Antiretroviral pill count and clinical outcomes in treatment-naïve patients with HIV infection. HIV Medicine
Young et al. assessed whether the one-pill combination of efavirenz, emtricitabine and tenofovir reduces the risk of AIDS or death in treatment-naïve HIV-infected patients starting ART compared with two- or three-pill formulations of the same regimen. The analysis was based on data from the Antiretroviral Therapy Cohort Collaboration (ART-CC) of observational HIV-infected cohorts from Europe and Northern America to predict the potential consequences of exposing a future population to either a one-pill regimen or a three-pill regimen.
Among 11’739 treatment-naïve patients starting the regimen, there were 386 AIDS events and 87 deaths. Follow-up often ended when patients switched to the same regimen with fewer pills. After the first month, two pills rather than one was associated with an increase in the risk of AIDS or death [hazard ratio (HR) 1.39; 95% confidence interval (CI) 1.01-1.91], but three pills rather than two did not appreciably add to that increase (HR 1.19; 95% CI 0.84-1.68). The authors estimated that 77 patients would need to be exposed to a one-pill regimen rather than a three-pill regimen for 1 year to avoid one additional AIDS event or death.
In conclusion, the study-results show that the one-pill combination of efavirenz, emtricitabine and tenofovir was associated with a modest decrease in the risk of progression to AIDS or death compared with two- or three-pill formulations of the same regimen. However, the authors conclude that this does not imply that a single tablet regimen should be used rather than a multiple-pill formulation of the same regimen using generic drugs. Rather, the authors provided statistics that could be used to evaluate whether single tablet regimen are more cost-effective than other formulations.