies, self-control (p = .029), social support (p = .006), problem solving (p = .013), and positive reappraisal (p = .049) led to an improvement in adherence.
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Affiliation(s)
- Caio C. Camargo
- Department of Tropical Diseases, Botucatu Medical School (FMB), Univ Estadual Paulista (UNESP), Botucatu, Brazil
| | - Nayara R. V. Cavassan
- Department of Tropical Diseases, Botucatu Medical School (FMB), Univ Estadual Paulista (UNESP), Botucatu, Brazil
| | - Karen I. Tasca
- Department of Tropical Diseases, Botucatu Medical School (FMB), Univ Estadual Paulista (UNESP), Botucatu, Brazil
| | - Silmara Meneguin
- Department of Nursing, Botucatu Medical School (FMB), Univ Estadual Paulista (UNESP), Botucatu, Brazil
| | - Hélio A. Miot
- Department of Dermatology, Botucatu Medical School (FMB), Univ Estadual Paulista (UNESP), Botucatu, Brazil
| | - Lenice R. Souza
- Department of Tropical Diseases, Botucatu Medical School (FMB), Univ Estadual Paulista (UNESP), Botucatu, Brazil
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Carvalho PP, Barroso SM, Coelho HC, Penaforte FRDO. Factors associated with antiretroviral therapy adherence in adults: an integrative review of literature. CIENCIA & SAUDE COLETIVA 2019; 24:2543-2555. [PMID: 31340272 DOI: 10.1590/1413-81232018247.22312017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/19/2017] [Indexed: 12/29/2022] Open
Abstract
AIDS is an advanced clinical manifestation of HIV infection. It generates severe immunodeficiency and associated infections that may lead to death. The antiretroviral therapy (ART) has reduced the morbimortality of HIV/AIDS, but its benefits depend on ART adherence. This integrative review followed the PICO method to identify factors associated with adult adherence to ART. Empirical papers published between January 2010 and December 2016 in the Medline, SciELO, Lilacs and PePSIC databases were included. We analyzed 125 papers regarding the characteristics of studies, adherence measures and associated factors. Results showed a wide variety in the definition of adherence and the use of measures for its monitoring, as well as several adherence-associated factors. These were categorized as follows: 1- Individual variables; 2- Treatment characteristics; 3- HIV/aids infection characteristics; 4- Relationship with the health services; 5- Social support. Health services should characterize the users' profiles, systematize adherence measures and regionally assess adherence-associated factors for the early detection of non-adherence to ART and implementation of effective intervention plans.
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Affiliation(s)
- Patrícia Paiva Carvalho
- Hospital de Clínicas, Universidade Federal do Triângulo Mineiro (UFTM). Av. Getúlio Guaritá 130, Nossa Sra. da Abadia. 38025-440 Uberaba MG Brasil.
| | | | - Heloisa Correa Coelho
- Hospital de Clínicas, Universidade Federal do Triângulo Mineiro (UFTM). Av. Getúlio Guaritá 130, Nossa Sra. da Abadia. 38025-440 Uberaba MG Brasil.
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Dworkin MS, Panchal P, Wiebel W, Garofalo R, Haberer JE, Jimenez A. A triaged real-time alert intervention to improve antiretroviral therapy adherence among young African American men who have sex with men living with HIV: focus group findings. BMC Public Health 2019; 19:394. [PMID: 30971243 PMCID: PMC6458676 DOI: 10.1186/s12889-019-6689-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/21/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Among persons living with HIV, poorer antiretroviral therapy adherence has been reported in African Americans and disproportionate mortality reported in young African American men who have sex with men (AAMSM) compared to whites. We report the results of focus groups with young AAMSM living with HIV that explore their opinions about the acceptability and feasibility of a triaged real-time missed dose alert intervention to improve treatment adherence. The purpose of this study is to develop a theory-driven triaged real-time adherence monitoring intervention to promote HIV medication adherence in young AAMSM. METHODS We performed five focus groups and two individual interviews among young HIV-positive AAMSM (n = 25) in Chicago guided by the Technology Acceptance Model and explored perceptions regarding the monitoring concept including device issues and concerns about inclusion of support persons whose involvement is triggered by sustained missed doses. The purpose was to inform the development of this intervention in this population. RESULTS Generally, the participants found the proposed intervention acceptable and useful. Privacy was a major concern for participants especially with attention to possible disclosure of their HIV status by receiving a medication-related text that someone else might view and could lead to unwanted attention. There was concern that the device could be confused with a taser. Approximately half of the men already had a close personal contact that helped them with medication taking. Some participants acknowledged that the notification might lead to friction. CONCLUSIONS A triaged real-time alert intervention to improve treatment adherence is acceptable and feasible among young AAMSM living with HIV.
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Affiliation(s)
- Mark S. Dworkin
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, 1603 W. Taylor Street, MC 923, Chicago, IL 60612 USA
| | - Palak Panchal
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, 1603 W. Taylor Street, MC 923, Chicago, IL 60612 USA
| | - Wayne Wiebel
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, 1603 W. Taylor Street, MC 923, Chicago, IL 60612 USA
| | - Robert Garofalo
- Department of Pediatrics, Northwestern University/Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Jessica E. Haberer
- Massachusetts General Hospital Center for Global Health, Boston, MA 02114 USA
| | - Antonio Jimenez
- University of Illinois at Chicago School of Public Health, Community Outreach Intervention Projects, 1603 W. Taylor Street, Chicago, IL 60612 USA
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Altice F, Evuarherhe O, Shina S, Carter G, Beaubrun AC. Adherence to HIV treatment regimens: systematic literature review and meta-analysis. Patient Prefer Adherence 2019; 13:475-490. [PMID: 31040651 PMCID: PMC6452814 DOI: 10.2147/ppa.s192735] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
- Frederick Altice
- Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | - Obaro Evuarherhe
- Value Demonstration Practice, Oxford PharmaGenesis Ltd, Oxford, UK,
| | - Sophie Shina
- Value Demonstration Practice, Oxford PharmaGenesis Ltd, Oxford, UK,
| | - Gemma Carter
- Value Demonstration Practice, Oxford PharmaGenesis Ltd, Oxford, UK,
| | - Anne Christine Beaubrun
- Health Economics and Outcomes Research, Medical Affairs, Gilead Sciences, Foster City, CA, USA
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Navarro J, Santos JR, Silva A, Burgos J, Falcó V, Ribera E, Imaz A, Curran A. Effectiveness of Once/Day Dolutegravir Plus Boosted Darunavir as a Switch Strategy in Heavily Treated Patients with Human Immunodeficiency Virus. Pharmacotherapy 2019; 39:501-507. [PMID: 30723941 DOI: 10.1002/phar.2227] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
STUDY OBJECTIVE Dual therapy with once/day dolutegravir (DTG) plus boosted darunavir (DRV/b) may be a suitable and effective strategy with a high genetic barrier to resistance in patients infected with human immunodeficiency virus (HIV). Our aim was to evaluate the effectiveness of DTG plus DRV/b (DTG+DRV/b) as a switch strategy in HIV-infected patients, irrespective of their history of virologic failure (VF). DESIGN Multicenter retrospective cohort study. SETTING Human immunodeficiency outpatient treatment clinics at three university hospitals in Spain. PATIENTS Fifty HIV-infected adults who had a stable antiretroviral treatment (ART) regimen and an undetectable viral load for at least 6 months, and whose ART was switched to once/day DTG+DRV/b between January 2015 and January 2018 were included in the analysis. Historical genotype at the time of VF was available in 44 patients. MEASUREMENTS AND MAIN RESULTS Patients were followed until VF or treatment discontinuation for any reason. The primary outcome was the percentage of patients with a viral load of 50 copies/mL or lower at the last follow-up visit. Secondary outcomes included changes in CD4+ cell count, lipid profile, and renal function. Of the 50 patients included, median time of viral suppression was 52 months (interquartile range [IQR] 18-103 mo) and nadir CD4+ 89 cells/mm3 (IQR 37-241 cells/mm3 ). Patients had a history of a median of 8 ART combinations (IQR 4-11 combinations) and 3 VFs (IQR 2-8 VFs). The historical genotypes from 44 patients showed 41 patients (93.2%) with nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) resistance-associated mutations (RAMs), 32 (72.7%) with nonnucleoside reverse transcriptase inhibitor (NNRTI) RAMs, and 12 (27.3%) with primary protease inhibitor (PI) RAMs; 7 (15.9%) had darunavir RAMs, and no patients had baseline integrase strand transfer inhibitor RAMs. Thirty-seven patients (84.1%) had resistance to at least two antiretroviral classes. After a median of 25 months (IQR 17-28 mo) of follow-up, 49 patients (98%) maintained a viral load of 50 copies/mL or lower, and 1 patient (2%) had VF. No new RAMs emerged at VF. At week 4, serum creatinine concentration increased a median of 0.12 mg/dl (0.03-0.23 mg/dl). At last visit, total cholesterol and low-density lipoprotein cholesterol levels increased by a median of 9 mg/dl (IQR -18 to 40 mg/dl) and 16 mg/dl (IQR -9 to 40 mg/dl), respectively, whereas CD4+ cell count remained stable (median +13 cell/mm3 ). CONCLUSION In this cohort of heavily treated HIV-infected patients with virologic suppression, switching to the combination of DTG+DRV/b was a convenient regimen that was highly effective and had good tolerability.
