Antiretroviral Therapy for HIV Infection: Time to Switch to Once-Daily Regimens?

Data is scarce regarding virologic and immunologic outcomes and the side-effect profile of antiretroviral therapy in the private health sector in India.

We retrospectively reviewed the case records of 250 HIV infected individuals being followed up at a private sector hospital, with emphasis on the nature of antiretroviral regimens prescribed, virologic and immunologic response to therapy and the side-effect profile of medications.

Once daily co-formulated tenofovir-emtricitabine-efavirenz was the most commonly used antiretroviral regimen (58% of patients). Virologic suppression (HIV RNA quantitative RT-PCR < 200 copies/ml) was achieved in 79% of patients at 6 months, 81% patients at 1 year and 87% at 5 years. The mean CD4 count at treatment initiation was 191 cells/ µl, and increased to 359 cells/µl after 1 year and to 521 cells /µl after 5 years. Stavudine was stopped in 16.7% due to side-effects, abacavir associated hypersensitivity reactions developed in 13%, zidovudine associated anemia developed in 5.2% and tenofovir was discontinued due to nephrotoxicity in 1.4%. Serum LDL, fasting blood glucose and serum creatinine did not significantly change over time in our patient population.

In a private sector setting, ART with co-formulated single tablet TDF/FTC/EFV resulted in excellent virologic suppression and immune reconstitution and had few adverse effects over a follow up period of almost 5 years. Nephrotoxicity was not a major concern and it may not be necessary to monitor blood glucose and lipid profiles on this regimen. Based upon our results and WHO guidelines, we recommend that the public sector ART program adopt annual virologic monitoring and switch to single pill once daily relatively non-toxic formulations as first-line regimens.