P-394. Antiretroviral therapy persistence following a change or restart in regimen among people with HIV

TL;DR

The study compares how long people with HIV stay on different antiretroviral therapy regimens after switching or restarting treatment, focusing on overall and Medicare Advantage patients.

Contribution

The study provides new insights into regimen persistence among HIV patients, particularly in Medicare Advantage enrollees.

Findings

B/F/TAF showed significantly greater persistence at 1 year compared to DTG/3TC and other regimens.

Similar results were observed in Medicare Advantage patients despite older age and more comorbidities.

Abstract

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

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.

A total of 113,705 individuals had a diagnosis of HIV, and of those, 14,344 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 (Table 1).

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 (Figure 1 and 2).

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.

Funding: Gilead Sciences Inc.

Benjamin Chastek, MS, Optum (UnitedHealth Group): Stocks/Bonds (Public Company) Uche Mordi, PharmD, MS, Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Seojin Park, PharmD, MS, Gilead Sciences, Inc.: Employee at the time of the development Cassidy Trom, PharmD, AAHIVE, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Ownership Interest|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Travis Lim, MSc, DrPH, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Mary J. Christoph, PhD, MPH, AstraZeneca: Advisor/Consultant|AstraZeneca: Employee|AstraZeneca: Stocks/Bonds (Public Company)|Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company)

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