Is One-Pill ART Superior to Multi-Pill Regimens Among HIV-Infected Youth?
NEW ORLEANS, LA—Compared to multi-pill antiretroviral therapy (ART), 1-pill ART is associated with improved likelihoods of initial and sustained virologic suppression among HIV-positive young people, according to findings from a retrospective multi-institutional analysis reported at IDWeek 2016.
Over a third of youth in both the 1-pill and multi-pill ART study groups had no available viral load measurements at 1 year after initiation of ART, “suggesting that a significant proportion are sub-optimally engaged in care,” noted David Griffith, BS, of Johns Hopkins University School of Medicine in Baltimore, MD, and coauthors.
Use of 1-pill ART might improve virologic suppression among youth, but “interventions to sustain engagement in care are critical to ultimately improving overall outcomes in this age group,” the authors concluded.
Young people with HIV infection “often struggle with sustaining adherence to antiretroviral therapy,” they noted. “Decreased pill burden may be associated with better ART adherence and several one-pill regimens are recommended for first-line ART for youth.”
The researchers studied initiation and outcomes for 1-pill vs. multi-pill ART among treatment-naïve, non-perinatally infected HIV-positive (nPHIV) youth aged 12–24 years, from 2006–2014. Time to initial virologic suppression within the first year (defined as <400 copies/mL) was calculated and multivariate analyses of factors associated with initiation of 1-pill vs. multi-pill ART, and virologic suppression after 1 year of ART (± 3months) were conducted.
“Of 1,646 treatment-naïve nPHIV youth, 62% initiated 1-pill ART (72% efavirenz/tenofovir/emtricitabine), with increasing proportion yearly (47% in 2006 to 78% in 2014),” the authors reported. Other 1-pill ART regimens included rilpivirine/tenofovir/lamivudine (15%), elvitegravir/cobicistat/tenofovir/emtricitabine (13%), and dolutegravir/abacavir/lamivudine (1%).
Male gender and CD4 count >200 cells/mm3 independently predicted 1-pill ART initiation.
After statistically adjusting for factors like sex, race, baseline CD4 and viral load, 1-pill ART was associated with better initial viral suppression than multi-pill ART within a year of treatment (hazard ratio [HR], 1.16; 95% CI: 1.03–1.31). 1-pill ART was similarly associated with improved virologic suppression at 9–15 months after initiation (29% and 33%, respectively).