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Is It Time to Try a Single-Tablet Regimen for HIV?

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Treatment for human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in the last few decades is heralded as one of the great medical advancements of our time. Once considered a virtual death sentence, HIV patients can now expect to live a near-normal lifespan of approximately 70 years--if they adhere to their HIV treatment regimen. This can be quite challenging, though, since patients may have to take multiple pills throughout the day. That’s why the new single-tablet regimen--taking just one pill, once a day--is such an exciting advancement.

Treating HIV: We’ve Come a Long Way

In my career, I’ve watched the landscape of the HIV epidemic change radically, and I’ve seen the way we treat HIV patients change dramatically too. When I was in training, most people with HIV required multiple pills, called antiretroviral therapies, taken several times a day to keep the virus at bay. These drugs often had a lot of unpleasant side effects. For instance, we often had to add an antidiarrheal medication to the patient’s list of medications because we knew the regimen would cause diarrhea. These medications worked, but they weren’t easy to take because the regimens were so complicated.

Over time, these combination therapies became even more effective and simpler to take with fewer side effects. However, adhering to treatment plans was still a major issue for patients because they were still on complicated regimens that required taking multiple pills at different times of day. Medical professionals have learned, like with any chronic or infectious disease, being able to take just one pill once a day increases the likelihood that a patient will stick to his or her treatment plan. And in the early 2000s, combining multiple medications into a single tablet revolutionized the way we treat HIV. In many cases, the single pill drugs were more effective and less toxic, and patients were relieved of the burden of taking multiple pills in a day.

Compliance Is Crucial

While medication compliance is important for treating any condition, it’s absolutely crucial for treating HIV. The HIV virus replicates extremely quickly, can change form in the body, and can quickly become resistant to medications if they’re not taken consistently. In fact, even missing one day of virus-suppressing medication can cause the virus to become resistant to that particular treatment. If you become resistant to one treatment, there may be other drugs that work, but your treatment options will be very limited.

However, failed compliance isn’t always caused by forgetfulness. In fact, I’ve seen patients who are typically very good about following their multiple-pill treatment routine, but then their prescription refill lapses, so they take only two of the three pills needed to fight the virus. While this seems like the best course of action at the time--taking some instead of none--it’s actually more harmful than not taking any of the pills until the prescription is filled.

Because it makes taking medication easier, the one tablet regimen significantly reduces the risk of developing drug resistance and puts less of a burden on the patient. I’ve been amazed at the effectiveness of the new drugs developed to treat HIV and how easy it is to take them.

Switching to a Single Pill Drug Therapy: What to Know

There are several reasons you may want to switch to a single-tablet regimen. You may have been on a multiple pill treatment plan for your HIV for a long time and are doing just fine with your current routine. However, we’ve learned some older regimens for HIV treatment can cause long-term toxicity to the body that can lead to chronic health issues. Mild toxicity might result in rashes and moderate-to-severe toxicity side effects could include pancreatitis, a disease in which the pancreas becomes inflamed, and drug-induced hepatitis, a disease that infects the liver. If you’re concerned about these side effects, have a discussion with your physician to review other options.  

A complicated regimen is another reason you may want to try a single pill for your HIV. If you’re having trouble staying on top of a multi-pill regimen, switching to a single pill could make a big difference in your treatment. If you do want to move to a single-pill plan from an existing regimen, your physician will examine your prior regimens to be certain that phasing out old drugs and replacing them with newer ones will not be detrimental to your health. This is because your virus may have already developed resistance to certain classes of antiretrovirals. In those situations, it may not be possible to switch to a single-tablet regimen--but your doctor may still be able to simplify the regimen by reducing the number of pills. For many patients who are effectively controlling their virus by taking 2 to 3 pills once a day, switching to a single-tablet regimen is a feasible way to simplify treatment and still keep the virus in check. Have a conversation with your physician to discuss if changing your HIV treatment regimen is a possibility for you.

Looking Ahead

Single-tablet regimens have made it easier than ever for HIV patients to combat their virus. When their virus is suppressed, they’re not only improving their quality of life, but are also preventing the transmission of the virus to other people.

As a healthcare provider and AIDS researcher, I know we still have more work to do in fighting this virus and its effects on our patients. Right now the big advancement is one pill once a day, but we are researching and evaluating other treatments, such as long-acting injections that could be given just once a month.

Until then, the option of single pill drug therapy offers patients a sustainable, practical way to live healthy a life with HIV. Ask your physician if a single tablet treatment plan could work for you.

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THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.