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Affiliation(s)
- Jordi Navarro
- Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute, Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - José Ramón Santos
- Fundació Lluita contra la Sida, University Hospital Germans Trias i Pujol, Badalona, Spain.,Infectious Diseases Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Ana Silva
- HIV and STI Unit, Infectious Diseases Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregrat, Spain
| | - Joaquin Burgos
- Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute, Barcelona, Spain
| | - Vicenç Falcó
- Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute, Barcelona, Spain
| | - Esteban Ribera
- Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute, Barcelona, Spain
| | - Arkaitz Imaz
- HIV and STI Unit, Infectious Diseases Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregrat, Spain
| | - Adrian Curran
- Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute, Barcelona, Spain
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Hines DM, Ding Y, Wade RL, Beaubrun A, Cohen JP. Treatment Adherence And Persistence Among HIV-1 Patients Newly Starting Treatment. Patient Prefer Adherence 2019; 13:1927-1939. [PMID: 31806941 PMCID: PMC6844203 DOI: 10.2147/ppa.s207908] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 08/01/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To assess adherence and persistence with first-line single-tablet regimen (STR) and multi-tablet regimen (MTR) antiretroviral therapy (ART) in newly treated HIV-1 patients. METHODS Retrospective analysis of longitudinal pharmacy claims among US patients initiating ART between 1/1/2016 and 5/31/2016 (index date was defined by first ART claim for STRs, and fill date for the last therapy in the regimen for MTRs). Adherence was assessed over a 12-month period and reported as the proportion of adherent or non-adherent (defined as ≤5-day and > a 5-day gap between successive fills, respectively) patients. Sensitivity analysis using ≤7-day and ≤14-day gap thresholds to define adherence was performed. Persistence was assessed as the number of days on therapy from index until treatment discontinuation (>90 day gap in therapy). Kaplan-Meier curves and Cox Proportional Hazard models were generated to evaluate discontinuation rates. Assessments were performed on STRs vs MTRs overall and by regimen. RESULTS Patients initiating ART (STR: n=10,623; MTR: n=2504) had a mean age of 42.8 years; 76.0% were male. STR patients were >2 times more likely to be adherent over 12 months than MTR patients (24.9% vs 11.7%, respectively). Patients using EVG/COBI/FTC/TAF had greater adherence than those using other STRs. Among MTRs, patients were more adherent with FTC/TDF+DTG (15.1%) than other MTRs. Persistence was also greater with STRs, with MTR patients being 61% more likely to discontinue therapy. Persistence was best for FTC/TAF-based regimens. Predictors of treatment discontinuation included younger age, female gender, and Medicare or Medicaid insurance type. CONCLUSION Patients receiving STRs were significantly less likely to discontinue therapy and were more adherent with their regimens, providing further evidence of greater adherence and persistence with STRs versus MTRs. However, there was a large proportion of patients who interrupted or discontinued treatment. Further research examining treatment patterns beyond first line is warranted.
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Affiliation(s)
- Dionne M Hines
- Health Economics and Outcomes Research, IQVIA Inc, Plymouth Meeting, PA, USA
| | - Yao Ding
- Health Economics and Outcomes Research, IQVIA Inc, Plymouth Meeting, PA, USA
| | - Rolin L Wade
- Health Economics and Outcomes Research, IQVIA Inc, Plymouth Meeting, PA, USA
- Correspondence: Rolin L Wade IQVIA Inc., One IMS Drive, Plymouth Meeting, PA19462, USATel +1 215 434 812 2958 Email
| | - Anne Beaubrun
- Health Economics and Outcomes Research, Gilead Sciences Inc, Foster City, CA, USA
| | - Joshua P Cohen
- Institute for Clinical Research and Health Policy Studies, Tufts University, Boston, MA, USA
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Griffith DC, Farmer C, Gebo KA, Berry SA, Aberg J, Moore RD, Gaur AH, Mathews WC, Beil R, Korthuis PT, Nijhawan AE, Rutstein RM, Agwu AL. Uptake and virological outcomes of single- versus multi-tablet antiretroviral regimens among treatment-naïve youth in the HIV Research Network. HIV Med 2018; 20:169-174. [PMID: 30561888 DOI: 10.1111/hiv.12695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Several single-tablet regimens (STRs) are now available and are recommended for first-line antiretroviral therapy (ART); however, STR use for youth with HIV (YHIV) has not been systematically studied. We examined the characteristics associated with initiation of STRs versus multi-tablet regimens (MTRs) and the virological outcomes for youth with nonperinatally acquired HIV (nPHIV). METHODS A retrospective cohort study of nPHIV youth aged 13-24 years initiating ART between 2006 and 2014 at 18 US HIV clinical sites in the HIV Research Network was performed. The outcomes measured were initiation of STRs versus MTRs, virological suppression (VS) at 12 months, and time to VS. Demographic and clinical factors associated with initiation of STR versus MTR ART and VS (< 400 HIV-1 RNA copies/mL) at 12 months after initiation were assessed using multivariable logistic regression. Cox proportional hazards regression was used to assess VS within the first year. RESULTS Of 987 youth, 67% initiated STRs. Of the 589 who had viral load data at 1 year, 84% of those on STRs versus 67% of those on MTRs achieved VS (P < 0.01). VS was associated with STR use [adjusted odds ratio (AOR) 1.61; 95% confidence interval (CI) 1.01-2.58], white (AOR 2.41; 95% CI 1.13-5.13) or Hispanic (AOR 2.38; 95% CI 1.32-4.27) race/ethnicity, and baseline CD4 count 351-500 cells/μL (AOR 1.94; 95% CI 1.18-3.19) and > 500 cells/μL (AOR 1.76; 95% CI 1.0-3.10). STR use was not associated with a shorter time to VS compared with MTR use [hazard ratio (HR) 1.07; 95% CI 0.90-1.28]. CONCLUSIONS Use of STR was associated with a greater likelihood of sustained VS 12 months after ART initiation in YHIV.
