Viral suppression more likely among youth using single-tablet antiretroviral treatment regimes
New research reveals that, like adults, young people have better treatment outcomes with a lower pill burden.
84% of young people in the USA using single-tablet regimes achieved viral load suppression one year after starting antiretroviral treatment, compared to just 73% of those on multi-tablet regimes.
A retrospective analysis was carried out of young people living with HIV aged 13 to 24 and starting treatment between 2006 and 2014 at 18 clinical sites in the USA. Researchers looked at the number of young people starting single-tablet versus multi-tablet regimes, viral suppression (VS) at 12 months, and time to VS.
Most (67%) of the 987 youths included in the cohort started on a single-tablet regime, and they had 1.61 increased odds of achieving viral suppression after one year. Youths who started treatment in either 2013 or 2014 were most likely to be initiated on these regimes – which reflects an increase in single-tablet regimes available for this group.
Researchers also analysed demographic factors, with viral load suppression associated with being of white or Hispanic ethnicity, despite 62% of the youths starting treatment in this time being African American. Unsurprisingly, VS was also associated with having a higher CD4 cell count at treatment initiation – that is, a higher number of infection-fighting white blood cells when they started their regime.
Compared to adults, young people face unique challenges relating to treatment adherence. These include behavioural challenges, such as a lack of motivation to prioritise their health over social engagements, in addition to wider environmental factors such as unstable housing, poor health literacy, and under-employment, and barriers related to cognitive development, stigma, and comorbid mental health issues and/or substance use.
A wealth of evidence exists to show that adults respond better to single-tablet regimes, as pill burden has been shown to be associated with better adherence and viral load. But until now, minimal data was available for young people, despite guidelines now recommending single-tablet regimes for adolescents for the same reasons.
While pathways to viral suppression are complex and dependent on multiple factors – the current research supports the use of single-tablet regimes as one important element in providing comprehensive care to this challenging group.