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Lower Pill Burden and Once-Daily Antiretroviral Treatment Regimens for HIV Infection: A Meta-Analysis of Randomized Controlled Trials

Identifieur interne : 005280 ( Main/Curation ); précédent : 005279; suivant : 005281

Lower Pill Burden and Once-Daily Antiretroviral Treatment Regimens for HIV Infection: A Meta-Analysis of Randomized Controlled Trials

Auteurs : Jean B. Nachega [États-Unis, Afrique du Sud] ; Jean-Jacques Parienti [France] ; Olalekan A. Uthman [Royaume-Uni, Afrique du Sud] ; Robert Gross [États-Unis] ; David W. Dowdy [États-Unis] ; Paul E. Sax [États-Unis] ; Joel E. Gallant [États-Unis] ; Michael J. Mugavero [États-Unis] ; Edward J. Mills [Canada] ; Thomas P. Giordano [États-Unis]

Source :

RBID : Pascal:14-0137144

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English descriptors

Abstract

Background. Contemporary antiretroviral treatment regimens are simpler than in the past, with lower pill burden and once-daily dosing frequency common. We performed a meta-analysis of randomized controlled trials (RCTs) to investigate the impact of pill burden and once-daily vs twice-daily dosing on ART adherence and virological outcomes. Methods. A literature search of 4 electronic databases through 31 March 2013 was used. RCTs comparing once-daily vs twice-daily ART regimens that also reported on adherence and virological suppression were included. Study design, study population characteristics, intervention, outcome measures, and study quality were extracted. Study quality was rated using the Cochrane risk-of-bias tool. Results. Nineteen studies met our inclusion criteria (N = 6312 adult patients). Higher pill burden was associated with both lower adherence rates (P = .004) and worse virological suppression (P < .0001) in both once-daily and twice-daily subgroups, although the association with adherence in the once-daily subgroup was not statistically significant. The average adherence was modestly higher in once-daily regimens than twice-daily regimens (weighted mean difference = 2.55%; 95% confidence interval [CI], 1.23 to 3.87; P = .0002). Patients on once-daily regimens did not achieve virological suppression more frequently than patients on twice-daily regimens (relative risk [RR] = 1.01; 95% CI, 0.99 to 1.03; P = .50). Both adherence and viral load suppression decreased over time, but adherence decreased less with once-daily dosing than with twice-daily dosing. Conclusions. Lower pill burden was associated with both better adherence and virological suppression. Adherence, but not virological suppression, was slightly better with once- vs twice-daily regimens.

