title: Persistence and adherence to single-tablet regimens in HIV treatment: a cohort study from the French National Healthcare Insurance Database.
abstract: OBJECTIVE
  To compare adherence and persistence (continuous treatment with a prescribed medication) in HIV adult patients who received combination ART (cART) as a once-daily single-tablet regimen (STR) versus other administration schedules.
  
  
  METHODS
  A representative random sample of the French National Healthcare Insurance Database was used. Adherence and persistence were compared according to their administration schedules using χ(2) and survival analyses. STRs were marketed in France in 2009 and the study period was selected to allow a sufficient number of patients with an STR and a relevant duration of follow-up.
  
  
  RESULTS
  During the period covered (2006-11), 362 HIV-positive adult antiretroviral-naive patients (566 lines of treatments) were selected. The mean rates of adherence were 89.6% for the STR (tenofovir/emtricitabine/efavirenz; n = 76), 86.4% for cART with >1 pill once daily (n = 242) and 77.0% for cART with >1 daily intake (n = 248; P < 0.0001 versus STR). Kaplan-Meier estimations of persistence after 2 years of treatment were 79.1% for the STR, 53.3% for cART with >1 pill once daily and 51.8% for cART with >1 daily intake (P = 0.001; log-rank test). Sensitivity analyses confirmed these results. After excluding treatment sequences showing a switch from tenofovir/emtricitabine plus efavirenz to the similar STR, the rates of persistence were 80.3% for the STR (n = 60), 77.3% for atazanavir-containing cART (n = 96) and 68.3% for darunavir-containing cART (n = 56) at 18 months (global P = 0.006).
  
  
  CONCLUSIONS
  These results suggest that persistence is higher in HIV patients treated with an STR compared with other administration schedules. Significant benefit in terms of adherence was observed with the STR in comparison with regimens with >1 daily intake but no difference was observed when comparing with regimens involving >1 pill once daily.
authors.affiliation: Department of Infectious Diseases, University Hospital, Nantes, France.
authors.forename: François
authors.initials: F
authors.lastname: Raffi
authors.affiliation: ATIP-AVENIR Inserm 'Modélisation, Aide à la Décision, et Coût-Efficacité en Maladie Infectieuses', IAME, UMR 1137 INSERM, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Paris, France.
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
authors.affiliation: Cemka Eval, Bourg-la-Reine, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Fagnani
authors.affiliation: Cemka Eval, Bourg-la-Reine, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Laurendeau
authors.affiliation: Cemka Eval, Bourg-la-Reine, France antoine.lafuma@cemka.fr.
authors.forename: Antoine
authors.initials: A
authors.lastname: Lafuma
authors.affiliation: UMS011 INSERM - UVSQ 'Cohortes en population', Hôpital Paul Brousse, Villejuif, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Gourmelen
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D005260:Female; D005602:France; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011897:Random Allocation; D012189:Retrospective Studies; D012494:Sampling Studies; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: ART; HIV infection; antiretroviral treatment; fixed-dose combinations