HIV meds: Is less more?

April 1, 2000

Pharmaceutical Representative

Researchers at the Duke University Medical Center have discovered that HIV patients who take fewer pills tend to do better than patients on a more complex medical regimen. Based on an analysis of more than 3,000 patients involved in triple-drug combination trials to treat HIV infection, researchers speculate that patients who take fewer pills, as few as four a day, are more likely to adhere to their medication regimen - and therefore receive the greatest benefits of the therapy – than those on complex regimens who must take up to 16 pills at different times during the day.

Researchers at the Duke University Medical Center have discovered that HIV patients who take fewer pills tend to do better than patients on a more complex medical regimen. Based on an analysis of more than 3,000 patients involved in triple-drug combination trials to treat HIV infection, researchers speculate that patients who take fewer pills, as few as four a day, are more likely to adhere to their medication regimen - and therefore receive the greatest benefits of the therapy – than those on complex regimens who must take up to 16 pills at different times during the day.

"This study is an affirmation of our clinical experience that simpler regimens may lead to better treatment outcomes," said Dr. John Bartlett, director of clinical research at the Duke University Center for AIDS Research. "The results of the current study would seem to emphasize the importance of developing drug regimens that are simple, potent and easy for patients to take.

"We assume that the reason for better outcomes is improved adherence," Bartlett continued. "Other studies have shown that fewer pills can lead to better adherence, but this is the first to demonstrate a link to better outcomes."

In clinical trials for antiretroviral agents, the key indicator of success is the number of copies of HIV genetic material detectable in the blood. The number indicates how the virus is replicating, and for the study, less than 50 copies per milliliter of blood indicates that a medication has been successful.

"We found that about 75% of patients on the simplest regimens had less than 50 copies of HIV RNA in their blood," Bartlett said. "In comparison, only about 20% of patients with the most complex regimens had less than 50 copies. We know that levels less than 50 are an important indicator of a durable response to the medications."

Concluded Bartlett: "We controlled for the kinds of drugs that were being used and their combinations. Even after this analysis, the pill count was still a statistically significant indicator of patient outcome." PR