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Improving Adherence in HIV Treatment with Once-Daily Therapies

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  • 1. The Problem of Nonadherence Initial Results with Diabetes and Hypertensive Patients Initial Results with HIV/AIDS Drugs 3/29/2009 1
  • 2. The risk of virologic failure rises with  noncompliance (N=161 HIV-infected women)* 17% virologic failure with 88% or greater compliance with  drug regimen  72% virologic failure with 12% or less compliance Predictors of nonadherence to regimen  Active drug use, alcohol use   More frequent antiretroviral dosing Improving long-term adherence in women should  be a public health priority *Howard AA, et al. AIDS. 2002;16:2175-82. 3/29/2009 2
  • 3. Suboptimal adherence is a strong predictor of  treatment failure Inconvenient treatment regimens are factors  associated with poor adherence Frank I, JAIDS. 2002;31:S10–S15 3/29/2009 3
  • 4. Frank I, JAIDS. 2002;31:S10–S15 3/29/2009 4
  • 5. OD Therapy Improves Adherence  Adherence indices rates were 60.5% in the OD cohort  (n = 746) and 52% in the BID cohort (n = 246)  At 12 months, these dropped to 44.4% (OD) and 35.8% (BID) Dezii DM, et al. South Med J. 2002;95(1):68-71. 3/29/2009 5
  • 6. Methods such as drug regimen simplification 1. should be aggressively sought to improve adherence. Improved adherence rates may be achieved with a 2. once-daily regimen despite a higher pill burden. Once-daily pharmacotherapy results in higher 3. adherence and persistence with therapy compared with a twice-daily regimen. Dezii DM, et al. South Med J. 2002;95(1):68-71. 3/29/2009 6
  • 7. Overall compliance was 98.9% with OD  therapy, and 97.5% with BID therapy (n = 133) 2.6% missed doses in the OD group, and 3.3%  missed doses in the BID group Blood pressure normalized (<140 mm Hg  systolic and <90 mm Hg diastolic) in 41% of the OD patients and 27% of the BID patients Andrejak M, et al. Am J Hypertens. 2000;13:184–190. 3/29/2009 7
  • 8. Patients (n = 69) with viral loads of <50 HIV-1  RNA copies/mL were switched after 2 years of therapy on BID saquinavir soft-gelatin capsules (SQV-SGC) (1400 mg) plus zidovudine/ lamivudine or didanosine/stavudine to OD SQV-SGC/RTV (1600/100 mg) with continuing nucleoside reverse transcriptase inhibitors (NRTIs). Cardiello PG, et al. JAIDS. 2002;29:464–470. 3/29/2009 8
  • 9. 93% (n = 64) had plasma viral loads of <50  copies/mL 24 weeks after switching regimens 5 patients had plasma viral loads of <300 copies/mL  Median CD4 cell count increased from 534/mL  to 695/mL in the 24 weeks (p < .001) since switching to OD treatment Cardiello PG, et al. JAIDS. 2002;29:464–470. 3/29/2009 9
  • 10. The data suggests that the combination of SQV-  SGC/RTV (1600/100 mg) once daily plus two NRTIs may be a realistic option to simplify PI-containing therapy and   improve compliance in a select group of HIV-1– infected patients with plasma viral loads of <50 copies/mL. Cardiello PG, et al. JAIDS. 2002;29:464–470. 3/29/2009 10
  • 11. Adherence remains one of the greatest  challenges for patients receiving antiretroviral treatment Increased simplification of treatment regimens  should assist in improving the long-term adherence to therapy and maintaining treatment efficacy Frank I, JAIDS. 2002;31:S10–S15. 3/29/2009 11
  • 12. In the future, once-daily regimens will become  the standard of care for HIV infection Several currently available antiretroviral drugs  can be used once daily, or   have the pharmacokinetic potential for once-daily dosing, and  others are in development Frank I, JAIDS. 2002;31:S10–S15. 3/29/2009 12
  • 13. 1. Gifford AL, Bormann JE, Shively MJ, Wright, BC, Richman DD, Bozzette SA: Predictors of self- reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens. JAIDS. 2000;23:386–395. 2. Howard AA, Arnsten JH, Yungtai L,Vlahov D, et al; for HER Study Group. A prospective study of adherence and viral load in a large multi-center cohort of HIV-infected women. AIDS. 2002;16:2175–2182. 3. Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133:21–30. 4. Mannerheimer S, Friedland G, Matts J, et al. Self-reported antiretroviral adherence correlates with HIV viral load and declines over time [abstract TuOrB421]. Abstract presented at the XIII International AIDS Conference; Durban, South Africa; July 9–14, 2000; Abstracts-On-Disk, XIII International AIDS Conference [CD-ROM] published by Merck Sharp & Dohme. 3/29/2009 13
  • 14. 5. Dezii CM, Kawabata H, Tran M: Effects of once-daily and twice-daily dosing on adherence with prescribed glipizide oral therapy for type 2 diabetes. South Med J. 2002;95(1):68-71. 6. Andrejak M. Electronic Pill-Boxes in the Evaluation of Antihypertensive Treatment Compliance: Comparison of Once Daily Versus Twice Daily Regimen. Am J Hypertens. 2000;13:184–190. 7. Cardiello PG, et al. Simplifying protease inhibitor therapy with once-daily dosing of saquinavir soft-gelatin capsules/ritonavir (1600/100 mg): HIVNAT 001.3 study. JAIDS. 2002;29:464–470. 8. Frank I. Once-daily HAART: toward a new treatment paradigm. JAIDS. 2002;31:S10–S15. 3/29/2009 14