title: Systematic review and meta-analysis: Patient and programme impact of fixed-dose combination antiretroviral therapy.
abstract: OBJECTIVE
  To compare the advantages to patients and to programmes between fixed-dose combination (FDC) antiretroviral therapy and separate tablet regimens.
  
  
  METHODS
  Three electronic databases and two conference abstract sites were searched from inception to 01 March 2013 without geographical, language or date limits. Studies were included if they reported data on clinical outcomes, patient-reported outcomes and programme-related outcomes that could be related to pill burden for adult and adolescent patients on ART. For the primary outcomes of adherence and virological suppression, relative risks and 95% confidence intervals were calculated, and these were pooled using random effects meta-analysis.
  
  
  RESULTS
  Twenty-one studies including information on 27,230 subjects were reviewed. Data from randomised trials showed better adherence among patients receiving FDCs than among patients who did not (relative risk 1.10, 95%CI 0.98-1.22); these findings were consistent with data from observational cohorts (RR 1.17, 95% CI 1.07-1.28). There was also a tendency towards greater virological suppression among patients receiving FDCs in randomised trials (RR 1.04, 95%CI 0.99-1.10) and observational cohort studies (RR 1.07, 95% CI 0.97-1.18). In all studies reporting patient preference, FDCs were preferred. The overall quality of the evidence was rated as low.
  
  
  CONCLUSIONS
  Fixed-dose combinations appear to offer multiple advantages for programmes and patients, particularly with respect to treatment adherence.
authors.affiliation: Department of Infectious Diseases, Faculty of Medicine, Imperial College, London, UK.
authors.forename: Rubeena
authors.initials: R
authors.lastname: Ramjan
authors.forename: Alexandra
authors.initials: A
authors.lastname: Calmy
authors.forename: Marco
authors.initials: M
authors.lastname: Vitoria
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
authors.forename: Andrew
authors.initials: A
authors.lastname: Hill
authors.forename: Graham
authors.initials: G
authors.lastname: Cooke
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods / Q000706:statistics & numerical data*; D004338:Drug Combinations; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic
chemical_list: D019380:Anti-HIV Agents; D004338:Drug Combinations
keywords: adherence; antiretrovirals; fixed-dose combinations; virological suppression