Associate Director of Epidemiology AbbVie Inc. Cincinnati, United States
Background: People living with HIV (PLWHIV) require lifelong antiretroviral therapy (ART) to maintain viral suppression, decrease transmission, and reduce AIDS-associated morbidity and mortality. PLWHIV may switch ART regimens to achieve better outcomes; thus, a clearer understanding of the current treatment landscape is needed to identify unmet treatment needs, including a possible cure and improving quality of life.
Objectives: To evaluate ART use patterns among PLWHIV in the U.S.
Methods: This cross-sectional study used the MarketScan® Commercial Claims Database to identify adults (≥18 years) with ≥1 incident or chronic HIV-1 ICD-10-CM diagnosis codes and ≥1 ART prescription claim from January-1-2020 through June-30-2021. The index date was defined as the date of the first ART prescription claim within the study period. Time to ART initiation, ART prescription patterns, and treatment gaps were assessed.
Results: Among 25,285 PLWHIV, mean age was 47.4 (SD 11.5) years and 21,029 (83.2%) were male. Most individuals (96.6%) had prior or current ART use. Within the study interval, median time from HIV-1 diagnosis code to first ART prescription was 1.1 months [IQR 0.3-10.4]. A nucleoside reverse transcriptase inhibitor (NRTI)/integrase strand transfer inhibitor (INSTI)-based regimen [bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF)] was the most frequently prescribed ART during the study period (30.7% of total ART initiation). Other NRTI-based regimens accounted for 17.6% [elvitegravir (EVG)/cobicistat (COBI)/FTC/TAF], 12.5% [abacavir sulfate (ABC)/dolutegravir sodium (DTG)/lamivudine (3TC)], and 10.0% [FTC/TAF] of initial prescriptions during the study period. Among 6,903 PLWHIV without prior use of the aforementioned drugs, 83% were prescribed one ART regimen, 14% had two regimens, and 3% had three regimens. Mean number of regimens prescribed was 1.4 per individual over 18 months. Treatment interruption of ≥60-days was observed for 944 (13.7%) individuals. Among those who initiated BIC/FTC/TAF, 408 (12.0%) individuals had ≥60-day gap in prescription coverage and then resumed the same ART regimen, whereas 34 (1.0%) individuals switched to a different ART regimen.
Conclusions: Even with modern oral ART regimens, treatment switches or interruptions over an 18-month interval may increase HIV resistance and the potential for HIV transmission. Further research is needed to develop novel therapies that reduce treatment switching and interruption by enabling immune-mediated ART-free viral control toward a potential cure.