This article previously appeared on Aidsmap.com’s HIV Update. For a more complete account bu Gus Cairns go here.
HIV treatment usually involves taking a combination of three or four different anti-HIV drugs. But more than one drug may be combined into a single tablet, which may make it easier to take.
For example, a tablet called Atripla combines three drugs which can also be taken as separate pills – tenofovir, emtricitabine and efavirenz. Whether the drugs are taken separately or as Atripla, they should be taken once a day. But doctors disagree on whether people are more likely to take their HIV treatment in the right way (often called ‘adherence’) if the numbers of pills is reduced in this way.
A new analysis has re-examined data from previous studies to see whether people have better results when they are prescribed the single-tablet regimen Atripla, compared to people given the three component drugs as separate pills.
In terms of ‘virological failure’, in other words viral load that was not undetectable, results were the same, regardless of the number of pills a person was taking. Virological failure happened to around one-in-five people.
But there was a difference in the time to virological failure. When it happened, it occurred quicker to people taking separate pills (average seven months after starting treatment) than to people on Atripla (average twelve months). In addition, those prescribed separate pills were more likely to have drug-resistant virus than those on Atripla.
This isn’t the first study to look at whether results are better when people are taking fewer pills. For example, we’ve reported on other studies in October 2012, October 2013 and February 2014. Different studies have looked at different kinds of outcomes – including having an undetectable viral load, taking pills regularly and needing to go to hospital – and the results have varied. But several have shown slightly better results when fewer pills are taken.
On the other hand, pharmaceutical companies sometimes charge the NHS a much higher price for tablets which combine several drugs in one, such as Atripla. Giving patients the same drugs but in separate pills usually costs less money. This is especially the case when the separate pills are available from other pharmaceutical companies as generic drugs.
NHS doctors and managers need to decide whether the benefits of the more expensive versions are worth the extra expense.