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Affiliation(s)
- D C Griffith
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Farmer
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K A Gebo
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S A Berry
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Aberg
- Mount Sinai School of Medicine, New York, NY, USA
| | - R D Moore
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A H Gaur
- St. Jude's Children's Research Hospital, Memphis, TN, USA
| | - W C Mathews
- University of California at San Diego, San Diego, CA, USA
| | - R Beil
- Montefiore Medical Group, New York, NY, USA
| | - P T Korthuis
- Oregon Health & Sciences University, Portland, OR, USA
| | - A E Nijhawan
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - R M Rutstein
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - A L Agwu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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29
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Kapadia SN, Grant RR, German SB, Singh B, Davidow AL, Swaminathan S, Hodder S. HIV virologic response better with single-tablet once daily regimens compared to multiple-tablet daily regimens. SAGE Open Med 2018; 6:2050312118816919. [PMID: 30574301 PMCID: PMC6295695 DOI: 10.1177/2050312118816919] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/12/2018] [Indexed: 11/16/2022] Open
Abstract
Background Single-tablet regimens are preferred prescription choices for HIV treatment, but there are limited outcomes data comparing single-tablet regimens to multiple-tablet regimens. Methods We retrospectively assessed treatment-naïve patients at a single urban HIV clinic in the United States for viral load suppression at 6 and 12 months after initiating either single-tablet or multiple-tablet regimens. Multivariate regression was performed to obtain relative risks and adjust for potential confounders. Results Of 218 patients, 47% were on single-tablet regimens and 53% on multiple-tablet regimens; 77% of single-tablet regimen patients had undetectable viral load at 6 months compared to 61% of multiple-tablet regimen patients (p = 0.012). At 12 months, 82% on single-tablet regimens and 66% on multiple-tablet regimens (p = 0.019) had undetectable viral load. Relative risk of any detectable viral load was 1.6 (95% confidence interval: 1.1-2.5) for patients on multiple-tablet regimens compared to single-tablet regimens at 6 months, and 2.2 (95% confidence interval: 1.2-4.0) at 12 months. Conclusion Single-tablet regimens may provide better virologic control than multiple-tablet regimens in urban HIV-infected persons.
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Affiliation(s)
- Shashi N Kapadia
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | | | - Susan B German
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Amy L Davidow
- Department of Biostatistics, Rutgers School of Public Health, Newark, NJ, USA
| | - Shobha Swaminathan
- Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Sally Hodder
- West Virginia Clinical and Translational Science Institute, West Virginia University, Morgantown, WV, USA
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30
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Clay PG, Yuet WC, Moecklinghoff CH, Duchesne I, Tronczyński KL, Shah S, Shao D. A meta-analysis comparing 48-week treatment outcomes of single and multi-tablet antiretroviral regimens for the treatment of people living with HIV. AIDS Res Ther 2018; 15:17. [PMID: 30373620 PMCID: PMC6206661 DOI: 10.1186/s12981-018-0204-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/10/2018] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To compare outcomes with single tablet regimens (STR) versus multi-tablet regimens (MTR) for human immunodeficiency virus (HIV) treatment using published data. DESIGN Systematic review and random-effects meta-analysis of literature on approved and investigational HIV regimens. METHODS The research followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Single or un-blinded studies reporting a direct comparison between STR and MTR were eligible for the meta-analysis. Double-blinded studies were excluded due to lack of difference in pill burden between cohorts. The key outcomes of interest included: adherence rates/proportion meeting target, efficacy, safety/tolerability, non-clinical and economic outcomes. RESULTS After screening 63 full-text articles and posters, 14 studies were eligible for the meta-analysis. The analysis showed that patients taking STR had improved outcomes over those taking MTR. Patients were significantly more adherent regardless of daily dosing frequency (odds ratio [OR]: 1.96, p < 0.001) and were more likely to achieve virological suppression (relative risk [RR]: 1.05, p = 0.002). There was a trend toward a lower discontinuation risk in the STR cohort, together with reported higher therapy satisfaction, better symptom control, improved health status, reduced healthcare resource utilization and demonstrated cost-effectiveness compared to MTR. There were no differences in CD4 cell count increase (at 48 weeks) or safety outcomes. CONCLUSIONS The findings of this study confirm previously reported preliminary findings of the advantages of STR over MTR for HIV treatment in adherence, therapy continuation, viral suppression, tolerability, quality of life improvement, cost-effectiveness and healthcare resource utilization.
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Affiliation(s)
- Patrick G. Clay
- University of North Texas System College of Pharmacy, 3500 Camp Bowie Blvd, Fort Worth, TX 76107 USA
| | - Wei C. Yuet
- University of North Texas System College of Pharmacy, 3500 Camp Bowie Blvd, Fort Worth, TX 76107 USA
| | | | - Inge Duchesne
- Janssen EMEA, Turnhoutseweg 30, 2340 Beerse, Belgium
| | | | - Sandip Shah
- Market Access Solutions, LLC, 575 NJ-28, Raritan, NJ 08869 USA
| | - Dong Shao
- Market Access Solutions, LLC, 575 NJ-28, Raritan, NJ 08869 USA
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31
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Tsai HC, Chen IT, Lee SSJ, Chen YS. HIV-1 genotypic drug resistance in patients with virological failure to single-tablet antiretroviral regimens in southern Taiwan. Infect Drug Resist 2018; 11:1061-1071. [PMID: 30122963 PMCID: PMC6082324 DOI: 10.2147/idr.s165811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Sparse data are available on the prevalence of resistance among HIV-1-infected patients with virological failure to a single-tablet regimen (STR). This study aimed to evaluate the prevalence of HIV genotypic drug resistance in HIV-1-infected patients with virological failure to STRs in southern Taiwan. Patients and methods This retrospective study investigated drug resistance in patients with virological failure to STR from January 2016 to September 2017. Antiretroviral resistance mutations were defined using the 2017 International AIDS Society-USA HIV drug resistance algorithm, and drug resistance was compared using the HIVdb program of the Stanford University HIV Drug Resistance Database. Variables between resistance and non-resistance groups were compared. Results Thirty-nine HIV-1-infected patients with treatment failure were tested for resistance, of whom 89% were infected by men who have sex with men. Subtype B HIV-1 strains were found in 90% of the patients. Eight patients were treatment naïve and initiated STRs, while 31 patients experienced treatment failure after switching to STRs. Eighty-seven percent of the patients harbored any of four classes of resistance (nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors (PIs), and integrase strand transfer inhibitors). The prevalence rates of nucleoside reverse transcriptase inhibitor, non-nucleoside reverse transcriptase inhibitor, PI, and integrase strand transfer inhibitor resistance were 72%, 82%, 10%, and 3%, respectively. Patients with PI resistance were more likely to respond to treatment with a non-tenofovir disoproxil fumarate/emtricitabine/efavirenz-based STR (.=0.004) and a longer duration of antiretroviral therapy (101 months [72.0-123.3] vs 11 months [7-44], P=0.007). There were no associations between different STRs and transmission risk factors, HIV subtype, duration of antiretroviral therapy, and resistance to tenofovir disoproxil fumarate. Conclusion A high rate of antiretroviral drug resistance was found in the patients who failed STR treatment. The presence of PI resistance in these patients represented an inappropriate switch from a multiple tablet regimen to an STR. These findings should remind clinicians that detailed drug resistance history and close monitoring are mandatory after switching to an STR.
