Desimplification of antiretroviral therapy

In an Italian HIV-cohort, 243 patients on stable antiretroviral
therapy with fixed dose coformulations (FDCs) were enrolled
in a study of “desimplification”. The term desimplification
was used for a switch from a FDC to a multi tablet combination
(MTR). The rationale for switching is that FDCs are more
expensive than MTRs. As treatment is free of charge in Italy
there was no personal economic incentive for the participants
to switch. The 240 participants were asked if they agreed to
switch their treatments for altruistic reasons. 163/243 (67 %)
agreed to switch. Participants were evaluated for virological
and immunological responses at baseline, after 24, 48, and 96
weeks comparing those who switched to those who remained
on their original therapy. Fifteen patients decided to return to
their original FDCs for convenience. In short summary there
were no statistically significant differences in HIV-RNA levels
at any time-point. At 96 weeks the median CD4 count increased
in both groups though the increase was larger in the MTR group.

Ref; Rossi et al. World J Clin Cases 2019;14:1814-1824

Comment: It has been postulated that adherence is better
with single dose regimens and that treatment results improve
compared to multiple tablet regimens. To my knowledge this
has not been proven in clinical trials. With the increasing availability
of generic drugs significant economic savings can be
achieved by splitting single dose tablets without compromising
treatment outcome.