Actual medication pill burden and dosing frequency in HIV-infected patients with undetectable viral loads

Studies have shown equivalent or improved outcomes with once-daily antiretroviral (ARV) regimens, but have failed to quantify the true daily dosing frequency and pill burden of HIV-infected patients, by not considering concomitant medications. This study was conducted to describe the total daily number (pill burden) and dosing frequency for all oral medicines, and not just ARV medications in HIV-infected patients with undetectable viral loads. A retrospective chart review of patients with undetectable viral loads in an HIV primary care clinic identified dosing frequency and pill burden for all prescribed medications. These patients were divided into those with concomitant medications (WITH) and those only on ARV medications (WITHOUT). One hundred and seventeen patients qualified for the evaluation. Ninety-three were in the WITH group and 24 were in the WITHOUT group. WITH patients were older (p < 0.05), and had advanced US Centers for Disease Control and Prevention (CDC)-defined HIV disease stage (p< 0.05), a longer duration of HIV infection (p= 0.03), and a longer duration of AIDS (p= 0.02). WITH patients had a significantly greater total pill burden (p<0.01) and dosing frequency (p<0.001) when considering all medications. Assessing only ARV medications, a significant difference existed only in pill burden (mean +/- SD) (WITH = 9.91 +/- 2.1 versus WITHOUT = 6.6 +/- 1; p < 0.01), and no difference existed in ARV dosing frequency of 2.09 +/- 1.9 and 1.83 +/- 1.7, respectively (p = 0.07). Higher dosing frequencies and pill burdens were present in patients with co-morbid conditions. All patients were on more than once-daily therapies. Dosing requirements for non-ARV medications should also be considered when optimizing or simplifying ARV regimens.