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Affiliation(s)
- Hung-Chin Tsai
- Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, , .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, , .,Department of Parasitology, Kaohsiung Medical University, Kaohsiung, Taiwan,
| | - I-Tzu Chen
- Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ,
| | - Susan Shin-Jung Lee
- Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, , .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ,
| | - Yao-Shen Chen
- Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, , .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ,
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Magagnoli J, Sutton SS, Hardin JW, Edun B. Longitudinal trends in base antiretroviral therapy utilization for human immunodeficiency virus from 2000 to 2016. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2018. [DOI: 10.1002/jac5.1016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Joseph Magagnoli
- WJB Dorn Veterans Affairs Medical Center Dorn Research Institute Columbia South Carolina
| | - S. Scott Sutton
- WJB Dorn Veterans Affairs Medical Center Dorn Research Institute Columbia South Carolina
- Department of Clinical Pharmacy and Outcomes Sciences South Carolina College of Pharmacy, University of South Carolina Columbia South Carolina
| | - James W. Hardin
- WJB Dorn Veterans Affairs Medical Center Dorn Research Institute Columbia South Carolina
- Department of Epidemiology & Biostatistics University of South Carolina Columbia South Carolina
| | - Babatunde Edun
- WJB Dorn Veterans Affairs Medical Center, Division of Infectious Diseases Columbia South Carolina
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Time factor in antiretroviral adherence: analysis of adherence to single-tablet regimens versus multiple-tablet regimens over a 5-year period. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0491-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Abstract
Antiretroviral therapy (ART) is a combination treatment involving three or more antiretroviral agents for patients with HIV. ART has reduced HIV-related morbidity and mortality via single-tablet or multiple-tablet regimens. Single-tablet regimens, with their lower pill burdens, have demonstrated higher adherence rates, improved viral suppression, and reduced resource use compared with multiple-tablet regimens. In addition, select newer ARTs do not require the high levels of adherence for viral load suppression required by older ART formulations.
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Caplan MR, Daar ES, Corado KC. Next generation fixed dose combination pharmacotherapies for treating HIV. Expert Opin Pharmacother 2018; 19:589-596. [PMID: 29557204 DOI: 10.1080/14656566.2018.1450866] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Treatment options for patients with HIV-1 infection have grown over the past two decades to include multiple fixed-dose combination pharmacotherapies that have greatly simplified administration of antiretroviral therapy (ART) for both patients and providers. Effective virologic control can often be achieved with once-daily use of a single-tablet regimen. Over the past three years, ART drug development has focused on the next generation of fixed-dose combinations for initial and maintenance therapy with improved efficacy, safety and tolerability. AREAS COVERED This review covers pre-clinical and clinical data searched through PubMed and presented at major conferences through November 2017. EXPERT OPINION Currently available single-tablet regimens have clinical limitations related to adverse event profiles, drug-drug and drug-food interactions and variable barriers to resistance. Anticipated advances in ART fixed-dose combinations promise combinations of current multiple tablet regimens into single tablets, as well as combinations with novel drugs with improved safety and tolerability. The traditional dogma of effective ART containing at least three active antiretroviral drugs is being challenged by promising data to support efficacy of certain regimens containing two drugs. Implementation of next generation ART will bring to light issues of clinical preference and cost-effectiveness as patents of existing drugs expire and more generic formulations become available.
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Affiliation(s)
- Margaret R Caplan
- a Division of HIV Medicine, Department of Internal Medicine , Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance , CA , USA
| | - Eric S Daar
- a Division of HIV Medicine, Department of Internal Medicine , Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance , CA , USA
| | - Katya C Corado
- a Division of HIV Medicine, Department of Internal Medicine , Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance , CA , USA
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36
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Zhang Y, Wilson TE, Adedimeji A, Merenstein D, Milam J, Cohen J, Cohen M, Golub ET. The Impact of Substance Use on Adherence to Antiretroviral Therapy Among HIV-Infected Women in the United States. AIDS Behav 2018; 22:896-908. [PMID: 28560499 PMCID: PMC5709246 DOI: 10.1007/s10461-017-1808-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Research is scant regarding differential effects of specific types of recreational drugs use on antiretroviral therapy adherence among women, particularly to single-tablet regimens (STR). This is increasingly important in the context of marijuana legalization. We examined the effects of self-reported substance use on suboptimal (<95%) adherence in the Women's Interagency HIV Study, 2003-2014. Among 1799 HIV-infected women, the most prevalent substance used was marijuana. In multivariable Poisson GEE regression, substance use overall was significantly associated with suboptimal adherence (adjusted prevalence ratio, aPR = 1.20, 95% CI 1.10-1.32), adjusting for STR use, socio-demographic, behavioral, and clinical factors. Among STR users, compared to no drug use, substance use overall remained detrimental to ART adherence (aPR = 1.61, 95% CI 1.24-2.09); specifically, both marijuana (aPR = 1.48, 95% CI: 1.11-1.97) and other drug use (aPR = 1.87, 95% CI 1.29-2.70) predicted suboptimal adherence. These findings highlight the need to intervene with drug-using women taking antiretroviral therapy to maintain effective adherence.
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Affiliation(s)
- Yuehan Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., E7636, Baltimore, MD, 21205, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, SUNY Downstate Medical Center, New York City, NY, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Joel Milam
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Jennifer Cohen
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA, USA
| | - Mardge Cohen
- Departments of Medicine, John Stroger (Formerly Cook County) Hospital and Rush University, Chicago, IL, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., E7636, Baltimore, MD, 21205, USA.
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Kim J, Lee E, Park BJ, Bang JH, Lee JY. Adherence to antiretroviral therapy and factors affecting low medication adherence among incident HIV-infected individuals during 2009-2016: A nationwide study. Sci Rep 2018; 8:3133. [PMID: 29453393 PMCID: PMC5816616 DOI: 10.1038/s41598-018-21081-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 01/30/2018] [Indexed: 11/17/2022] Open
Abstract
For ideal clinical benefit, human immunodeficiency virus (HIV)-infected individuals should receive continuous medication. This is the first nationwide antiretroviral therapy (ART) adherence study in Asia, where medication monitoring at national level is systemically available. We estimated the ART adherence of incident HIV-infected individuals and investigated factors affecting low medication adherence using the national health insurance (NHI) claims data from 2007 to 2016. Medication possession ratio (MPR) was used to measure medication adherence and risk factors were identified by multivariable logistic regression analysis. Of the 8,501 newly diagnosed HIV-infected individuals during 2009–2016 with at least one ART prescription, 70.4% of HIV patients had adequate adherence to ART defined as MPR ≥95%. Requiring prophylactic antibiotics, female gender, age of 0–19 and same or over 50 s compared to 30–39, and having a history of malignancy, lower socioeconomic status, not visiting tertiary hospital, and being diagnosed in the earlier years were risk factors for lower adherence (Odds ratio 1.7, 1.6, 1.6, 1.4, 1.6, 2.1, 1.2, and 1.6 to 3.8 respectively). Health authority should take into consideration of these modifiable and unmodifiable barriers to establish sustainable monitoring system at national level and to improve adherence.
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Affiliation(s)
- Jungmee Kim
- Medical Research Centre, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eunyoung Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Byung-Joo Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hwan Bang
- Division of Infectious Diseases, Seoul National University Boramae Medical Centre, Seoul, Republic of Korea.
| | - Jin Yong Lee
- Public Health Medical Service, Boramae Medical Centre, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Institute of Health Policy and Management, Medical Research Centre, Seoul National University, Seoul, Republic of Korea.