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Pascal:14-0137144

Le document en format XML

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<term>Infections à VIH (traitement médicamenteux)</term>
<term>Observance thérapeutique</term>
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<term>HIV Infections</term>
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<term>Agents antiVIH</term>
</keywords>
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<term>Adult</term>
<term>Humans</term>
<term>Patient Compliance</term>
<term>Randomized Controlled Trials as Topic</term>
<term>Viral Load</term>
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<term>Charge virale</term>
<term>Essais contrôlés randomisés comme sujet</term>
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<term>Observance thérapeutique</term>
<term>SIDA</term>
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<div type="abstract" xml:lang="en">Background. Contemporary antiretroviral treatment regimens are simpler than in the past, with lower pill burden and once-daily dosing frequency common. We performed a meta-analysis of randomized controlled trials (RCTs) to investigate the impact of pill burden and once-daily vs twice-daily dosing on ART adherence and virological outcomes. Methods. A literature search of 4 electronic databases through 31 March 2013 was used. RCTs comparing once-daily vs twice-daily ART regimens that also reported on adherence and virological suppression were included. Study design, study population characteristics, intervention, outcome measures, and study quality were extracted. Study quality was rated using the Cochrane risk-of-bias tool. Results. Nineteen studies met our inclusion criteria (N = 6312 adult patients). Higher pill burden was associated with both lower adherence rates (P = .004) and worse virological suppression (P < .0001) in both once-daily and twice-daily subgroups, although the association with adherence in the once-daily subgroup was not statistically significant. The average adherence was modestly higher in once-daily regimens than twice-daily regimens (weighted mean difference = 2.55%; 95% confidence interval [CI], 1.23 to 3.87; P = .0002). Patients on once-daily regimens did not achieve virological suppression more frequently than patients on twice-daily regimens (relative risk [RR] = 1.01; 95% CI, 0.99 to 1.03; P = .50). Both adherence and viral load suppression decreased over time, but adherence decreased less with once-daily dosing than with twice-daily dosing. Conclusions. Lower pill burden was associated with both better adherence and virological suppression. Adherence, but not virological suppression, was slightly better with once- vs twice-daily regimens.</div>
</front>
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<country>Canada</country>
<wicri:noRegion>Ontario</wicri:noRegion>
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<title level="j" type="main">Clinical infectious diseases</title>
<title level="j" type="abbreviated">Clin. infect. dis.</title>
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<div type="abstract" xml:lang="en">Background. Contemporary antiretroviral treatment regimens are simpler than in the past, with lower pill burden and once-daily dosing frequency common. We performed a meta-analysis of randomized controlled trials (RCTs) to investigate the impact of pill burden and once-daily vs twice-daily dosing on ART adherence and virological outcomes. Methods. A literature search of 4 electronic databases through 31 March 2013 was used. RCTs comparing once-daily vs twice-daily ART regimens that also reported on adherence and virological suppression were included. Study design, study population characteristics, intervention, outcome measures, and study quality were extracted. Study quality was rated using the Cochrane risk-of-bias tool. Results. Nineteen studies met our inclusion criteria (N = 6312 adult patients). Higher pill burden was associated with both lower adherence rates (P = .004) and worse virological suppression (P < .0001) in both once-daily and twice-daily subgroups, although the association with adherence in the once-daily subgroup was not statistically significant. The average adherence was modestly higher in once-daily regimens than twice-daily regimens (weighted mean difference = 2.55%; 95% confidence interval [CI], 1.23 to 3.87; P = .0002). Patients on once-daily regimens did not achieve virological suppression more frequently than patients on twice-daily regimens (relative risk [RR] = 1.01; 95% CI, 0.99 to 1.03; P = .50). Both adherence and viral load suppression decreased over time, but adherence decreased less with once-daily dosing than with twice-daily dosing. Conclusions. Lower pill burden was associated with both better adherence and virological suppression. Adherence, but not virological suppression, was slightly better with once- vs twice-daily regimens.</div>
</front>
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<name sortKey="Nachega, Jean B" sort="Nachega, Jean B" uniqKey="Nachega J" first="Jean B." last="Nachega">Jean B. Nachega</name>
<affiliation>
<nlm:aff id="af1">
<addr-line>Department of Epidemiology</addr-line>
,
<institution>Pittsburgh University Graduate School of Public Health</institution>
,
<addr-line>Pennsylvania</addr-line>
</nlm:aff>
</affiliation>
<affiliation wicri:level="2">
<nlm:aff id="af2">
<institution>Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health</institution>
,
<addr-line>Baltimore, Maryland</addr-line>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Maryland</region>
</placeName>
<wicri:cityArea>Baltimore</wicri:cityArea>
</affiliation>
<affiliation>
<nlm:aff id="af3">
<addr-line>Department of Medicine,</addr-line>
</nlm:aff>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="af4">
<addr-line>Centre for Infectious Diseases, Faculty of Medicine & Health Sciences</addr-line>
,
<institution>Stellenbosch University</institution>
,
<addr-line>Cape Town</addr-line>
,
<country>South Africa</country>
</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Parienti, Jean Jacques" sort="Parienti, Jean Jacques" uniqKey="Parienti J" first="Jean-Jacques" last="Parienti">Jean-Jacques Parienti</name>
