Antiretroviral treatments are, to say the least, often very demanding. They require daily follow-up – often several times a day – often over the course of years. However, thanks to research, the trend is now for the number of doses required to decrease significantly, which means an improvement in patients’ quality of life and also in observance of treatment. These constraints are in fact the price paid for the success that followed the 1996 introduction of tritherapies based on highly active retroviral therapy (HAART). Indeed, thanks to this revolutionary form of treatment, HIV has ceased to be synonymous with a short-term death sentence and has become a chronic disease in its own right.
Of course, today we have come a long way from the fistfuls of drugs that sufferers used to have to take each day, and had to take several times a day. Since the arrival of tritherapies in 1996, the figures had been heading downwards with more than ten tablets, pills or capsules per day only rarely being required. Today prescriptions vary between 1 and 5 tablets a day, resulting in much improved observance of treatment and also in patient wellbeing. But research is continuing in order to simplify these protocols still further.
This research often relates to existing medication and focuses on modifying the formulation to make observance easier. For example, one study (VERxVE), presented at the 18th International AIDS Society Conference in Vienna (Austria), demonstrated that a single daily dose of nevirapine (Viramune®) was just as effective as two. In very common use – according to Professor François Raffi (Nantes University Hospital), it is prescribed to approximately 35% of patients – this drug is normally administered in two 200 mg daily doses in association with a bitherapy based on Tenofovir/Emtricitabine (Truvada®). Its long-term benefits had already been demonstrated by the ARTEN study presented in July 2009 in Cape Town (South Africa).
Conducted on 1,011 patients, the VERxVE study revealed that taking a single 400 mg slow release tablet produced results that were of at least equally good quality. In fact, after 48 weeks of this therapy, the virological response to the treatment – measured by obtaining an undetectable viral load in the blood – was 81% for slow-release nevirapine compared with 75.9% with the traditional treatment. In other words, both the effectiveness of the treatment and its tolerance were equivalent with each of the two forms of administration.
“These studies show that the transition from three doses to a single dose makes a real difference in terms of observance. By changing from two doses to one dose per day, a definite improvement in patient wellbeing is observed”, points out Dr Jean-Michel Livrozet (HIV Day Unit, Edouard Herriot Hospital, Lyon). Viramune® also has the advantage “of being able to be taken independently of meals”. Up to now only one treatment (Atripla®) could be administered in the form of a single tablet per day. Gradually these new tritherapy approaches are bringing about an improvement in patients’ quality of life also in encouraging scrupulous adherence to a vital treatment.