Better Adherence with Once‐Daily Antiretroviral Regimens: A Meta‐Analysis

Parienti, Jean Jacques; Bangsberg, David R.; Verdon, Renaud; Gardner, Edward M.

doi:10.1086/596482

Cited by 217 publications

(180 citation statements)

References 24 publications

(35 reference statements)

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“…Care should also be taken to ensure the patient can adhere to the regimen by reducing "pill burden." Oncedaily regimens are associated with better adherence [3].…”

Section: Clinical Use Of Arv Drugs (Arvs)mentioning

confidence: 99%

A Review of the Toxicity of HIV Medications

et al. 2013

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Antiretroviral therapy has changed human immunodeficiency virus (HIV) infection from a near-certainly fatal illness to one that can be managed chronically. More patients are taking antiretroviral drugs (ARVs) for longer periods of time, which naturally results in more observed toxicity. Overdose with ARVs is not commonly reported. The most serious overdose outcomes have been reported in neonates who were inadvertently administered supratherapeutic doses of HIV prophylaxis medications. Typical ARV regimens include a "backbone" of two nucleoside reverse transcriptase inhibitors (NRTI) and a "base" of either a protease inhibitor (PI) or nonnucleoside reverse transcriptase inhibitor. New classes of drugs called entry inhibitors and integrase inhibitors have also emerged. Older NRTIs were associated with mitochondrial toxicity, but this is less common in the newer drugs, emtricitabine, lamivudine, and tenofovir. Mitochondrial toxicity results from NRTI inhibition of a mitochondrial DNA polymerase. Mitochondrial toxicity manifests as myopathy, neuropathy, hepatic failure, and lactic acidosis. Routine lactate assessment in asymptomatic patients is not indicated. Lactate concentration should be obtained in patients taking NRTIs who have fatigue, nausea, vomiting, or vague abdominal pain. Mitochondrial toxicity can be fatal and is treated by supportive care and discontinuing NRTIs. Metabolic cofactors like thiamine, carnitine, and riboflavin may be helpful in managing mitochondrial toxicity. Lipodystrophy describes changes in fat distribution and lipid metabolism that have been attributed to both PIs and NRTIs. Lipodystrophy consists of loss of fat around the face (lipoatrophy), increase in truncal fat, and hypertriglyceridemia. There is no specific treatment of lipodystrophy. Clinicians should be able to recognize effects of chronic toxicity of ARVs, especially mitochondrial toxicity.

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“…Care should also be taken to ensure the patient can adhere to the regimen by reducing "pill burden." Oncedaily regimens are associated with better adherence [3].…”

Section: Clinical Use Of Arv Drugs (Arvs)mentioning

confidence: 99%

A Review of the Toxicity of HIV Medications

et al. 2013

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“…There is significant variability among MTR regimens by drugs included and frequency of dosing regimen. Differences in adherence have previously been observed between MTR regimens dosed once and twice daily [18]. Our study did not assess the impact of this varying regimen complexity, particularly adherence, within the MTR population, as no significant differences in comorbidity control were observed between STR and MTR populations in bivariate analysis.…”

Section: Discussionmentioning

confidence: 82%

“…Thus, comorbidity control should not be the sole deciding factor for clinicians to prescribe a STR or MTR. However, previous studies have observed patient preference for STRs, resulting in improved outcomes [3,9,17,18]. Ultimately, consideration of patients' motivation and virologic control should still be primary factors for clinicians selecting an ART regimen.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes Associated with Single Tablet Regimens: Relationship between Antiretroviral Therapy Pill Burden and Control of Concomitant Comorbidities among HIV-Infected Patients

Malek¹,

Yager²,

Britt³

et al. 2017

J HIV Retrovirus

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Background: There is limited understanding of the relationship between single tablet regimen (STR) use and non-HIV related health outcomes among patients with HIV infection. It is unclear if STR use may assist HIV-infected patients with comorbidity control. The purpose of the present study was to compare the frequency of achieving or maintaining cardiometabolic comorbidity control between STR and multiple tablet regimen (MTR) recipients.

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“…This practice, known as "boosting," allows for a higher steady state concentration and prolonged half-life of the primary PI with fewer doses of medication and once daily dosing, thereby reducing the pill burden and improving adherence. Similarly, cobicistat, a CYP3A4 inhibitor without anti-HIV activity, inhibits elvitegravir (INSTI) metabolism and enhances its pharmacokinetic profile [6]. The same principle of inhibition applies to co-ingestion of HIV and non-HIV medications.…”

Section: Antiretroviral Therapy and Cytochrome P450mentioning

confidence: 99%

A Review of the Toxicity of HIV Medications II: Interactions with Drugs and Complementary and Alternative Medicine Products

et al. 2015

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For many patients today, HIV has become a chronic disease. For those patients who have access to and adhere to lifelong antiretroviral (ARV) therapy, the potential for drugdrug interactions has become a real and life-threatening concern. It is known that most ARV drug interactions occur through the cytochrome P450 (CYP) pathway. Medications for comorbid medical conditions, holistic supplements, and illicit drugs can be affected by CYP inhibitors and inducers and have the potential to cause harm and toxicity. Protease inhibitors (PIs) tend to inhibit CYP3A4, while most nonnucleoside reverse transcriptase inhibitors (NNRTIs) tend to induce the enzyme. As such, failure to adjust the dose of coadministered medications, such as statins and steroids, may lead to serious complications including rhabdomyolysis and hypercortisolism, respectively. Similarly, gastric acid blockers can decrease several ARV absorption, and warfarin doses may need to be adjusted to maintain therapeutic concentrations. Illicit drugs such as methylenedioxymethamphetamine (MDMA, "ecstasy") in combination with PIs lead to increased toxicity, while the concomitant administration of sedative drugs such as midazolam and alprazolam in patients taking PIs can result in prolonged sedation, delayed recovery, and increased length of stay. Even supplements like St. John's Wort can alter PI concentrations. In theory, any drug that is metabolized by CYP has potential for a pharmacokinetic drug-drug interaction with all PIs, cobicistat, and most NNRTIs. When adding a new medication to an ARV regimen, use of a drug-drug interaction software and/or consultation with a clinical pharmacist/pharmacologist or HIV specialist is recommended.

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Better Adherence with Once‐Daily Antiretroviral Regimens: A Meta‐Analysis

Cited by 217 publications

References 24 publications

A Review of the Toxicity of HIV Medications

A Review of the Toxicity of HIV Medications

Clinical Outcomes Associated with Single Tablet Regimens: Relationship between Antiretroviral Therapy Pill Burden and Control of Concomitant Comorbidities among HIV-Infected Patients

A Review of the Toxicity of HIV Medications II: Interactions with Drugs and Complementary and Alternative Medicine Products

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