A single tablet regimen is associated with higher adherence and viral suppression than multiple tablet regimens in HIV+ homeless and marginally housed people.
A single tablet regimen is associated with higher adherence and viral suppression than multiple tablet regimens in HIV+ homeless and marginally housed people.
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DOI：
10.1097/qad.0b013e328340a209
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发表时间：
2010-11-27
期刊：
影响因子：
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通讯作者：
Deeks SG
中科院分区：
文献类型：
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作者：
Bangsberg DR;Ragland K;Monk A;Deeks SG
虽然单片方案（STR）依法韦仑、恩曲西滨和富马酸替诺福韦酯（EFV/FTC/TDF）可能对不依从性高风险的HIV感染者有吸引力，但这种简化制剂对依从性的影响程度尚不清楚。考虑到这些药物的耐药性快速选择性，这种STR在潜在非依从人群中的病毒学有效性仍然是一个问题。我们进行了一项前瞻性观察性研究，评估了一组无家可归者和边缘居住者对EFV/FTC/TDF STR的依从性和病毒学应答。我们将依从性和病毒抑制与同一队列中的历史对照进行了比较。在控制多种混杂因素后，EFV/FTC/TDF STR方案的依从性高于非一丸每日一次治疗（p=0.0060）。EFV/FTC/TDF STR方案的病毒抑制（HIV RNA <50 c/ml）高于非每日一片方案（69.2% vs 46.5%; p=0.02），但在控制依从性后，病毒抑制无差异。每日一次EFV/TNF/FTC STR似乎是有多种依从性障碍的个体的合理选择。需要针对该患者人群的各种治疗策略进行随机临床试验。
Although, single tablet regimen (STR) efavirenz, emtricibine, and tenofovir disoproxil fumarate (EFV/FTC/TDF) may be appealing in HIV infected persons who are at high risk for non-adherence, the degree to which this simplified formulation affects adherence is not known. The virologic effectiveness of this STR in a potentially non-adherent population remains a concern, given the rapid selection of drug-resistance seen with these drugs. We performed a prospective observational study assessing adherence and virologic response to EFV/FTC/TDF STR among a cohort of homeless and marginally housed individuals. We compared adherence and viral suppression to historical controls followed in the same cohort. Adherence was higher in EFV/FTC/TDF STR regimen compared to non-one-pill once daily therapy (p=0.0060) after controlling for multiple confounders. Viral suppression (HIV RNA <50 c/ml) was greater in EFV/FTC/TDF STR than non-one pill daily regimens (69.2% vs 46.5%; p=0.02), but there was no difference in viral suppression after controlling for adherence. Once daily EFV/TNF/FTC STR appears to be a reasonable option for individuals with multiple barriers to adherence. Randomized clinical trials addressing various therapeutic strategies for this patient population are needed.