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38
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Krentz HB, Campbell S, Gill VC, Gill MJ. Patient perspectives on de-simplifying their single-tablet co-formulated antiretroviral therapy for societal cost savings. HIV Med 2018; 19:290-298. [PMID: 29368401 DOI: 10.1111/hiv.12578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The incremental costs of expanding antiretroviral (ARV) drug treatment to all HIV-infected patients are substantial, so cost-saving initiatives are important. Our objectives were to determine the acceptability and financial impact of de-simplifying (i.e. switching) more expensive single-tablet formulations (STFs) to less expensive generic-based multi-tablet components. We determined physician and patient perceptions and acceptance of STF de-simplification within the context of a publicly funded ARV budget. METHODS Programme costs were calculated for patients on ARVs followed at the Southern Alberta Clinic, Canada during 2016 (Cdn$). We focused on patients receiving Triumeq® and determined the savings if patients de-simplified to eligible generic co-formulations. We surveyed all prescribing physicians and a convenience sample of patients taking Triumeq® to see if, for budgetary purposes, they felt that de-simplification would be acceptable. RESULTS Of 1780 patients receiving ARVs, 62% (n = 1038) were on STF; 58% (n = 607) of patients on STF were on Triumeq®. The total annual cost of ARVs was $26 222 760. The cost for Triumeq® was $8 292 600. If every patient on Triumeq® switched to generic abacavir/lamivudine and Tivicay® (dolutegravir), total costs would decrease by $4 325 040. All physicians (n = 13) felt that de-simplifying could be safely achieved. Forty-eight per cent of 221 patients surveyed were agreeable to de-simplifying for altruistic reasons, 27% said no, and 25% said maybe. CONCLUSIONS De-simplifying Triumeq® generates large cost savings. Additional savings could be achieved by de-simplifying other STFs. Both physicians and patients agreed that selective de-simplification was acceptable; however, it may not be acceptable to every patient. Monitoring the medical and cost impacts of de-simplification strategies seems warranted.
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Affiliation(s)
- H B Krentz
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - S Campbell
- Southern Alberta Clinic, Calgary, AB, Canada
| | - V C Gill
- Southern Alberta Clinic, Calgary, AB, Canada
| | - M J Gill
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
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Abstract
BACKGROUND Barriers to HIV medication adherence may differ by levels of dosing schedules. PURPOSE The current study examined adherence barriers associated with medication regimen complexity and simplification. METHODS A total of 755 people living with HIV currently taking anti-retroviral therapy were recruited from community services in Atlanta, Georgia. Participants completed audio-computer-assisted self-interviews that assessed demographic and behavioral characteristics, provided their HIV viral load obtained from their health care provider, and completed unannounced phone-based pill counts to monitor medication adherence over 1 month. RESULTS Participants taking a single-tablet regimen (STR) were more likely to be adherent than those taking multi-tablets in a single-dose regimen (single-dose MTR) and those taking multi-tablets in a multi-dose regimen (multi-dose MTR), with no difference between the latter two. Regarding barriers to adherence, individuals taking STR were least likely to report scheduling issues and confusion as reasons for missing doses, but they were equally likely to report multiple lifestyle and logistical barriers to adherence. CONCLUSIONS Adherence interventions may need tailoring to address barriers that are specific to dosing regimens.
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40
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Naccarato MJ, Yoong DM, Fong IW, Gough KA, Ostrowski MA, Tan DHS. Combination Therapy with Tenofovir Disoproxil Fumarate/Emtricitabine/Elvitegravir/Cobicistat Plus Darunavir Once Daily in Antiretroviral-Naive and Treatment-Experienced Patients: A Retrospective Review. J Int Assoc Provid AIDS Care 2018; 17:2325957417752260. [PMID: 29385867 PMCID: PMC6748498 DOI: 10.1177/2325957417752260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Patients with drug-resistant HIV often require complex antiretroviral regimens. However, combining fixed-dose combination tablets such as tenofovir-disoproxil-fumarate, emtricitabine, and cobicistat-boosted elvitegravir (TDF/FTC/EVG/cobi) with darunavir (DRV) can provide a simple, once-daily (QD), 2-tablet regimen for patients with drug-resistant HIV. Primary objective was to determine the percentage of patients with HIV-1 RNA <40 copies/mL at 48 weeks. METHODS We performed a retrospective chart review of patients initiated on TDF/FTC/EVG/cobi plus DRV. RESULTS Among the 21 included patients, prior resistance showed a median of 2 nucleoside reverse transcriptase inhibitor mutations, 1 nonnucleoside reverse transcriptase mutation, and 1 protease inhibitor mutation. At week 48, 14 (67%) patients achieved HIV-1 RNA <40 copies/mL, 1 patient experienced viral rebound, and 6 (29%) had missing data or discontinued therapy. No patient discontinued for adverse events. CONCLUSION According to this observational study, QD TDF/FTC/EVG/cobi plus DRV is considered safe, well tolerated, and generally effective in suppressing HIV drug-resistant virus.
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Affiliation(s)
- Mark J. Naccarato
- Department of Pharmacy, St Michael’s Hospital, Toronto, Ontario,
Canada
- Division of Infectious Diseases, St Michael’s Hospital, Toronto, Ontario,
Canada
| | - Deborah M. Yoong
- Department of Pharmacy, St Michael’s Hospital, Toronto, Ontario,
Canada
- Division of Infectious Diseases, St Michael’s Hospital, Toronto, Ontario,
Canada
| | - Ignatius W. Fong
- Division of Infectious Diseases, St Michael’s Hospital, Toronto, Ontario,
Canada
| | - Kevin A. Gough
- Division of Infectious Diseases, St Michael’s Hospital, Toronto, Ontario,
Canada
- Department of Medicine, University of Toronto, Toronto, Ontario,
Canada
| | - Marian A. Ostrowski
- Division of Infectious Diseases, St Michael’s Hospital, Toronto, Ontario,
Canada
- Department of Medicine, University of Toronto, Toronto, Ontario,
Canada
- Keenan Research Centre for Biomedical Science, St Michael’s Hospital,
Toronto, Ontario, Canada
| | - Darrell H. S. Tan
- Division of Infectious Diseases, St Michael’s Hospital, Toronto, Ontario,
Canada
- Department of Medicine, University of Toronto, Toronto, Ontario,
Canada
- Centre for Research on Inner City Health, St Michael’s Hospital, Toronto,
Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of
Toronto, Toronto, Ontario, Canada
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41
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Hirasen K, Evans D, Maskew M, Sanne IM, Shearer K, Govathson C, Malete G, Kluberg SA, Fox MP. The right combination - treatment outcomes among HIV-positive patients initiating first-line fixed-dose antiretroviral therapy in a public sector HIV clinic in Johannesburg, South Africa. Clin Epidemiol 2017; 10:17-29. [PMID: 29296098 PMCID: PMC5739109 DOI: 10.2147/clep.s145983] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Long-term antiretroviral therapy (ART) adherence is critical for achieving optimal HIV treatment outcomes. Fixed-dose combination (FDC) single-pill regimens, introduced in South Africa in April 2013, has simplified pill taking. We evaluated treatment outcomes among patients initiated on a FDC compared to a similar multi-pill ART regimen in Johannesburg, South Africa. Methods We conducted a retrospective cohort study of ART-naïve HIV-positive non-pregnant adult (≥18 years) patients without tuberculosis who initiated first-line ART on tenofovir and emtricitabine or lamivudine with efavirenz at Themba Lethu Clinic in Johannesburg, South Africa. We compared those initiated on a multi-pill ART regimen (3–5 pills/day; September 1, 2011–August 31, 2012) to those initiated on a FDC ART regimen (one pill/day; September 1, 2013–August 31, 2014). Treatment outcomes included attrition (combination of lost to follow-up and mortality), missed medical visits, and virologic suppression (viral load <400 copies/mL) by 12 months post-ART initiation. Cox proportional hazards models and Poisson regression were used to estimate the association between FDCs vs multiple pills and treatment outcomes. Results We included 3151 patients in our analysis; 2230 (70.8%) patients initiated multi-pill ART and 921 (29.2%) patients initiated on a FDC. By 12 months post-initiation, attrition (adjusted hazard ratio: 0.98; 95% CI: 0.77–1.24) was similar across regimen types (FDC vs multi-pill). Although not significant, patients on a FDC were marginally more likely to achieve viral suppression by 6 (adjusted relative rate [aRR]: 1.10; 95% CI: 0.99–1.23) and 12 months (aRR: 1.12; 95% CI: 0.92–1.36) on ART. Patients initiated on a FDC were significantly less likely to miss medical visits during the first 12 months of treatment (aRR: 0.66; 95% CI: 0.52–0.83). Conclusion Our results suggest FDCs may have a role to play in supporting patient adherence and medical monitoring through improved medical visit attendance. This may potentially improve treatment outcomes later on in treatment.
