Who gets single tablet regimes and why?
Dr Laura Tarrier, Dr Stephen Kegg, Trafalgar Clinic, Queen Elizabeth Hospital, London
introduction
The BHIVA guidelines now feature three
single tablet regimens (STRs) as
recommended treatments for HIV-positive
people new to therapy.[1] They are popular
with patients, and are attractive in a number
of clinical scenarios. We sought to determine
how our use of STRs had developed over a
three year period, and how the decision to opt
for an STR was made.
methods
•
Retrospective case-note review and
database interrogation
•
All patients starting ART from 1
st
March
2011 to 31
st
March 2014.
results
215 patients started ART over the three year
period. 58% were Black-African and 31%
White British. 53% were male and 53% of
those were MSM. Mean age was 37. Median
CD4 at baseline was 272 (range 1-1,044).
Viral Load (VL) at baseline ranged from 105
to ten million and 32% had a VL >100,000. 12
individuals had evidence of transmitted drug
resistance (3 NNRTI, 2 PI and 7 NRTI).
88 patients started an STR (40.9%). Two of
these tested positive for HLAB5701 and none
had a 10 year CVS risk score of >20%. 36%
had a baseline VL>100,000. Of the 127
patients starting a non-STR regimen, one
tested positive for HLAB5701, 29% had a
VL>100 000 and none had an elevated CVS
risk.
% of
Patients
Started on
STR
2011-12
2012-13
2013-14
25%
57%
44%
Mean baseline eGFR was 92ml/min in the
STR group compared to 98ml/min in those
receiving a non-STR.
Use of STRs increased over the three years.
There was no difference in STR prescribing
between ethnicity, nor men and women. In
men, heterosexual male patients were more
likely to be prescribed an STR than MSM
males (43% v 54%, p 0.005).
43% patients indicated a preference for an
STR and 36% expressed a preference for a
particular drug. 2% requested to be on the
same treatment as a partner. In those
patients who expressed an interest in a
particular drug, 11% had received information
from a friend or partner. In 33% of patients an
STR was felt by the clinician to be the best
option, largely based on concerns around pill-
burden and adherence (31%), viral load
(17%) and renal or cardiac risk (7%).
conclusion
Use of STRs is increasing. This is not driven
on in our cohort by cardiovascular risk or
HLAB5701 carriage but by patient and
clinician preference, and to a lesser extent by
higher baseline viral loads.
[1] British HIV Association (BHIVA).
Treatment of HIV-1 positive
adults with antiretroviral therapy.
BHIVA
.
Report, 2013.
patient preference
clinician chice
combination/unknown