P-390. Persistence and Adherence of People With HIV (PWH) and Mental Health Disorder Diagnosis Who Restart Antiretroviral Therapy (ART)

TL;DR

This study examines how people with HIV and mental health disorders fare when restarting antiretroviral therapy, finding that some drug regimens lead to better persistence and fewer treatment switches.

Contribution

The study provides new insights into the effectiveness of specific HIV regimens for patients with mental health disorders who restart ART after treatment interruptions.

Findings

PWH with mental health disorders on B/F/TAF showed higher persistence compared to DTG/ABC/3TC and DTG MTR.

Adherence levels were similar across all regimens, ranging from 78.7% to 80.2%.

Switching therapies was more common for all regimens compared to B/F/TAF.

Abstract

Nearly half of PWH on ART have a mental health or substance use disorder (MH/SUD) comorbidity and thus have a higher risk of treatment interruptions (TI). TI can lead to viremia, drug resistance, clinical progression, and transmission of HIV. We compared persistence and adherence by regimen for PWH with MH/SUD resuming ART after a gap in therapy.

We analyzed pharmacy and medical claims data from HealthVerity Marketplace from January 2015-February 2024. PWH aged ≥18 years old restarting one of the following index regimens after a ≥90 day gap in therapy were identified: B/F/TAF, DTG/3TC, DTG/ABC/3TC, or DTG-based multi-tablet regimen (MTR; DTG+TDF/FTC or DTG+TAF/FTC). Continuous enrollment was required for ≥ 365 days pre-restart and ≥ 90 days post-restart. We calculated non-persistence as a discontinuation (medication gap of 91+ days) or regimen switch. Adherence was measured as the proportion of days covered while persistent. We fit inverse probability of treatment weighted (IPTW) Cox models to calculate pair-wise hazard ratios (HR) of non-persistence outcomes, with censoring for disenrollment, evidence of pregnancy, or end of study, comparing B/F/TAF to each other regimen.

20,623 unique individuals were indexed restarting the same ART after a TI > 90 days. Of these, 8,953 (43.4%) had any mental health diagnosis, including 5,857 (28.4%) with severe mental health disorder and 4,015 (19.5%) with substance use disorder. The proportion of PWH insured by Medicaid differed significantly across ARTs, ranging from 71.9% of PWH taking DTG MTRs and 54.2% of those on DTG/3TC. After IPTW for restarters with MH/SUD, balance was achieved on baseline characteristics (Table 1). Upon re-starting, compared to individuals on B/F/TAF, the hazard of subsequent non-persistence was higher for DTG/ABC/3TC and DTG MTR, but similar for DTG/3TC (Table 2). Compared to B/F/TAF, the hazard of switching was higher for all regimens, including DTG/3TC (Table 2). Adherence was similar by regimen (PDC range 78.7–80.2%).

MH/SUD are prevalent among PWH with TI resuming ART. PWH with MH/SUD disorders on B/F/TAF were more persistent compared to DTG/ABC/3TC and DTG MTR, and less likely to switch therapy vs. those on DTG/3TC.

Travis Lim, MSc, DrPH, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Amanda Kong, DrPH, Aetion: Employee|Aetion: Stocks/Bonds (Private 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) Uche Mordi, PharmD, MS, Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Jacqueline Lucia, BS, Aetion: Employee|Aetion: Stocks/Bonds (Private Company) Gulce Askin, MPH, Aetion: Employee|Aetion: Stocks/Bonds (Private Company) Daniela Yucuma, MD, MPH, Aetion: Employee Neia Prata Menezes, PhD, Gilead Sciences, Inc.: Stocks/Bonds (Private Company)

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