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Affiliation(s)
- Kamban Hirasen
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Denise Evans
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mhairi Maskew
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ian M Sanne
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Right to Care, Johannesburg, South Africa.,Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kate Shearer
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline Govathson
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Given Malete
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sheryl A Kluberg
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Matthew P Fox
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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42
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Rwagitinywa J, Lapeyre-Mestre M, Bourrel R, Sommet A. Generic antiretroviral drug use in HIV-infected patients: A cohort study from the French health insurance database. Therapie 2017; 73:257-266. [PMID: 29195713 DOI: 10.1016/j.therap.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/26/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to estimate the rate of generic users among HIV-infected patients treated by antiretroviral (ARV) drugs potentially substitutable and to determine factors associated with switch from brand to generic ARV in real-life settings in a French region. METHODS Cohort of HIV-infected patients aged of ≥18 years, exposed to at least one of the generic of lamivudine (3TC-150mg/300mg), zidovudine/lamivudine (AZT-200mg/3TC-150mg), nevirapine (NVP-200mg), efavirenz (EFV-600mg) and those exposed to brand 3TC, AZT/3TC, NVP, EFV, the fixed-dose combination abacavir/lamivudine (ABC/3TC) or the single-tablet regimen efavirenz/emtricitabine/tenofovir (EFV/FTC/TDF) as recorded in the French health insurance database between January 2012 and May 2015 were included. Factors associated with switch (for each generic versus its brand drug; and for situation requiring breaking the combination) were investigated through a logistic regression. RESULTS Among the 1539 patients likely to switch from brand ARV drugs, only 165 (11%) were exposed to generics. For EFV users, switch from brand to generic was associated with age (aOR=1.04 [CI: 1.00-1.08]). For ABC/3TC users, switch was significantly more frequent in patients receiving a monthly average of more than two non-ARV drugs (3.08 [1.42-6.68]) and whose regimen contained a non-nucleoside reverse transcriptase inhibitor (NNRTI) as index medication (3rd agent) (5.68 [2.68-11.39]). By contrast, switch was less frequent in AZT/3TC users exposed to drugs used in digestive disorders (0.39 [0.18-0.88]) or analgesics (0.42 [0.20-0.90]). CONCLUSION Treatment-experienced HIV patients whose disease has been stabilized (less comorbidities) are more likely to switch to generic antiretroviral drugs.
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Affiliation(s)
- Joseph Rwagitinywa
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine, CHU de Toulouse, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, university Toulouse III, 31000 Toulouse, France.
| | - Maryse Lapeyre-Mestre
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine, CHU de Toulouse, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, university Toulouse III, 31000 Toulouse, France; CIC 1436, Toulouse university hospital, 31000 Toulouse, France
| | - Robert Bourrel
- Direction de l'échelon médical, Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), 31000 Toulouse, France
| | - Agnès Sommet
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine, CHU de Toulouse, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, university Toulouse III, 31000 Toulouse, France; CIC 1436, Toulouse university hospital, 31000 Toulouse, France
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43
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Yager J, Faragon J, McGuey L, Hoye-Simek A, Hecox Z, Sullivan S, Neubert S, Patel N. Relationship Between Single Tablet Antiretroviral Regimen and Adherence to Antiretroviral and Non-Antiretroviral Medications Among Veterans' Affairs Patients with Human Immunodeficiency Virus. AIDS Patient Care STDS 2017; 31:370-376. [PMID: 28771023 DOI: 10.1089/apc.2017.0081] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Several antiretrovirals (ART) have been coformulated as single tablet regimens (STR). Study objectives were to compare ART and non-ART adherence between STR and multiple tablet regimens (MTR) recipients, determine whether STR independently predicts ART adherence, and determine whether ART adherence influences non-ART adherence. A retrospective cohort study was performed among Upstate New York Veterans' Healthcare Administration (VISN-2) patients from 2000 to 2013. Inclusion criteria were age ≥18 years, human immunodeficiency virus (HIV) infection, receipt of ≥3 ART medications for ≥3 months, and available pharmacy refill records. The two study outcomes were adherence to ART medications and non-ART medications. Adherence was determined with pharmacy refill records that were used to calculate medication possession ratios. Among the 1202 subjects, there were 165 (13.7%) STR and 1037 (86.3%) MTR recipients. Mean ± standard deviation (SD) ART adherence was significantly higher for STR recipients (81.5% ± 15.3%) than MTR recipients (66.1% ± 21.1%), p < 0.001. Use of STR [adjusted odds ratio (aOR): 5.76, 95% confidence interval (CI): 3.84-8.65, p < 0.001] was independently associated with optimal (≥90%) adherence to ART. Mean ± SD non-ART adherence did not differ between STR (78.8% ± 15.6%) and MTR recipients (80.8% ± 16.0%), p = 0.17. Optimal adherence to ART medications (aOR: 2.30, 95% CI: 1.57-3.38, p < 0.001) was independently associated with optimal adherence to non-ART medications. The use of STRs are associated with optimal adherence to ART medications, but not directly associated with adherence to non-ART medications.
