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Systematic review and meta‐analysis: Patient and programme impact of fixed‐dose combination antiretroviral therapy
Author(s) -
Ramjan Rubeena,
Calmy Alexandra,
Vitoria Marco,
Mills Edward J.,
Hill Andrew,
Cooke Graham,
Ford Nathan
Publication year - 2014
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12297
Subject(s) - medicine , observational study , meta analysis , relative risk , confidence interval , pill , fixed dose combination , cohort study , antiretroviral therapy , human immunodeficiency virus (hiv) , pediatrics , family medicine , viral load , pharmacology
Abstract Objectives To compare the advantages to patients and to programmes between fixed‐dose combination ( FDC ) antiretroviral therapy and separate tablet regimens. Methods Three electronic databases and two conference abstract sites were searched from inception to 01 March 2013 without geographical, language or date limits. Studies were included if they reported data on clinical outcomes, patient‐reported outcomes and programme‐related outcomes that could be related to pill burden for adult and adolescent patients on ART . For the primary outcomes of adherence and virological suppression, relative risks and 95% confidence intervals were calculated, and these were pooled using random effects meta‐analysis. Results Twenty‐one studies including information on 27 230 subjects were reviewed. Data from randomised trials showed better adherence among patients receiving FDC s than among patients who did not (relative risk 1.10, 95% CI 0.98–1.22); these findings were consistent with data from observational cohorts ( RR 1.17, 95% CI 1.07–1.28). There was also a tendency towards greater virological suppression among patients receiving FDC s in randomised trials ( RR 1.04, 95% CI 0.99–1.10) and observational cohort studies ( RR 1.07, 95% CI 0.97–1.18). In all studies reporting patient preference, FDC s were preferred. The overall quality of the evidence was rated as low. Conclusions Fixed‐dose combinations appear to offer multiple advantages for programmes and patients, particularly with respect to treatment adherence.