Adherence to HIV treatment regimens: systematic literature review and meta-analysis
Received 8 November 2018
Accepted for publication 14 February 2019
Published 3 April 2019 Volume 2019:13 Pages 475—490
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Johnny Chen
Frederick Altice,1 Obaro Evuarherhe,2 Sophie Shina,2 Gemma Carter,2 Anne Christine Beaubrun3
1Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT, USA; 2Value Demonstration Practice, Oxford PharmaGenesis Ltd, Oxford, UK; 3Health Economics and Outcomes Research, Medical Affairs, Gilead Sciences, Foster City, CA, USA
Background: Antiretroviral therapy (ART), when taken consistently, reduces morbidity and mortality associated with human immunodeficiency virus and viral transmission. Suboptimal treatment adherence is associated with regimen complexity and high tablet burden. Single-tablet regimens (STRs) provide a complete treatment regimen in a single tablet. This study examined the relationship between STRs (vs multiple-tablet regimens [MTRs]), treatment adherence, and viral suppression.
Methods: A systematic review was conducted to identify studies investigating at least one of the following: (1) STR/MTR use and adherence; (2) levels of adherence and viral suppression; and (3) STR/MTR use and viral suppression. Meta-analysis was performed to assess the relationship between STR vs MTR use and adherence in observational settings at ≥95% and ≥90% adherence thresholds.
Results: In total, 29 studies were identified across the three objectives; two studies were relevant for all objectives. STRs were associated with higher treatment adherence than MTRs in 10/11 observational studies: a 63% greater likelihood of achieving ≥95% adherence (95% CI=1.52–1.74; P<0.001) and a 43% increase in the likelihood of achieving ≥90% adherence (95% CI=1.21–1.69; P<0.001). Higher adherence rates were associated with higher levels of viral suppression in 13/18 studies. Results were mixed in five studies investigating the association between STR or MTR use and viral suppression.
Conclusion: Although the direct effect of STRs vs MTRs on viral suppression remains unclear, this study provided a quantitative estimate of the relationship between STRs and ART adherence, demonstrating that STRs are associated with significantly higher ART adherence levels at 95% and 90% thresholds. Findings from the systematic review showed that improved adherence results in an increased likelihood of achieving viral suppression in observational settings. Future research should utilize similar measures for adherence and evaluate viral suppression to improve assessment of the relationship between pill burden, adherence, and viral suppression.
Keywords: human immunodeficiency virus, antiretroviral therapy, treatment adherence, systematic review, meta-analysis
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