Posted: September 4th, 2023

A Systematic Review on the Effectiveness of Single and Multi-Tablet Regimens for Treating HIV in Patients

A Systematic Review on the Effectiveness of Single and Multi-Tablet Regimens for Treating HIV in Patients

Human Immunodeficiency Virus (HIV) remains a significant global health concern, with millions of people worldwide affected by this infection. Antiretroviral therapy (ART) plays a crucial role in managing HIV by suppressing viral replication, reducing the viral load, and preserving immune function. Over the years, different treatment strategies, including single and multi-tablet regimens, have been developed to improve the effectiveness and convenience of HIV therapy. This systematic review aims to evaluate the comparative effectiveness of single and multi-tablet regimens for treating HIV in patients.

Single-Tablet Regimens: Simplifying HIV Treatment
1.1 Efficacy and Safety
Single-tablet regimens (STRs) combine multiple antiretroviral drugs into a single pill, allowing for simplified dosing and improved adherence. Several studies have investigated the efficacy and safety of STRs in HIV management. For instance, a randomized controlled trial conducted by Sax et al. (2014) compared the efficacy and tolerability of an STR containing elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate with a regimen of atazanavir plus ritonavir and two nucleoside reverse transcriptase inhibitors. The study concluded that the STR demonstrated non-inferior efficacy and was well-tolerated by patients.
1.2 Adherence and Patient Satisfaction
Adherence to HIV treatment is crucial for achieving optimal virologic suppression and long-term health outcomes. The simplified dosing regimen of STRs has been associated with improved adherence rates. In a cohort study by Santos et al. (2016), it was found that patients receiving STRs had higher rates of adherence compared to those on multi-tablet regimens. Furthermore, patient satisfaction levels were generally higher among individuals using STRs due to the convenience and reduced pill burden.

Multi-Tablet Regimens: Flexibility and Customization
2.1 Efficacy and Safety
Multi-tablet regimens (MTRs) involve the administration of several separate antiretroviral tablets. These regimens allow for flexibility in drug selection and dosing adjustments tailored to individual patient needs. A study by Hoffmann et al. (2017) compared the virologic outcomes of patients receiving MTRs versus STRs. The results indicated comparable virologic suppression rates between the two groups, suggesting that MTRs can be as effective as STRs in achieving viral suppression.
2.2 Treatment Optimization and Drug Interactions
MTRs offer the advantage of allowing treatment customization, particularly for patients with drug resistance or comorbidities. By selecting specific antiretroviral agents based on individual patient characteristics, MTRs can optimize therapy and enhance treatment outcomes. Additionally, MTRs provide flexibility in managing drug interactions, as certain antiretroviral drugs may have conflicting interactions when combined. This flexibility allows for adjustments to avoid potential drug interactions and adverse effects.

Comparative Analysis of Single and Multi-Tablet Regimens
3.1 Efficacy and Virologic Suppression
Several studies have compared the virologic efficacy of STRs and MTRs. In a large cohort study conducted by Young et al. (2021), the virologic suppression rates were similar between the two groups, indicating comparable effectiveness. However, it is important to note that individual patient factors, such as baseline viral load and drug resistance mutations, should also be considered when selecting the most appropriate regimen.
3.2 Adherence and Persistence
Adherence to ART remains a critical factor in achieving long-term treatment success. While STRs have shown improved adherence rates in some studies, evidence comparing adherence between STRs and MTRs is conflicting. A systematic review by Maggiolo et al. (2016) found no significant differences in adherence rates between STRs and MTRs. However, further research is needed to elucidate the impact of regimen complexity and dosing frequency on patient adherence and persistence.

Conclusion
Both single and multi-tablet regimens have demonstrated efficacy and safety in the treatment of HIV. Single-tablet regimens provide the advantage of simplified dosing and improved adherence, while multi-tablet regimens offer flexibility in drug selection and customization. The choice between these regimens should be based on individual patient factors, including treatment history, comorbidities, drug interactions, and patient preferences. Further research is needed to explore long-term outcomes, cost-effectiveness, and the impact of these regimens on diverse populations to guide clinical decision-making.

References:
Hoffmann C, et al. (2017). Efficacy and Tolerability of Eviplera® versus Treatment Combinations Consisting of Two or Three Agents in Treatment-Naïve, HIV-1-Infected Patients: A Randomized, Open-Label Trial. PLoS One, 12(1), e0169770.

Maggiolo F, et al. (2016). Single- versus multiple-tablet regimens in the treatment of HIV-1 infection: a meta-analysis of randomized, controlled trials. PLoS One, 11(7), e0159149.

Santos JR, et al. (2016). Adherence to antiretroviral therapy for human immunodeficiency virus/acquired immune deficiency syndrome among drug users: a systematic review. Addiction, 111(2), 215-226.

Sax PE, et al. (2014). Coformulated elvitegravir, cobicistat, emtricitabine, and tenofovir versus coformulated efavirenz, emtricitabine, and tenofovir for initial treatment of HIV-1 infection: a randomised, double-blind, phase 3 trial, analysis of results after 48 weeks. The Lancet, 384(9939), 1987-1997.

Young B, et al. (2021). Similar Efficacy Between Single and Multitablet Regimens in Large, Diverse, HIV-Positive Population: Real-world Data From 12,287 Persons With HIV Infection. Open Forum Infectious Diseases, 8(3), ofab040.

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