Virology

Biography

Biography: Yohanna Kambai Avong

Abstract

Background There are mixed reports on the effectiveness of fixed-dose combination (FDC) anti-retroviral medications at enhancing adherence to medications. However, some countries have completely replaced the single-drug combinations (SDCs) antiretroviral medications with the FDC, which limit treatment options and promote poly-pharmacy with attendance drug-drug interactions and additive toxicities. We investigated whether the FDCs have superior adherence effects and virologic suppression over the SDCs, to warrant their exclusive retention in anti-retroviral therapy (ART) formularies. Methods We included 501 HIV/AIDS patients (≥18 years), prescribed FDCs and SDCs at the University of Abuja Teaching Hospital, Nigeria, over a five year period (from April 2005 to May 2010). The FDCs contained three drugs with a daily pill burden of two pills while the SDCs contained a combination of single drugs and dual fixed dose combinations with daily pill burden of eight pills. Self-reported adherence to ART was defined as taking at least 95% of medication in correct doses, frequency and schedule of administration over the previous three days. Virologic suppression was defined as achieving a HIV-1 RNA of 400 copies/mL. Propensity score method was used to make sure treatments were randomly assigned in the two cohorts and logistic regression applied to compare rates of adherence to ART and virologic suppression across the two cohorts. Results: 501 patients were prescribed either FDC [206(41.2%)] or SDC [295(58.8%)]; majority of the females compared with males were FDC users [123(48.4%) vs 83(33.6%); p <0.001)]. Most of SDC users had secondary education [105(60.4%) vs 69(39.6%)], were married [181(59.9%) vs 121(40.1%)] and had informal employment [174(61.3% vs 110 (38.7%) compared with the FDC users. Most of the FDCs users were on therapy for more than 48months [127(64.5%) vs 70(35.5%] and a fewer proportion experienced adverse drug reactions [39 (44.8%) vs 48 (55.2%)] compared with the SDC users. The proportion of SDC users who achieved virologic suppression [238(80.7%) vs 164(79.6%)] or who were adherent to ART over the previous three days [259(87.8%) vs 187(90.8%)] were similar when compared to the FDC users. In a multivariate logistic regression model adjusting for age, gender, education and duration on ART, viral suppression and adherence to ART over the previous 3 days were not statistically different between the SDC and FDC users [Viral suppression (OR=0.94 (95% CI 0.54 – 1.45; p=0.64); Adherence to ART (OR=1.37 (95% CI 0.76 – 2.46; p=0.30)] . Conclusion: FDCs had no superior adherence and virologic suppression potential over the single drug combinations in this cohort. SDCs should be retained alongside the FDCs in resource limited settings.