<affiliation>
<nlm:aff id="af5">
<addr-line>Department of Biostatistics and Clinical Research</addr-line>
,
<institution>Côte de Nacre University, Côte de Nacre Teaching Hospital</institution>
</nlm:aff>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="af6">
<addr-line>Faculté de Médecine</addr-line>
,
<institution>Université de Caen Basse-Normandie, EA 4655 Risque Microbien</institution>
,
<addr-line>Caen</addr-line>
,
<country>France</country>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Uthman, Olalekan A" sort="Uthman, Olalekan A" uniqKey="Uthman O" first="Olalekan A." last="Uthman">Olalekan A. Uthman</name>
<affiliation>
<nlm:aff id="af7">
<addr-line>Division of Health Sciences</addr-line>
,
<institution>Warwick-Centre for Applied Health Research and Delivery (WCARHD), Warwick Medical School, The University of Warwick</institution>
,
<addr-line>Coventry</addr-line>
</nlm:aff>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="af8">
<institution>Liverpool School of Tropical Medicine, International Health Group</institution>
,
<country>United Kingdom</country>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="af9">
<addr-line>Centre for Evidence-based Health Care, Faculty of Health Sciences</addr-line>
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<institution>Stellenbosch University</institution>
,
<addr-line>Cape Town</addr-line>
,
<country>South Africa</country>
</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Gross, Robert" sort="Gross, Robert" uniqKey="Gross R" first="Robert" last="Gross">Robert Gross</name>
<affiliation>
<nlm:aff id="af10">
<addr-line>Perelman School of Medicine, and Philadelphia Veterans Affairs Medical Center</addr-line>
,
<institution>University of Pennsylvania</institution>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Dowdy, David W" sort="Dowdy, David W" uniqKey="Dowdy D" first="David W." last="Dowdy">David W. Dowdy</name>
<affiliation wicri:level="2">
<nlm:aff id="af2">
<institution>Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health</institution>
,
<addr-line>Baltimore, Maryland</addr-line>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Maryland</region>
</placeName>
<wicri:cityArea>Baltimore</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Sax, Paul E" sort="Sax, Paul E" uniqKey="Sax P" first="Paul E." last="Sax">Paul E. Sax</name>
<affiliation wicri:level="2">
<nlm:aff id="af11">
<institution>Brigham and Women's Hospital, Harvard Medical School</institution>
,
<addr-line>Boston, Massachusetts</addr-line>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Massachusetts</region>
</placeName>
<wicri:cityArea>Boston</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Gallant, Joel E" sort="Gallant, Joel E" uniqKey="Gallant J" first="Joel E." last="Gallant">Joel E. Gallant</name>
<affiliation wicri:level="2">
<nlm:aff id="af12">
<institution>Southwest CARE Center</institution>
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</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Nouveau-Mexique</region>
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<author>
<name sortKey="Mugavero, Michael J" sort="Mugavero, Michael J" uniqKey="Mugavero M" first="Michael J." last="Mugavero">Michael J. Mugavero</name>
<affiliation>
<nlm:aff id="af13">
<institution>University of Alabama at Birmingham</institution>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Mills, Edward J" sort="Mills, Edward J" uniqKey="Mills E" first="Edward J." last="Mills">Edward J. Mills</name>
<affiliation wicri:level="1">
<nlm:aff id="af14">
<addr-line>Faculty of Health Sciences</addr-line>
,
<institution>University of Ottawa</institution>
,
<addr-line>Ontario</addr-line>
,
<country>Canada</country>
</nlm:aff>
<country xml:lang="fr">Canada</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Giordano, Thomas P" sort="Giordano, Thomas P" uniqKey="Giordano T" first="Thomas P." last="Giordano">Thomas P. Giordano</name>
<affiliation wicri:level="2">
<nlm:aff id="af15">
<addr-line>Department of Medicine, Baylor College of Medicine, and The Center for Innovations in Quality, Effectiveness and Safety</addr-line>
,
<institution>Michael E. DeBakey VA Medical Center</institution>
,
<country>Houston, Texas</country>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Texas</region>
</placeName>
<wicri:cityArea>The University of Pittsburgh Drug Discovery Institute, Pittsburgh</wicri:cityArea>
</affiliation>
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<title xml:lang="en" level="a" type="main">Lower Pill Burden and Once-Daily Antiretroviral Treatment Regimens for HIV Infection: A Meta-Analysis of Randomized Controlled Trials</title>
<author>
<name sortKey="Nachega, Jean B" sort="Nachega, Jean B" uniqKey="Nachega J" first="Jean B." last="Nachega">Jean B. Nachega</name>
<affiliation>
<nlm:aff id="af1">
<addr-line>Department of Epidemiology</addr-line>
,
<institution>Pittsburgh University Graduate School of Public Health</institution>
,
<addr-line>Pennsylvania</addr-line>
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</affiliation>
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<nlm:aff id="af3">
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<affiliation wicri:level="1">
<nlm:aff id="af4">
<addr-line>Centre for Infectious Diseases, Faculty of Medicine & Health Sciences</addr-line>
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,
<addr-line>Cape Town</addr-line>
,
<country>South Africa</country>
</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Parienti, Jean Jacques" sort="Parienti, Jean Jacques" uniqKey="Parienti J" first="Jean-Jacques" last="Parienti">Jean-Jacques Parienti</name>
<affiliation>
<nlm:aff id="af5">
<addr-line>Department of Biostatistics and Clinical Research</addr-line>
,
<institution>Côte de Nacre University, Côte de Nacre Teaching Hospital</institution>
</nlm:aff>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="af6">
<addr-line>Faculté de Médecine</addr-line>
,
<institution>Université de Caen Basse-Normandie, EA 4655 Risque Microbien</institution>
,
<addr-line>Caen</addr-line>
,
<country>France</country>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Uthman, Olalekan A" sort="Uthman, Olalekan A" uniqKey="Uthman O" first="Olalekan A." last="Uthman">Olalekan A. Uthman</name>
