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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Lower pill burden and once-daily antiretroviral treatment regimens for HIV infection: A meta-analysis of randomized controlled trials
Clinical Infectious Diseases, Volume 58, No. 9, Year 2014
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Description
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. © The Author 2014.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3982838/bin/supp_58_9_1297__index.html
https://efashare.b-cdn.net/share/pmc/articles/PMC3982838/bin/supp_ciu046_ciu046supp_data.pdf
Authors & Co-Authors
Nachega, J. B.
United States, Pittsburgh
University of Pittsburgh Graduate School of Public Health
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
South Africa, Cape Town
Stellenbosch University, Faculty of Medicine and Health Sciences
Parienti, Jean Jacques
France, Caen
Hopital Cote de Nacre
France, Caen
Université de Caen Normandie
Uthman, Olalekan A.
United Kingdom, Coventry
Warwick Medical School
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
South Africa, Cape Town
Stellenbosch University, Faculty of Medicine and Health Sciences
Gross, Robert
United States, Philadelphia
University of Pennsylvania Perelman School of Medicine
Dowdy, David W.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Sax, Paul Edward
United States, Boston
Brigham and Women's Hospital
Gallant, Joel E.
Mexico
Southwest Care Center
Mugavero, Michael J.
United States, Birmingham
The University of Alabama at Birmingham
Mills, Edward J.
Canada, Ottawa
University of Ottawa
Giordano, Thomas P.
United States, Houston
Baylor College of Medicine
Statistics
Citations: 346
Authors: 10
Affiliations: 13
Identifiers
Doi:
10.1093/cid/ciu046
ISSN:
10584838
e-ISSN:
15376591
Research Areas
Infectious Diseases
Study Design
Randomised Control Trial
Cross Sectional Study
Study Approach
Systematic review