Effectiveness and tolerance of single tablet versus once daily multiple tablet regimens as first-line antiretroviral therapy - Results from a large french multicenter cohort study.
OBJECTIVE
Pill burden during antiretroviral treatment (ART) is associated with worse adherence and impaired virological suppression. We compared the effectiveness, tolerance, and persistence on treatment of single tablet regimens (STRs) with non-STR once-daily regimens in patients receiving first-line ART.


METHODS
Retrospective analysis of naïve HIV-1 infected patients prospectively enrolled in the French Dat'AIDS cohort and initiating first-line ART with STRs or once-daily non-STRs from 2004 to 2013. The primary outcome was time to treatment discontinuation defined by any change in the treatment regimen. STR and non-STR groups were compared controlling for baseline risk factors by inverse probability weighted treatment Cox analysis (IPWT) and propensity-score matching (PSM).


RESULTS
Overall, 3212 patients (STR 499, non-STR 2713) were included. Median time to treatment discontinuation was shorter in non-STR patients than in STR patients, both in the IPWT (HR = 0.61, p<0.0001) and the PSM cohort (HR = 0.55, p<0.0001). This difference disappeared when censoring ART modification for simplification, both in the IPWT (HR = 0.97, p = 0.65) and the PSM cohort (HR = 0.91, p = 0.33). A lower rate of virological failure was observed with STRs than with non-STRs in both cohorts (HR = 0.23; p = 0.002 and HR = 0.22, p = 0.003, respectively). A lower rate of treatment modification for adverse event was observed with non-STRs in the IPWT cohort (HR = 1.46, p<0.0001), but not in the PSM cohort (HR = 1.22, p = 0.11).


CONCLUSIONS
First-line therapy with STRs was associated with a longer time to treatment discontinuation than with non-STRs. However, when ART modification for simplification was not considered as a failure, STRs and non-STRs were similar.
Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.|INSERM U1052, Lyon, France.
Laurent
L
Cotte
Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
Tristan
T
Ferry
Department of Infectious Diseases, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet, Nice, France.
Pascal
P
Pugliese
Department of Infectious Diseases, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France.|Sorbonne University, UPMC University, Paris, France.|INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.
Marc-Antoine
MA
Valantin
Department of Infectious Diseases, Hôtel Dieu, Nantes, France.
Clotilde
C
Allavena
Department of Infectious Diseases, CHU de Martinique, Fort-de-France, France.|Université des Antilles EA4537, Fort-de-France, France.|INSERM CIC1424, Fort-de-France, France.
André
A
Cabié
Immuno-hematology clinic, Assistance Publique - Hôpitaux de Marseille, Hôpital Sainte-Marguerite, Marseille, France.|Aix-Marseille University, Marseille, France.|INSERM U912 (SESSTIM), Marseille, France.
Isabelle
I
Poizot-Martin
HIV Infection Care Centre, Hôpitaux Universitaires, Strasbourg, France.
David
D
Rey
Department of Infectious Diseases, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Assistance Publique - Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France.|Université Paris Descartes, Sorbonne Paris Cité, EA7327, Paris, France.
Claudine
C
Duvivier
Université Paris Descartes, Sorbonne Paris Cité, EA7327, Paris, France.|Department of Internal Medicine, Centre Hospitalier Universitaire, Bicètre, France.
Antoine
A
Cheret
Department of Infectious Diseases, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet, Nice, France.
Pierre
P
Dellamonica
INSERM U1052, Lyon, France.|Center for Clinical Research, Department of Hepatology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
Pierre
P
Pradat
Department of Infectious Diseases, Côte de Nacre University Hospital, Caen, France.|Department of Biostatistics, Côte de Nacre University Hospital, Caen, France.
Jean-Jacques
JJ
Parienti
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D004334:Drug Administration Schedule; D005260:Female; D005602:France; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D008297:Male; D012189:Retrospective Studies
D019380:Anti-HIV Agents