Aims: Low rates of persistence are associated with poor outcomes in people with HIV (PWH). This retrospective cohort study assessed treatment persistence as measured by time to treatment switch in treatment-experienced (TE) PWH initiating integrase strand transfer inhibitor (INSTI)-based regimens.
Methods: United States prescription claims and medical history data from the IQVIA Longitudinal Access and Adjudication Dataset between January 1, 2018, and August 31, 2023, were analyzed. TE PWH with ≥1 prescription claim for initiation of an INSTI-based antiretroviral regimen during the index period (January 1, 2020, to December 31, 2022) were included. Descriptive analyses of demographic and comorbidity variables were performed, stratified by regimen. Kaplan-Meier analysis was used to evaluate time to subsequent treatment switch in the overall population and among PWH aged ≥50 years, those receiving Medicare, and those with mental health conditions or substance use disorders.
Results: Overall, 29,348 TE PWH were included. The majority of INSTI-based regimen initiations were for bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) (61%; n = 17,917), followed by dolutegravir/lamivudine (27.4%; n = 8034) and cabotegravir + rilpivirine (7.4%; n = 2186). A subsequent switch occurred in 3341 (11.4%) PWH. Risk factors for switch included female sex, Medicare/Medicaid coverage, and higher Charlson Comorbidity Index scores. B/F/TAF was associated with the fewest subsequent switches (9.2%; n = 1656) and was significantly less likely than any other regimen to lead to a subsequent switch, either in the overall population or in the three at-risk subgroups.
Limitations: No data are available to determine the underlying reasons for initial treatment choice or subsequent treatment switch.
Conclusions: This study provides evidence for greater treatment persistence with B/F/TAF versus other INSTI-based regimens. Unlike prior studies that focused on treatment-naïve individuals, this analysis uniquely evaluates persistence among treatment-experienced PWH initiating newer INSTI-based regimens.
Keywords: Antiretroviral therapy; C93; I12; I13; I18; human immunodeficiency virus; medicare; treatment patterns; treatment persistence; treatment switching.
Antiretroviral drugs are effective at controlling the virus in people with HIV, provided they are taken as part of a long-term treatment plan. Researchers looked at prescription information for people in the United States who had recently changed their HIV treatment to one that included a class of drug called an integrase strand transfer inhibitor, or “INSTI”. Researchers then looked at whether people stayed on their new treatment or switched treatment again. Around 60% of the nearly 30,000 people with HIV in this study who started a new INSTI-based treatment between 2020 and 2022 were prescribed bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF). Overall, around 10% of people starting an INSTI-based therapy switched their treatment again. Those who started B/F/TAF were less likely to change their treatment again compared to those who started other treatments. Women, those with Medicaid or Medicare coverage, those with a higher number of other health conditions, and those taking an antiretroviral treatment with many tablets were more likely to switch their treatment again. These results show that people with HIV tend to stay on B/F/TAF versus other INSTI-based therapies.