@article{84638df25cfa4ab998e1f46dab94ceb2,
title = "Lower pill burden and once-daily antiretroviral treatment regimens for HIV infection: A meta-analysis of randomized controlled trials",
abstract = "Background. Contemporary antiretroviral treatment regimens are simpler than in the past, with lower pill burden and once-daily dosing frequency common. We performed a meta-analysis of randomized controlled trials (RCTs) to investigate the impact of pill burden and once-daily vs twice-daily dosing on ART adherence and virological outcomes.Methods. A literature search of 4 electronic databases through 31 March 2013 was used. RCTs comparing once-daily vs twice-daily ART regimens that also reported on adherence and virological suppression were included. Study design, study population characteristics, intervention, outcome measures, and study quality were extracted. Study quality was rated using the Cochrane risk-of-bias tool.Results. Nineteen studies met our inclusion criteria (N = 6312 adult patients). Higher pill burden was associated with both lower adherence rates (P =. 004) and worse virological suppression (P <. 0001) in both once-daily and twice-daily subgroups, although the association with adherence in the once-daily subgroup was not statistically significant. The average adherence was modestly higher in once-daily regimens than twice-daily regimens (weighted mean difference = 2.55%; 95% confidence interval [CI], 1.23 to 3.87; P =. 0002). Patients on once-daily regimens did not achieve virological suppression more frequently than patients on twice-daily regimens (relative risk [RR] = 1.01; 95% CI, 0.99 to 1.03; P =. 50). Both adherence and viral load suppression decreased over time, but adherence decreased less with once-daily dosing than with twice-daily dosing.Conclusions. Lower pill burden was associated with both better adherence and virological suppression. Adherence, but not virological suppression, was slightly better with once- vs twice-daily regimens.",
keywords = "ART, fixed-dose combination, once-daily, randomized controlled trials, twice-daily",
author = "Nachega, {Jean B.} and Parienti, {Jean Jacques} and Uthman, {Olalekan A.} and Robert Gross and Dowdy, {David W.} and Sax, {Paul E.} and Gallant, {Joel E.} and Mugavero, {Michael J.} and Mills, {Edward J.} and Giordano, {Thomas P.}",
note = "Funding Information: Potential conflicts of interest. J. B. N. has received consulting fees for continuing medical education HIV lectures from Gilead Sciences, Glaxo-SmithKline (GSK), and Boerhinger-Ingelheim. J. J. P. has received research grant support or payment for conferences or participation at advisory boards from Abbott, Boerhinger-Ingelheim, Bristol-Myers Squibb (BMS), Gilead Sciences, Janssen-Cilag, Merck-Sharp and Dohme (MSD), Tibotec, and ViiV Healthcare. J. G. has received research grant support from BMS, Gilead Sciences, MSD, Sangamo BioSciences, Vertex Pharmaceuticals, and ViiV Healthcare, as well as consulting fees for participation on advisory boards from Gilead Sciences, Janssen Therapeutics, and MSD. P. S. has received research grant support from BMS, Gilead Sciences, GSK, as well as consulting fees or honorarium from AbbVie, BMS, Gilead, GSK, Janssen, and MSD. All other authors report no potential conflicts. Funding Information: Research grant support. The US National Institutes for Allergy and Infectious Disease-National Institutes of Health (NIAID-NIH), AIDS Clinical Trial Group (ACTG), Stellenbosch University (SU)-Clinical Trial Unit (CTU) Award: 2UM1AI069521-08 (J. B. N.); the US NIH-Fogarty International Center (FIC)/Health Resources and Services Administration (HRSA)/ US President Emergency Plan for AIDS Relief (PEPFAR) Grant Award, T84HA21652-01-00 for Medical Education Partnership Initiative (MEPI) (J. B. N.); the European Developing Countries Clinical Trial Partnership (EDCTP) Senior Fellowship Award: TA-08-40200-021 (J. B. N.); the Wellcome Trust Southern Africa Consortium for Research Excellence (SACORE): WT087537MA (J. B. N.); the National Institutes of Mental Health NIMH-NIH R34 MH083592-01A1 (E. J. M.). FAS Marie Curie International Post Doc: 2012-0064 (O. A. U.); the Penn Center for AIDS Research (CFAR), an NIH-funded program (P30 AI 045008) (R. G.). The Department of Veteran Affairs Health Services Research and Development Center Grant Award CIN 13-413 (T. P. G.). Agence Nationale de Recherche contre le SIDA (ANRS)/Institut National de la Sant{\'e} et de la Recherche M{\'e}d-icale (INSERM) ATIP Avenir Post-Doc program: 2012-YY1137 (J. J. P.); NIH Grant; NIAID-NIH Grant Award: UM1AI069412 (P. S.).",
year = "2014",
doi = "10.1093/cid/ciu046",
language = "English (US)",
volume = "58",
pages = "1297--1307",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "9",
}