Switching from a two-tablet regimen of tenofovir/emtricitabine and efavirenz to a one-tablet regimen may affect patients' perceptions and drug management

HIV Med. 2016 May;17(5):390-6. doi: 10.1111/hiv.12345. Epub 2015 Dec 21.

Abstract

Objectives: Simplification of antiretroviral therapy enhances a patient's adherence but a new formulation could also lead to new adverse events and changes in daily routine. This study compared medication adherence, tolerance and satisfaction among subjects switching from a two-tablet tenofovir/emtricitabine/efavirenz regimen to a one-tablet regimen.

Methods: Clinical and sociodemographic data were collected and three surveys were administered at month 0 (=switch), and then 1 and 4-6 months after the switch: the Beliefs about Medicines Questionnaire, the HIV-symptom index questionnaire, the Short HIV Treatment Satisfaction Questionnaire, the Swiss HIV Cohort Study (SHCS) two-item adherence questionnaire, and a questionnaire on daily combination antiretroviral therapy (cART) management. Medication adherence of a subgroup of subjects was routinely monitored using an electronic device (MEMS(™) ).

Results: Eighty-eight subjects gave informed consent to participate in the study. The subjects' back-switch rate was 7% (six of 88). Subjects who did not back-switch preferred the one-tablet regimen (median = 2; IQR = 1.3-2.5; on a -3 to 3 scale), but no change in adherence was found (10 of 46 nonadherent subjects; P = 1.00). The perception of treatment necessity score decreased (P = 0.004), the efavirenz blood level increased (14%; P = 0.04), and association/dissociation of cART with food intake evolved (P = 0.01) after the switch. Subjects listed equivalent numbers of symptoms during the three visits.

Conclusions: The one-tablet regimen was preferred but the number of back-switches was not negligible. The perception of treatment necessity score decreased with the simplification of the regimen from a two-tablet to a one-tablet formulation, which could negatively impact adherence. Switching is a sensitive time in a patient's treatment life and professionals should pay particular attention to patient's perceptions of treatment during such a transition.

Keywords: HIV; combination; drug therapy; efavirenz; medication adherence; medication therapy management; patient beliefs; regimen simplification; tenofovir.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alkynes
  • Benzoxazines / administration & dosage*
  • Benzoxazines / therapeutic use
  • Cohort Studies
  • Cyclopropanes
  • Drug Administration Schedule
  • Drug Combinations
  • Emtricitabine / administration & dosage*
  • Emtricitabine / therapeutic use
  • Female
  • HIV Infections / drug therapy*
  • Health Surveys
  • Humans
  • Male
  • Medication Adherence* / statistics & numerical data
  • Middle Aged
  • Patient Satisfaction* / statistics & numerical data
  • Prospective Studies
  • Tablets
  • Tenofovir / administration & dosage*
  • Tenofovir / therapeutic use
  • Treatment Outcome

Substances

  • Alkynes
  • Benzoxazines
  • Cyclopropanes
  • Drug Combinations
  • Tablets
  • Tenofovir
  • Emtricitabine
  • efavirenz