Maintenance ART Regimen Improves QoL in Patients With Controlled HIV-1

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Benefits of 4-days-a-week maintenance antiretroviral therapy include cost reduction and lower long-term toxicity.
Benefits of 4-days-a-week maintenance antiretroviral therapy include cost reduction and lower long-term toxicity.

In virologically controlled adults infected with human immunodeficiency virus 1 (HIV-1), antiretroviral maintenance therapy administered 4 days per week was shown to be effective in 96% of individuals, according to the results of a recent study published in the Journal of Antimicrobial Chemotherapy.

Researchers enrolled 100 patients (82% men; median age 47 years; mean CD4 T-cell count 665 cell/mm3) who had a viral load <50 copies/mL for at least 1 year and were receiving a stable regimen including a ritonavir-boosted protease inhibitor (PI; n=29) or a non-nucleoside reverse transcriptase inhibitor (NNRTI; n=71). Participants stayed on the same treatment combination but took the pills for 4 consecutive days followed by a 3-day interruption for 48 weeks. Biological and clinical evaluations were performed throughout the study.

At week 48, 4-days-a-week maintenance therapy was successful in 96% of participants.

Of the 4 patients with treatment failure, 3 cases of virologic failure occurred at week 4 (viral load: 271 copies/mL, confirmed at 785 copies/mL; PI-based therapy), week 12 (viral load: 124 and 55 copies/mL; NNRTI-based therapy), and week 40 (viral load: 969 and 227copies/mL; PI-based therapy). One participant discontinued the treatment strategy.

Between 90.4% and 98.8% of patients had self-reported adherence of >90% at each visit. In a subgroup of patients who received a Medication Event Monitoring System capped-container, bottle opening was consistent with the 4-days-a-week regimen in 89.9% to 96.9% of patients.

Most patients (78.6%) were fully satisfied with the 4-days-a-week treatment strategy at week 48. Furthermore, scores in 3 of the 8 health-related quality of life domains improved over the course of the study: stigma (P =.02), health concerns (P =.02), and treatment impact (P =.001).

The study authors noted that the benefits of 4-days-a-week maintenance therapy include cost reduction and lower long-term toxicity. They concluded that "the 96% success rate observed here at [week 48] with a 4-days-a-week antiretroviral regimen compares favourably with other triple-agent maintenance strategies and simplified regimens (PI/r monotherapy or dual combinations), for which 1 year success rates ranged from 65% to 88%."

Reference

de Truchis P, Assoumou L, Landman R, et al; ANRS 162-4D Study Group. Four-days-a-week antiretroviral maintenance therapy in virologically controlled HIV-1-infected adults: the ANRS 162-4D trial [published online November 25, 2017]. J Antimicrob Chemother. doi: 10.1093/jac/dkx434

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