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

Weston Malek, Jenna Yager, Nicholas Britt, Caroline Morse, Zachary Hecox, Adam Hoye-Simek, Steven Sullivan and Nimish Patel

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.

Methods and findings: A retrospective cohort study, employing repeated subject sampling, was performed among adult HIV-infected Veterans’ Affairs patients who received antiretroviral therapy within the Upstate New York Veterans’ Affairs Healthcare Network. Inclusion criteria were: 1) age ≥ 18 years, 2) documentedHIV-infection, 3) antiretroviral therapy for ≥ 3 months with ≥ 3 active agents, and 4) baseline and on-treatment measurements of blood pressure, glucose, lipid laboratory values or any combination thereof. Data collected for each subject included demographics, comorbidities, medication history and select laboratory values. The primary outcomes of this study were control of blood pressure, glucose and/or lipids, defined using national guidelines. There were a total of 1,202 subjects who received either a STR (n=165; 13.7%) or MTR (n=1,037; 86.3%). The mean ± standard deviation (SD) age of subjects was 50.6 ± 8.9 years. In the multivariate analyses, significant differences were not observed in either achieving or maintaining control of any of the cardiometabolic comorbidities evaluated between recipients of STRs and MTRs after adjustment for outcomespecific confounding variables.

Conclusion: For all study endpoints, there did not appear to be meaningful differences between STR/MTRs and patients’ ability to achieve control of HIV comorbidities after adjustment for confounding factors. Future studies should seek to further evaluate the impact of ART regimen type on both HIV and non-HIV health outcomes as newer STR products are adopted into standard practice.