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Affiliation(s)
- Jenna Yager
- Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, New York
| | - John Faragon
- Departments of Pharmacy and Medicine, Albany Medical Center Hospital, Albany, New York
| | - Liam McGuey
- Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, New York
| | - Adam Hoye-Simek
- Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, New York
| | - Zachary Hecox
- Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, New York
| | - Steven Sullivan
- Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, New York
| | - Stefanie Neubert
- Division of Infectious Diseases, Samuel S. Stratton Veterans' Affairs Medical Center, Albany, New York
| | - Nimish Patel
- Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, New York
- Division of Infectious Diseases, Samuel S. Stratton Veterans' Affairs Medical Center, Albany, New York
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Gagliardini R, Bandera A, Zaccarelli M, Sterrantino G, Latini A, D'Avino A, Lapadula G, Antinori A, Cauda R, De Luca A, Gori A, Di Giambenedetto S, Fabbiani M. 3-Year efficacy and durability of simplification to single tablet regimens: a comparison between co-formulated efavirenz/emtricitabine/tenofovir and rilpivirine/emtricitabine/tenofovir. Antivir Ther 2017; 23:139-148. [PMID: 28799920 DOI: 10.3851/imp3188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Few data are available about efficacy and durability of simplification from multi-tablet antiretroviral regimens to co-formulated efavirenz (EFV)/emtricitabine (FTC)/tenofovir (TDF) versus rilpivirine (RPV)/FTC/TDF in virologically suppressed HIV-1-infected patients. METHODS We retrospectively analysed HIV-infected patients with HIV RNA <50 copies/ml switching to co-formulated EFV/FTC/TDF or RPV/FTC/TDF at five Italian centres. Patients were followed from time of switch until regimen discontinuation or a maximum of 3-years follow-up. Time to treatment discontinuation (TD) and virological failure (VF; defined as two consecutive HIV RNA >50 copies/ml or a single determination >1,000 copies/ml) and their predictors were investigated. RESULTS 1,560 patients were reviewed of which 1,097 (70%) switched to EFV/FTC/TDF and 463 (30%) to RPV/FTC/TDF. During follow-up, VF and TD occurred in 44 (4%) and 242 (22%) patients in EFV/FTC/TDF and in 29 (6%) and 50 (11%) patients in RPV/FTC/TDF, respectively. The 3-year estimated probability of remaining free from VF was 96.2% with EFV/FTC/TDF versus 92.7% with RPV/FTC/TDF (P=0.003). At multivariate analysis, regimen type (EFV/FTC/TDF versus RPV/FTC/TDF aHR 0.24; P=0.004) and time of virological suppression (aHR 0.85; P=0.048) were the only independent predictors of VF. The estimated 3-year probability of remaining free from TD was 77.4% with EFV/FTC/TDF versus 88.4% with RPV/FTC/TDF (P=0.001). Predictors of TD were female sex, switching from PI-based regimens, older age, shorter time of virological suppression and regimen type (EFV/FTC/TDF versus RPV/FTC/TDF aHR 2.48; P<0.001). RPV/FTC/TDF showed a safer lipid profile and a greater increase in creatinine. CONCLUSIONS Both regimens showed good safety and efficacy in this real-life setting, although switch to RPV/FTC/TDF seemed better tolerated while EFV/FTC/TDF was associated with a lower probability of VF.
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Affiliation(s)
- Roberta Gagliardini
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandra Bandera
- Clinic of Infectious Diseases, San Gerardo Hospital - ASST Monza, Monza, Italy
| | - Mauro Zaccarelli
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Gaetana Sterrantino
- Clinic of Infectious and Tropical Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | | | - Alessandro D'Avino
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Giuseppe Lapadula
- Clinic of Infectious Diseases, San Gerardo Hospital - ASST Monza, Monza, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Roberto Cauda
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Andrea De Luca
- Infectious Diseases Unit, Siena University Hospital, Siena, Italy
| | - Andrea Gori
- Clinic of Infectious Diseases, San Gerardo Hospital - ASST Monza, Monza, Italy
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45
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Cioe PA, Gamarel KE, Pantalone DW, Monti PM, Mayer KH, Kahler CW. Cigarette Smoking and Antiretroviral Therapy (ART) Adherence in a Sample of Heavy Drinking HIV-Infected Men Who Have Sex with Men (MSM). AIDS Behav 2017; 21:1956-1963. [PMID: 27439456 PMCID: PMC5250588 DOI: 10.1007/s10461-016-1496-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cigarette smoking and heavy alcohol use is prevalent among HIV-infected men who sex with men (MSM) and have been linked to imperfect antiretroviral therapy (ART) adherence. Our study examined the correlates of smoking and whether smoking was independently associated with imperfect adherence in heavy-drinking HIV-infected MSM. Of the 185 participants, approximately half (n = 91, 49.2 %) reported having smoked cigarettes in the past 30 days. Current smokers were more likely to have reported imperfect adherence compared to non-smokers (37.4.2 vs. 22.3 %, p < 0.05). In multivariable regression analyses, only lower education was significantly associated with imperfect adherence. This study demonstrated that the greatest risk factor for smoking and imperfect ART adherence was low socioeconomic status, in which MSM of color were over-represented. As the first study to examine smoking and ART adherence in this population, our study has the potential to inform the clinical care provided to heavy-drinking MSM.
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Affiliation(s)
- Patricia A Cioe
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA.
| | - Kristi E Gamarel
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Peter M Monti
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
| | - Kenneth H Mayer
- Harvard University School of Public Health, Boston, MA, USA
- Fenway Community Health Center, Boston, MA, USA
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
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46
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Arribas JR, DeJesus E, van Lunzen J, Zurawski C, Doroana M, Towner W, Lazzarin A, Nelson M, McColl D, Andreatta K, Swamy R, Szwarcberg J, Nguyen T. Simplification to single-tablet regimen of elvitegravir, cobicistat, emtricitabine, tenofovir DF from multi-tablet ritonavir-boosted protease inhibitor plus coformulated emtricitabine and tenofovir DF regimens: week 96 results of STRATEGY-PI. HIV CLINICAL TRIALS 2017; 18:118-125. [PMID: 28555519 DOI: 10.1080/15284336.2017.1330440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Antiretroviral therapy (ART) simplification to a single-tablet regimen can benefit HIV-1-infected, virologically suppressed, individuals on ART composed of multiple pills. OBJECTIVE We assessed long-term efficacy and safety of switching to co-formulated elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (E/C/F/TDF) from multi-tablet ritonavir-boosted protease inhibitor (PI + RTV) plus F/TDF (TVD) regimens. METHODS STRATEGY-PI was a 96-week, phase 3b, randomized (2:1), open-label, non-inferiority study examining the efficacy, safety, and tolerability of switching to E/C/F/TDF from PI + RTV + TVD regimens in virologically suppressed individuals (HIV-1 RNA <50 copies/mL). Participants were randomized to switch to E/C/F/TDF (switch group) or to continue their PI + RTV + TVD regimens (no-switch group). Eligibility criteria included no resistance to F/TDF or history of virologic failure, and estimated creatinine clearance ≥70 mL/min. RESULTS At week 96, 87% (252/290) of switch and 70% (97/139) of no-switch participants maintained HIV-1 RNA <50 copies/mL (difference: 17%, 95% CI 8.7-26.0%, p < 0.001). Superiority of the switch to E/C/F/TDF vs. no-switch was due to a smaller proportion of both virologic failures (switch, 1% [3/290]; no-switch, 6% [8/139]) and discontinuations for non-virologic reasons (switch, 11% [31/290]; no-switch, 24% [33/139]). No treatment-emergent resistance was observed in switch subjects with virologic failure. Discontinuation rates from adverse events were 3% in both groups (9/293, switch; 4/140, no-switch). Switching from PI + RTV + TVD to E/C/F/TDF was associated with significant improvements in patient-reported outcomes related to gastrointestinal symptoms (nausea and bloating). CONCLUSION E/C/F/TDF is a safe, effective long-term alternative to multi-tablet PI + RTV + TVD-based regimens in virologically suppressed, HIV-1-infected adults, and improves patient-reported gastrointestinal symptoms.
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Affiliation(s)
- Jose R Arribas
- a Hospital Universitario La Paz , IdiPAZ , Madrid , Spain
| | | | - Jan van Lunzen
- c Universitaetsklinikum Hamburg-Eppendorf , Hamburg , Germany
| | | | | | - William Towner
- f Southern California Kaiser Permanente Medical Group , Los Angeles CA , USA
| | | | - Mark Nelson
- h Chelsea and Westminster Hospital , London , UK
| | | | | | - Raji Swamy
- i Gilead Sciences, Inc., Foster City , CA , USA
| | | | - Thai Nguyen
- i Gilead Sciences, Inc., Foster City , CA , USA
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47
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Drozd DR, Saag MS, Westfall AO, Mathews WC, Haubrich R, Boswell SL, Cole SR, Porter D, Kitahata MM, Juday T, Rosenblatt L. Comparative effectiveness of single versus multiple tablet antiretroviral therapy regimens in clinical HIV practice. Medicine (Baltimore) 2017; 96:e6275. [PMID: 28383402 PMCID: PMC5411186 DOI: 10.1097/md.0000000000006275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We determined risk of virologic failure (VF) in individuals initiating tenofovir/emtricitabine/efavirenz as single versus multiple tablet regimens (MTR). We found no significant difference in the risk of VF, though did observe a trend toward more VF and M184 V mutations among persons initiating MTR. Temporal trends in care may have confounded results.
