Reducing polypharmacy in HIV treatment
Cocohoba explained that there are essentially 2 frameworks for reducing polypharmacy that can be applied to HIV treatment regimens.
Consolidation. With consolidation, the focus is on reducing pill burden—but not by omitting medications. “It’s about looking into simpler dosage forms or combination medications to improve adherence and make life easier,” Cocohoba explained. “Same regimen, fewer pills.”
Simplification, on the other hand, is removing, and thus reducing the number of, agents a patient is taking. The question clinicians should be asking is, according to Cocohoba, “In what situations is it safe to strip down therapy to the bare essentials for the purposes of exposing people to fewer medications, reducing adverse effects, and keeping treatment as manageable as possible to optimize adherence?”
Simplification may be applied to either treatment-naïve or treatment-experienced patients. With the former, clinicians consider, for example, whether patients can be started on HIV treatment consisting of 2 rather than 3 medications. In the latter, “Clinicians may be dealing with patients who are fully virally suppressed on certain regimens and have been for a while; here we see if we can subtract medications, reducing say from triple to double therapy, while maintaining suppression,” explained Cocohoba.
“We want to offer people robust HIV treatment that is going to maintain viral suppression and prevent sequelae of HIV disease,” Cocohoba said, “but we need to balance that with safety, tolerability, and adherence.”
Continue to: An ongoing discussion and multidisciplinary effort