Patient-reported outcomes among people living with HIV on single- versus multi-tablet regimens

Background: Single-tablet regimens (STR) have become the golden
standard in antiretroviral therapy. However, there are calls to
reintroduce (generic) components as multi-tablet regimens (MTR) because of
cost-savings. Patient-reported outcome measures (PROs) are an important
touchstone to support or to renounce this proposal. As such, our aim was
to compare PROs of people living with HIV taking an STR versus a MTR in a
real world setting. Materials and methods: 188 people living with
HIV participated in a longitudinal study. 132 remained on their MTR and 56
switched to an STR. At baseline, months 1-3-6-12-18 and 24, participants
filled in questionnaires on health-related quality of life (HRQoL),
depressive symptoms, HIV symptoms, neurocognitive complaints (NCC)
treatment satisfaction and adherence. Generalized linear mixed models and
generalized estimation equations mixed models were built.
Results: At baseline, the two groups did not differ in clinical
parameters and PROs. The mixed models revealed differences among the
groups regarding neurocognitive complaints and treatment satisfaction. The
odds of having NCC increased by 4,1% per month in the STR-group as
compared to the MTR-group (p=0.035). Nonetheless, treatment satisfaction
also increased in the STR-group: at month 6, median change score was
highly positive: 24 (IQR 7,5-29). Treatment satisfaction showed a
significantly different evolution in the groups: the estimated state score
increased by 3,3 in the STR-group while it decreased by 0,2 in the
MTR-group (p=0.003). HRQoL measures, HIV symptoms, depressive symptoms and
adherence did not differ between the groups over time.
Conclusions: Neurocognitive complaints and treatment satisfaction
differed between the two groups. More people on an STR reported NCC over
time compared to the MTR-group. Contrarily, treatment satisfaction in the
STR-group increased significantly over time. It should be further
investigated to which extent treatment satisfaction is a predictor for
long-term treatment persistence and health outcomes.