VA study: Less is more when treating HIV

Jonathan Kaupanger
May 23, 2018 - 11:26 am

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There are more than 28,000 HIV positive veterans receiving treatment at VA. A new study finds that less is actually better when it comes to treating these veterans. 

VA doctors at the Michael E. DeBakey VA Medical Center in Houston, TX are working on a study that is changing how HIV is treated. In the past, HIV therapy was very complex and often patients would need to take dozens of pills every day. Modern treatment has reduced the amount of medication down to one pill per day. Until now there just hasn’t been a study to see which is better, less or more.

Recent studies show that patients prefer the single pill treatment. It decreases the pill burden for them which makes sticking to treatment easier. That in itself improves quality of life. The issue, most often, is insurance. Some of the common multiple-pill treatments are now available in generic versions, so they are less expensive. Insurance companies often require the less expensive treatment.

To see which way is best, Dr. Thomas P. Giordano and his research team at the Houston VAMC studied more than 1,000 patients at a non-VA clinic in the state. The patients were at the beginning of their HIV treatment. Some were placed on the single-tablet regimen and others on a multi-pill treatment.  All the patients were given the same basic drug. The single pill a day group came back with the most favorable results.

The study looked at three aspects of treatment: adherence, retention and HIV suppression. The patients in both groups took their meds more than 80 percent of the time, so adherence alone isn’t why the single pill works better.  Retention though had the largest difference between groups.

To show retention, patients have their viral load measurements taken several times per year. 81 percent of the single-tablet group showed retention and the multiple-pill group only had a 73 percent retention rate. HIV suppression was closer between the groups but the single tablet group had the better outcomes with an 84 percent viral suppression after the first year.  The suppression rate for the group with numerous pills came in at 78 percent.

Even though initial results show better clinical outcomes for single-tablet programs, more testing needs to happen. Dr. Giordano explains that it’s still not completely clear why the single pill approach works better. “It could be that the persons who got the multiple tablet regimens had more barriers to care,” said Giordano.  He says that the next step for his study is to figure out the difference in the types of meds being used verses the pill burden effect.  From there researchers can focus on which treatment is more cost-effective.

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