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Affiliation(s)
- Daniel R. Drozd
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
| | | | - Andrew O. Westfall
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | - Stephen R. Cole
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | | | - Mari M. Kitahata
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
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48
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Harris RA, Xue X, Selwyn PA. Housing Stability and Medication Adherence among HIV-Positive Individuals in Antiretroviral Therapy: A Meta-Analysis of Observational Studies in the United States. J Acquir Immune Defic Syndr 2017; 74:309-317. [PMID: 27787347 PMCID: PMC5305290 DOI: 10.1097/qai.0000000000001213] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/10/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous research has produced inconsistent evidence of an association between housing stability and medication adherence among HIV-positive individuals in antiretroviral therapy. OBJECTIVE We conducted a meta-analysis of the housing-adherence relationship based on a comprehensive search of observational studies in the PubMed, Embase, and Cochrane databases (January 2000-January 2016). Ten qualifying studies were identified representing 10,556 individuals. METHODS A random-effects model was used to estimate the overall effect size and 95% confidence interval (CI). Robustness of the estimate was determined by sensitivity analysis. Heterogeneity was assessed by meta-regression analysis, subgroup analysis, and quality effects estimation. Publication bias was evaluated with a funnel plot and the Egger and Begg tests. RESULTS The summary effect for the association between housing stability and medication adherence was positive and significant (standardized mean difference = 0.15, 95% CI: 0.02 to 0.29). The association was slightly larger in the quality effects analysis (standardized mean difference = 0.20, 95% CI: 0.01 to 0.39). Sensitivity analysis disclosed that the association was robust at the P = 0.09 level. Results of the subgroup and meta-regression analyses were nonsignificant. Publication bias was not detected. CONCLUSION Antiretroviral medication adherence is an increasing function of housing stability, but the magnitude of the effect is small. The finding challenges the view that unstable housing is incompatible with adherence and questions the potential benefit of deferring antiretroviral therapy initiation until the patient's housing circumstances are improved.
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Affiliation(s)
- Rebecca Arden Harris
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA; and
| | - Xiaonan Xue
- Albert Einstein College of Medicine, Bronx, NY
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49
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Sobrino-Jiménez C, Jiménez-Nácher I, Moreno-Ramos F, González-Fernández MÁ, Freire-González M, González-García J, Herrero-Ambrosio A. Analysis of antiretroviral therapy modification in routine clinical practice in the management of HIV infection. Eur J Hosp Pharm 2017; 24:96-100. [PMID: 31156912 DOI: 10.1136/ejhpharm-2016-000944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/21/2016] [Accepted: 06/28/2016] [Indexed: 11/03/2022] Open
Abstract
Objectives The main goal was to assess the reasons for antiretroviral therapy (ART) change in patients with HIV in a hospital setting in routine clinical practice. The economic impact of ART modification was also analysed. Methods Patients with HIV who changed their ART between 24 November and 24 December 2014 were registered. Length of initial therapy, type of ART before and after therapy modification, and reasons for the ART change were analysed. To assess the economic impact, antiretroviral drug costs at the time of the study were recorded. Results Of a cohort of 3850 patients with HIV, 1976 attended for pharmaceutical care consultation at Hospital Universitario La Paz during the study period. Ninety-two patients (4.7%) had their ART modified. The median length of the previous therapy was 26 months (range 1-144). The most common initial therapy regimen was 2 nucleoside reverse transcriptase inhibitors (NRTI)+1 non-nucleoside reverse transcriptase inhibitor (NNRTI) (29.4%), and the most common one after modification was 2 NRTI+1 integrase strand transfer inhibitor (INSTI) (40.2%). Forty-three modifications were made because of toxicity and adverse effects (46.7%), 25 because of therapy simplification (27.2%), 16 because of treatment failure (17.4%), and 8 because of drug-drug interactions (8.7%). ART costs increased by a mean of €14 (SD €216; range -€528 to +€831) per month per patient after therapy modification at the time of study. Conclusions Toxicity and adverse effects were the most common reason for ART alteration in patients with HIV in routine clinical practice in a hospital setting. Better knowledge about factors that motivate these changes may contribute to decreased toxicity and increased treatment success. ART modification had a variable but not very substantial economic impact.
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50
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Eyawo O, Franco-Villalobos C, Hull MW, Nohpal A, Samji H, Sereda P, Lima VD, Shoveller J, Moore D, Montaner JSG, Hogg RS. Changes in mortality rates and causes of death in a population-based cohort of persons living with and without HIV from 1996 to 2012. BMC Infect Dis 2017; 17:174. [PMID: 28241797 PMCID: PMC5329918 DOI: 10.1186/s12879-017-2254-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/08/2017] [Indexed: 12/22/2022] Open
Abstract
Background Non-HIV/AIDS-related diseases are gaining prominence as important causes of morbidity and mortality among people living with HIV. The purpose of this study was to characterize and compare changes over time in mortality rates and causes of death among a population-based cohort of persons living with and without HIV in British Columbia (BC), Canada. Methods We analysed data from the Comparative Outcomes And Service Utilization Trends (COAST) study; a retrospective population-based study created via linkage between the BC Centre for Excellence in HIV/AIDS and Population Data BC, and containing data for HIV-infected individuals and the general population of BC, respectively. Our analysis included all known HIV-infected adults (≥ 20 years) in BC and a random 10% sample of uninfected BC adults followed from 1996 to 2012. Deaths were identified through Population Data BC – which contains information on all registered deaths in BC (BC Vital Statistics Agency dataset) and classified into cause of death categories using International Classification of Diseases (ICD) 9/10 codes. Age-standardized mortality rates (ASMR) and mortality rate ratios were calculated. Trend test were performed. Results 3401 (25%), and 47,647 (9%) individuals died during the 5,620,150 person-years of follow-up among 13,729 HIV-infected and 510,313 uninfected individuals, respectively. All-cause and cause-specific mortality rates were consistently higher among HIV-infected compared to HIV-negative individuals, except for neurological disorders. All-cause ASMR decreased from 126.75 (95% CI: 84.92-168.57) per 1000 population in 1996 to 21.29 (95% CI: 17.79-24.79) in 2011-2012 (83% decline; p < 0.001 for trend), compared to a change from 7.97 (95% CI: 7.61-8.33) to 6.87 (95% CI: 6.70-7.04) among uninfected individuals (14% decline; p < 0.001). Mortality rates from HIV/AIDS-related causes decreased by 94% from 103.85 per 1000 population in 1996 to 6.72 by the 2011–2012 era (p < 0.001). Significant ASMR reductions were also observed for hepatic/liver disease and drug abuse/overdose deaths. ASMRs for neurological disorders increased significantly over time. Non-AIDS-defining cancers are currently the leading non-HIV/AIDS-related cause of death in both HIV-infected and uninfected individuals. Conclusions Despite the significant mortality rate reductions observed among HIV-infected individuals from 1996 to 2012, they still have excess mortality risk compared to uninfected individuals. Additional efforts are needed to promote effective risk factor management and appropriate screening measures among people living with HIV.
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Affiliation(s)
- Oghenowede Eyawo
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Conrado Franco-Villalobos
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada
| | - Mark W Hull
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada
| | | | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada
| | - Jeannie Shoveller
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada. .,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
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