Background: Although, single-tablet regimen (STR) efavirenz, emtricibine, and tenofovir disoproxil fumarate (EFV/FTC/TDF) may be appealing in HIV-infected persons who are at high risk for nonadherence, the degree to which this simplified formulation affects adherence is not known. The virologic effectiveness of this STR in a potentially nonadherent population remains a concern, given the rapid selection of drug resistance seen with these drugs.
Method: We performed a prospective observational study assessing adherence and virologic response to EFV/FTC/TDF STR among a cohort of homeless and marginally housed individuals. We compared adherence and viral suppression to historical controls followed in the same cohort.
Results: Adherence was higher in EFV/FTC/TDF STR regimen compared to non-one-pill-once-daily therapy (P = 0.006) after controlling for multiple confounders. Viral suppression (HIV RNA <50 copies/ml) was greater in EFV/ FTC/TDF STR than non-one-pill-once-daily regimens (69.2 versus 46.5%; P = 0.02), but there was no difference in viral suppression after controlling for adherence.
Conclusion: Once-daily EFV/TNF/FTC STR appears to be a reasonable option for individuals with multiple barriers to adherence. Randomized clinical trials addressing various therapeutic strategies for this patient population are needed.
aMassachusetts General Hospital Center for Global Health, Ragon Institute of MGH, MIT, and Harvard, Harvard Medical School, Boston, USA
bUniversity of California, San Francisco, USA.
Received 27 May, 2010
Revised 14 August, 2010
Accepted 8 September, 2010
Correspondence to David R. Bangsberg, MD, MPH, MGH Center for Global Health, Ragon Institute of MGH, MIT and Harvard, 104 Mt. Auburn St, Cambridge, MA 02138, USA. E-mail: firstname.lastname@example.org