Treatment simplification in HIV-infected adults as a strategy to prevent toxicity, improve adherence, quality of life and decrease healthcare costs

Abstract

Jean B Nachega1–3, Michael J Mugavero4, Michele Zeier2, Marco Vitória5, Joel E Gallant3,61Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 2Department of Medicine and Centre for Infectious Diseases (CID), Stellenbosch University, Faculty of Health Sciences, Cape Town, South Africa; 3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 4Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; 5HIV Department, World Health Organization, Geneva, Switzerland; 6Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USAAbstract: Since the advent of highly active antiretroviral therapy (HAART), the treatment of human immunodeficiency virus (HIV) infection has become more potent and better tolerated. While the current treatment regimens still have limitations, they are more effective, more convenient, and less toxic than regimens used in the early HAART era, and new agents, formulations and strategies continue to be developed. Simplification of therapy is an option for many patients currently being treated with antiretroviral therapy (ART). The main goals are to reduce pill burden, improve quality of life and enhance medication adherence, while minimizing short- and long-term toxicities, reducing the risk of virologic failure and maximizing cost-effectiveness. ART simplification strategies that are currently used or are under study include the use of once-daily regimens, less toxic drugs, fixed-dose coformulations and induction-maintenance approaches. Improved adherence and persistence have been observed with the adoption of some of these strategies. The role of regimen simplification has implications not only for individual patients, but also for health care policy. With increased interest in ART regimen simplification, it is critical to study not only implications for individual tolerability, toxicity, adherence, persistence and virologic efficacy, but also cost, scalability, and potential for dissemination and implementation, such that limited human and financial resources are optimally allocated for maximal efficiency, coverage and sustainability of global HIV/AIDS treatment.Keywords: ART, simplification, adherence, persistence, once-daily, coformulations, healthcare cost, quality of lifeVideo Abstract: http://dvpr.es/nachega