Abstract PS4/5
 
Effect of Once-daily Dosing and Lower Pill Burden Antiretroviral Regimens for HIV Infection: A Meta-analysis of Randomised Controlled Trials Print
 
J.B. Nachega1,2, J.-J. Parienti3, O.A. Uthman4,5, R. Gross6, D.W. Dowdy7, P.E. Sax8, J.E. Gallant9, M.J. Mugavero10, E.J. Mills11, T.P. Giordano12
1Pittsburgh University, Infectious Diseases Epidemiology, Pittsburgh, United States, 2Johns Hopkins University, Epidemiology and International Health, Baltimore, United States, 3Côte de Nacre University, Department of Biostatistics and Clinical Research, Côte de Nacre Teaching Hospital, Caen, France, 4Centre for Applied Health Research and Delivery, Warwick Medical School, University of Warwick, Coventry, United Kingdom, 5Liverpool School of Tropical Medicine, International Health Group, Liverpool, United Kingdom, 6University of Pennsylvania, Perelman School of Medicine, Department of Medicine, Philadelphia, United States, 7Johns Hopkins Bloomberg School of Public Health, Epidemiology, Baltimore, United States, 8Harvard Medical School, Brigham and Women’s Hospital, Boston, United States, 9Johns Hopkins University, School of Medicine, Baltimore, United States, 10University of Alabama, Department of Medicine, Alabama, United States, 11University of Ottawa, Ottawa, Canada, 12Baylor College of Medicine, Department of Medicine, Houston, United States
 
Objectives: Little is known about the impact of once-daily antiretroviral therapy (ART) dosing and pill burden on adherence and virologic outcomes. We performed a meta-analysis of randomised controlled trials (RCTs) to investigate the impact of once-daily vs. twice-daily dosing and pill burden on ART adherence and virologic outcomes.
Methods: Literature search of 4 electronic databases up to March 2013. RCTs comparing once-daily versus twice-daily ART regimens and that reported on adherence and virologic suppression were included. Study design, study population characteristics, intervention, outcome measures, and study quality were extracted. Study quality was rated by using the Cochrane risk-of-bias tool.
Results: Nineteen studies met our inclusion criteria (N = 6312 adult patients). Average adherence percentage was modestly higher in once-daily regimen than twice-daily regimen (weighted mean difference [WMD] = 2.51%; 95% confidence interval [CI] 1.20 to 3.83; p = 0.0002). Patients taking once-daily regimens did not achieve virologic suppression more frequently than patients taking twice-daily regimens (relative risk [RR] = 1.01; 95% CI 0.98 to 1.03; p = 0.57), including all subgroup comparisons. Higher pill burden was associated with both lower adherence rates and worse virologic suppression in both once-daily and twice-daily subgroups, although the association with adherence in the once-daily subgroup was not statistically significant.
Conclusion: Adherence, but not virologic suppression improved with once- vs twice-daily regimens. Lower pill burden was associated with both better adherence and virologic suppression.


Assigned speakers:
Jean Nachega , Pittsburgh University , Pittsburgh , United States

Assigned in sessions:
17.10.2013, 14:00-16:00, Parallel Session, PS4, Antiretroviral Therapy I, Bozar (Plenary Hall)