(254) Antiretroviral therapy persistence among treatment-experienced people with human immunodeficiency virus and mental health disorders in the United States

Background: : Lifelong antiretroviral therapy (ART) is necessary in HIV care. People with HIV (PWH) and concurrent mental health or substance use disorders (MH/SUD) may face difficulties remaining on ART.

Objective: : Compare regimen persistence after switching or restarting ART among PWH with MH/SUD and in PWH with low adherence to ART.

Methods: : This retrospective study used medical and pharmacy claims data among PWH with commercial insurance or Medicare Advantage (MA) with Part D coverage (Optum Research Database). Individuals were indexed at the first claim between 01/07/2017 – 30/11/2023 for B/F/TAF, DTG/ABC/3TC, DTG/3TC, DTG+F/TDF, DTG+F/TAF, or CAB+RPV for all who had prior treatment experience on any regimen with or without an intervening gap of any duration. Persistence was defined as time to the earliest ART discontinuation (gap of ≥90 days), switch or add-on therapy, death, or end of available data. Adherence was measured as proportion of days covered (PDC). Inverse probability treatment weighting was implemented to adjust for baseline demographic characteristics, clinical measures, and healthcare costs and utilization. Kaplan-Meier analysis was conducted after weighting to examine the effect of regimen selection on ART persistence at 1 year.

Results: : Of 14,826 PWH who met all inclusion criteria, 5310 had baseline MH/SUD and 3815 had PDC < 85% to index regimen during all follow up.
Weighted Kaplan-Meier analysis in the MHD/SUD subgroup indicated that the percent persistent at 1 year was significantly higher (P < 0.05) for B/F/TAF vs DTG/3TC/ABC, DTG+F/TAF, and DTG+F/TDF, and higher but not statistically different vs DTG/3TC and CAB+RPV. Among PWH with PDC < 85%, those on B/F/TAF persisted longer compared to DTG-based regimens.

Conclusions: : PWH on B/F/TAF were more likely to persist at 1 year compared to other ART regimens among both those with MH/SUD or low adherence. These findings in the US support prior European studies.

Sponsorship:: Gilead Sciences, Inc.