For EFV, cycles of 2 days off per week appeared no more likely to result in treatment failure than continuous therapy, as long as the treatment interruption was not prolonged [29, 30]. However, cycles of 7- or 28-day treatment interruption resulted in failure of EFV and selection of resistance [31, 32]. For PI/r, one study

found that average adherence, rather than duration of treatment interruption, was associated with virological response [33]. A recent overview of systematic reviews of consumer-oriented medication interventions found that simplified dosing regimens improved adherence in the majority of studies in several reviews [34]. Another review of Obeticholic Acid cell line adherence interventions found that reducing dosing to once daily had some effect on adherence but no effect on treatment outcome was observed [35]. NICE [8] reviewed several RCTs of interventions to reduce dose frequency and found that adherence may increase with once-daily dosing.

For ART regimens, a meta-analysis of once- vs. twice-daily ART regimens found that in the subgroup of treatment-naïve trials, once-daily ART was associated with a significantly AZD6244 supplier improved adherence and virological outcome [36]. Therefore, once-daily dosing is a reasonable intervention to reduce unintentional non-adherence to ART. In examining whether fixed-dose combination formulations (FDCs) of drugs improve adherence or treatment outcome, only studies comparing the same drugs with the same dose frequency given as combination or separate pills were considered. No meta-analyses have been published on this subject for ART. A meta-analysis of nine RCTs and cohort studies in a range of diseases found the use of FDCs was associated with a significant reduction in the risk of non-adherence [36]. Gupta

et al. [37] reported a meta-analysis of cohort studies and found that use of FDCs for antihypertensives was associated with increased adherence but with no improvement on the control of blood Verteporfin pressure. There are no published studies in HIV therapy directly comparing outcomes with FDCs versus separate agents. A retrospective study of a pharmacy database found no benefit in persistence on first-line ART for any FDC over separate agents [38]. In the ECHO/ THRIVE studies a lower virological response rate in patients with baseline VL >100 000 copies was observed for RPV- versus EFV-based regimens when dosed as separate agents [39]; this was not repeated when formulated as FDCs in the preliminary 48-week results from the STaR study [40]. Although the use of FDCs may have driven this apparent improvement in performance of RPV, it may also have arisen due to the simpler once-daily regimens in STaR, other methodological differences or by chance. A further advantage of FDCs is that they prevent patients from preferentially adhering less closely to one component of a regimen than others.