IMPLEMENTATION OF ONCE DAILY ANTIRETROVIRAL REGIMENS IN HIV POSITIVE PATIENTS IN A COMMUNITY SETTING

DALE LIEU, MD, LEIA HOANG, PharmD, JENNIGRACE BAUTISTA, PharmD, JOAN FURLANO, RPh, LARRY MILLER, MD; Kaiser Permanente, San Diego, CA.

43rd Annual Meeting of The Infectious Diseases Society of America

Oct 06, 2005 to Oct 09, 2005

Poster Abstract

Abstract 784

Background: Frequency and ease of medication dosing are factors in long term adherence. Once daily antiretroviral regimens can improve the management of HIV disease. Methods: In our staff model HMO practice of approximately 900 HIV-positive patients, the majority are under treatment with antiretrovirals. Over the past 3 years, 271 patients (103 antiretroviral medication naïve, 168 medication experienced) have been placed onto once daily antiretroviral regimens. Six month evaluation has been completed on 198 patients (72 medication naïve, 126 medication experienced). 115 of 168 medication experienced patients were viral load undetectable on their previous regimen prior to switch, while 53 of 168 medication experienced patients were viral load detectable at the time of start of new once daily regimen. Success was defined as the ability to remain viral load undetectable 6 months after start of once daily regimen. Results:

1. The 271 patients started on a once daily antiretroviral regimen (263 remain) represent a marked rise in the prevalence of once daily usage in our practice, rising from 0% in January 2002, to 5% in March 2003, to nearly 50% (263 of 529 patients) in April 2005.

2. Only 1 patient out of 271 switched away from a once daily regimen solely due to side effects.

3. 68 of 72 (94%) medication naïve patients achieved and maintained viral load undetectable at 6 months of follow up or longer. Only 3 of these 72 patients were not suppressed by any regimen after 6 months.

4. 76 of 78 (97%) undetectable non-naïve patients remained undetectable after switch to a once daily regimen.

5. 36 of 48 (75%) detectable non-naïve patients achieved undetectable status after switch to a new once daily regimen. Of the 12 detectable non-naïve patients not viral load suppressed by a once daily regimen, 6 were suppressed by a subsequent regimen.

Conclusions:

1. Once daily regimens have been remarkably successful in both naïve and non-naïve patients, with high rate of success as initial regimens for naïve patients, and with few failures when switching from previously suppressive regimens.

2. Once daily regimens are well tolerated and have become our standard of practice whenever possible.