(255) Antiretroviral therapy persistence following a change or restart in regimen among people with HIV

Background: : An estimated 1.2 million people in the United States are living with HIV. Management of HIV requires lifelong antiretroviral therapy (ART). Understanding real-world persistence of commonly used regimens can aid treatment selection and improve health outcomes.

Objective: : Describe and compare regimen persistence for people with HIV (PWH) after switching or restarting ART overall and among Medicare Advantage (MA) enrollees.

Methods: : This retrospective study used medical and pharmacy claims data for patients with commercial health insurance or MA with Part D coverage (Optum Research Database). The index line of therapy was identified for patients switching or restarting ART between 07/01/2017 – 11/30/2023. Persistence was defined as the time to the earliest of ART discontinuation (gap in all ART ≥90 days), ART switch or add on, death, or end of available data. Outcomes were evaluated for: DTG/ABC/3TC, B/F/TAF, DTG/3TC, DTG + F/TDF, DTG + F/TAF and CAB+RPV. Analysis was conducted overall and among MA enrollees. Inverse Probability Treatment Weighting was implemented to adjust for demographic characteristics, baseline clinical measures, and baseline health care cost and utilization. Kaplan-Meier analysis was conducted after weighting examining the effect of regimen selection on ART persistence at 1 year.

Results: : A total of 113,705 individuals had a diagnosis of HIV, and of those, 14,826 either switched or restarted ART. After weighting, mean age was 53 years, 20% of PWH were female, 44% were white, and 42% were enrolled in a MA plan.
From weighted Kaplan-Meier analysis of both the overall sample and the MA subgroup, the percent of PWH persistent at 1 year was significantly greater (P < 0.05) for B/F/TAF vs. DTG/3TC, DTG/3TC/ABC, DTG+F/TAF and DTG+F/TDF and numerically greater but not statistically different vs CAB+RPV though comparisons cannot be reliably calculated with CAB+RPV due to the limited available sample size.

Conclusions: : Treatment experienced PWH starting B/F/TAF were more likely to be persistent at 1 year compared to other commonly used ART regimens. Similar results were observed among the Medicare Advantage subgroup despite older age and greater burden of comorbidities.

Sponsorship:: Gilead Sciences Inc.,