What question did this study set out to answer?

This analysis aims to compare the effectiveness of single-tablet regimens (STRs) versus multiple-tablet regimens (MTRs) in HIV treatment.

March 26, 2026Advances in Therapy0 citationsOpen Access

Systematic Literature Review and Meta-Analysis of INSTI-Based Antiretroviral Therapy Single- Versus Multiple-Tablet Regimens for the Treatment of HIV

JTJan TužilCharles University MCMary J. Christoph MCMegan Chen

Key Points

This analysis aims to compare the effectiveness of single-tablet regimens (STRs) versus multiple-tablet regimens (MTRs) in HIV treatment.
Systematic literature review of studies from 2013 to 2023.
Search of MEDLINE and Embase databases.
Assessment of study quality using University of York guidelines.
Conducted pairwise meta-analyses for clinical outcomes.
STRs showed improved adherence in retrospective studies (RR = 1.64).
Increased persistence observed in STRs compared to MTRs (RR = 1.33).
Higher likelihood of discontinuation for MTRs in retrospective studies (hazard ratio = 1.62).
No significant differences in adherence or discontinuation found in RCTs.
Virologic failure rates were comparable between STRs and MTRs.

Abstract

Antiretroviral single-tablet regimens (STRs) have several advantages over multiple-tablet regimens (MTRs), including increased adherence and improved treatment satisfaction for people with HIV (PWH). This analysis has systematically reviewed and compared STRs and MTRs in adult PWH receiving integrase strand transfer inhibitor (INSTI)-based regimens. MEDLINE and Embase databases were searched on November 28, 2023, to identify studies published from 2013 to 2023 that evaluated INSTI-based STRs compared with ≥ 1 INSTI-based MTRs. Study quality was assessed based on the University of York Centre for Reviews and Dissemination guidelines. Pairwise meta-analyses were conducted to provide pooled relative estimates for key clinical outcomes. Twenty-five publications were included in the quantitative syntheses. STRs were associated with improved adherence based on 3 retrospective studies rate ratio (RR) = 1.64 (95% confidence interval: 1.46–1.83) but there was no difference in adherence in the 1 randomized controlled trial (RCT) that assessed adherence RR = 1.02 (0.77–1.35), though, due to blinding, both STR and MTR groups took multiple pills. STRs were associated with higher persistence than MTRs based on 7 retrospective studies RR = 1.33 (1.17–1.52). PWH treated with MTRs versus STRs were more likely to discontinue therapy in retrospective studies hazard ratio = 1.62 (1.52–1.72), 6 studies and prospective cohort studies RR = 4.43 (1.62–12.09), 3 studies, but not within RCTs where there was no difference in discontinuation RR = 0.83 (0.55–1.26), 4 trials. Risk of virologic failure was comparable between STRs and MTRs in RCTs RR = 1.00 (0.35–2.84), 5 trials and retrospective studies odds ratio = 1.30 (0.30–5.53), 5 studies. INSTI-based STRs were associated with improved adherence and persistence, and lower discontinuation rates compared with INSTI-based MTRs in observational, real-world studies, whereas no differences in adherence or discontinuation were seen in RCTs. Neither RCTs nor real-world studies showed any difference in virologic failure for STRs and MTRs. STRs are a potential tool for supporting adherence and persistence in real-world settings. PROSPERO number CRD42024525515.

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