Effectiveness of antiretroviral therapy in the single-tablet regimen era

• Published in: Revista de saúde pública 2018-11, Vol.52, p.87-87
• Main Authors: Costa, Juliana de Oliveira, Ceccato, Maria das Graças Braga, Silveira, Micheline Rosa, Bonolo, Palmira de Fátima, Reis, Edna Afonso, Acurcio, Francisco de Assis
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anti-HIV Agents - administration & dosage; Antiretroviral Therapy, Highly Active; Brazil; Cohort Studies; Drug Combinations; Evaluation of the Efficacy-Effectiveness of Interventions; Female; Follow-Up Studies; Health Policy & Services; HIV Infections - drug therapy; HIV Infections - virology; Humans; Life Style; Male; Middle Aged; Original; Prospective Studies; Viral Load - drug effects; Young Adult
• ISSN: 0034-8910; 1518-8787; 1518-8787
• DOI: 10.11606/S1518-8787.2018052000399

To evaluate the effectiveness of antiretroviral therapy and the associated factors according to the type of regimen used: Single Tablet Regimen or Multiple Tablet Regimen. Prospective cohort of 440 patients (male, 74.3%, median age, 36 years old) who initiated antiretroviral therapy between Jan/14 and Dec/15 at a referral service in Belo Horizonte. Efficacy was defined as viral suppression (viral load, VL < 50 copies/ml) and evaluated after six and twelve months of treatment. Sociodemographic, clinical and behavioral data were collected from clinical charts and from Information Systems. Multivariate analysis of overall effectiveness was performed by logistic regression. Most patients initiated Multiple Tablet Regimen antiretroviral therapy (n = 255, 58%). At six months, overall viral suppression was 74.6%, being higher among patients who used Single Tablet Regimen (80.6%, p = 0.04). At twelve months, 83.2% of patients reached viral suppression, with no difference between groups (p = 0.93). Factors independently associated with viral suppression at six and twelve months varied, being negatively associated with effectiveness: VL ≥ 100,000 copies/ml, symptoms of AIDS, longer interval time between diagnosis and initiation of antiretroviral therapy, antiretroviral switching, smoking or current illicit drugs usage (p < 0.05). Factors positively associated with viral suppression included adherence to antiretroviral therapy and category of risk/exposure of men who have sex with men (p < 0.05). Reaching viral suppression at six months was the main predictor of effectiveness at one year (OR = 8.96 and p < 0.01). Viral suppression was high and better results were achieved for patients who used Single Tablet Regimen regimens at six months. Clinical, behavioral, and antiretroviral therapy -related factors influence viral suppression and highlight the need for interventions to increase early diagnosis and initiation of antiretroviral therapy, patient's adherence, and to reduce illicit drugs and cigarette smoking in this population.