<affiliation>
<nlm:aff id="af7">
<addr-line>Division of Health Sciences</addr-line>
,
<institution>Warwick-Centre for Applied Health Research and Delivery (WCARHD), Warwick Medical School, The University of Warwick</institution>
,
<addr-line>Coventry</addr-line>
</nlm:aff>
</affiliation>
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<nlm:aff id="af8">
<institution>Liverpool School of Tropical Medicine, International Health Group</institution>
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</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="af9">
<addr-line>Centre for Evidence-based Health Care, Faculty of Health Sciences</addr-line>
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,
<addr-line>Cape Town</addr-line>
,
<country>South Africa</country>
</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Gross, Robert" sort="Gross, Robert" uniqKey="Gross R" first="Robert" last="Gross">Robert Gross</name>
<affiliation>
<nlm:aff id="af10">
<addr-line>Perelman School of Medicine, and Philadelphia Veterans Affairs Medical Center</addr-line>
,
<institution>University of Pennsylvania</institution>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Dowdy, David W" sort="Dowdy, David W" uniqKey="Dowdy D" first="David W." last="Dowdy">David W. Dowdy</name>
<affiliation wicri:level="2">
<nlm:aff id="af2">
<institution>Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health</institution>
,
<addr-line>Baltimore, Maryland</addr-line>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Maryland</region>
</placeName>
<wicri:cityArea>Baltimore</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Sax, Paul E" sort="Sax, Paul E" uniqKey="Sax P" first="Paul E." last="Sax">Paul E. Sax</name>
<affiliation wicri:level="2">
<nlm:aff id="af11">
<institution>Brigham and Women's Hospital, Harvard Medical School</institution>
,
<addr-line>Boston, Massachusetts</addr-line>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Massachusetts</region>
</placeName>
<wicri:cityArea>Boston</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Gallant, Joel E" sort="Gallant, Joel E" uniqKey="Gallant J" first="Joel E." last="Gallant">Joel E. Gallant</name>
<affiliation wicri:level="2">
<nlm:aff id="af12">
<institution>Southwest CARE Center</institution>
,
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</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Nouveau-Mexique</region>
</placeName>
<wicri:cityArea>Santa Fe</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Mugavero, Michael J" sort="Mugavero, Michael J" uniqKey="Mugavero M" first="Michael J." last="Mugavero">Michael J. Mugavero</name>
<affiliation>
<nlm:aff id="af13">
<institution>University of Alabama at Birmingham</institution>
</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Mills, Edward J" sort="Mills, Edward J" uniqKey="Mills E" first="Edward J." last="Mills">Edward J. Mills</name>
<affiliation wicri:level="1">
<nlm:aff id="af14">
<addr-line>Faculty of Health Sciences</addr-line>
,
<institution>University of Ottawa</institution>
,
<addr-line>Ontario</addr-line>
,
<country>Canada</country>
</nlm:aff>
<country xml:lang="fr">Canada</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author>
<name sortKey="Giordano, Thomas P" sort="Giordano, Thomas P" uniqKey="Giordano T" first="Thomas P." last="Giordano">Thomas P. Giordano</name>
<affiliation wicri:level="2">
<nlm:aff id="af15">
<addr-line>Department of Medicine, Baylor College of Medicine, and The Center for Innovations in Quality, Effectiveness and Safety</addr-line>
,
<institution>Michael E. DeBakey VA Medical Center</institution>
,
<country>Houston, Texas</country>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Texas</region>
</placeName>
<wicri:cityArea>The University of Pittsburgh Drug Discovery Institute, Pittsburgh</wicri:cityArea>
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<series>
<title level="j">Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America</title>
<idno type="ISSN">1058-4838</idno>
<idno type="eISSN">1537-6591</idno>
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<term>Adult</term>
<term>Anti-HIV Agents (administration & dosage)</term>
<term>Anti-HIV Agents (therapeutic use)</term>
<term>HIV Infections (drug therapy)</term>
<term>Humans</term>
<term>Patient Compliance</term>
<term>Randomized Controlled Trials as Topic</term>
<term>Viral Load</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr">
<term>Adulte</term>
<term>Agents antiVIH (administration et posologie)</term>
<term>Agents antiVIH (usage thérapeutique)</term>
<term>Charge virale</term>
<term>Essais contrôlés randomisés comme sujet</term>
<term>Humains</term>
<term>Infections à VIH (traitement médicamenteux)</term>
<term>Observance thérapeutique</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en">
<term>Anti-HIV Agents</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en">
<term>Anti-HIV Agents</term>
</keywords>
<keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr">
<term>Agents antiVIH</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en">
<term>HIV Infections</term>
</keywords>
<keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr">
<term>Infections à VIH</term>
</keywords>
<keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr">
<term>Agents antiVIH</term>
</keywords>
<keywords scheme="MESH" xml:lang="en">
<term>Adult</term>
<term>Humans</term>
<term>Patient Compliance</term>
<term>Randomized Controlled Trials as Topic</term>
<term>Viral Load</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr">
<term>Adulte</term>
<term>Charge virale</term>
<term>Essais contrôlés randomisés comme sujet</term>
<term>Humains</term>
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<front>
<div type="abstract" xml:lang="en">
<p>Once-daily compared with twice-daily antiretroviral therapy regimens increased adherence; however, the difference was modest and not associated with a difference in virological suppression. In addition, higher pill burden was associated with lower rates of virological suppression, whether once- or twice-daily regimens.</p>
</div>
</front>
<back>
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