Switch from protease inhibitor- to efavirenz-based antiretroviral therapy improves quality of life, treatment satisfaction and adherence with low rates of virological failure in virologically suppressed patients

Regimen selection in antiretroviral therapy can impact treatment adherence, quality of life (QoL) and treatment satisfaction, and may influence clinical outcome. We evaluated the effect of regimen switching on virological, safety and patient-reported outcomes. In this 48-week, open-label, randomized, non-inferiority study, 262 HIV-1-infected adult patients with a viral load <50 copies/mL on protease inhibitor (PI)-based regimens were switched to either once-daily efavirenz, lamivudine and enteric-coated didanosine (efavirenz-A [OD]) or once-daily efavirenz plus continuation of current nucleoside reverse transcriptase inhibitors (efavirenz-B). In the primary outcome of patients who maintained virological suppression at week 48, efavirenz-A (QD) was non-inferior to efavirenz-B (81% versus 79%, respectively). Both regimens were associated with low virological failure rates and significant improvements in treatment satisfaction, adherence and QoL after switching from PI-based therapy, with no differences between regimens. Switching from a PI- to an efavirenz-based regimen was generally safe and well tolerated.