Benefits of switching to a fixed-dose single-tablet elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide co-formulation from free multi- tablet antiretroviral regimens in people living with HIV: A real-world study

Abstract

Abstract Background Fixed-dose single-tablet drug formulations reduce pill burden and improve medication adherence and treatment efficacy in HIV patients taking antiretroviral therapy (ART). This study aimed to describe a single-center experience using co-formulated elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (EVG/COBI/FTC/TAF) for the treatment of HIV-infected patients in Southwest China. Methods This prospective study enrolled consecutive HIV-infected patients admitted to the Chongqing Public Health Medical Center from October 2019 to April 2021. The patients who switched from the freely-available standard regimens (available through the Chinese national antiretroviral treatment program) to the EVG/COBI/FTC/TAF tablet were enrolled. Baseline characteristics, HIV viral suppression (< 50 RNA copies/mL), immune status, laboratory indices, and patient-reported outcomes were recorded and analyzed. Results During the study period, 246 patients switched to EVG/COBI/FTC/TAF, and the most common regimen used before switching was tenofovir disoproxil fumarate + lamivudine + efavirenz (76.0%). The mean age of enrolled patients was 43.7 ± 13.8 years, and 84.6% of our study population was male. The mean baseline CD4 + T-lymphocyte count was 227.45 ± 177.01 cells/µl. Adverse drug reactions (ADRs) (n = 130, 52.9%), inconvenience (n = 64, 26.0%), and poor therapeutic effect (n = 52, 21.1%) were the reasons for switching therapy. After 24 weeks of EVG/COBI/FTC/TAF treatment, 100 patients underwent drug efficacy evaluation, and the viral suppression rate was observed to be significantly higher than baseline (99% vs. 90%, p = 0.001). Triglyceride, total cholesterol, and low-density lipoprotein levels were found to be higher than baseline (all p < 0.001). The proportion of patients with hyperglycemia and albuminuria was significantly reduced after switching (p < 0.05). Analysis of responses to the HIV treatment satisfaction questionnaire showed that patient satisfaction increased after switching (p < 0.001) ART drug regimen. Conclusions Switching from a multi-tablet regimen to the fixed-dose EVG/COBI/FTC/TAF single-tablet ART regimen was effective and well-tolerated in Chinese HIV-infected patients. Patient satisfaction increased significantly after switching.