Study Overview: HIV Treatment Switching Patterns
This retrospective analysis delved into treatment switching patterns among people with HIV (PWH) receiving various antiretroviral therapy (ART) regimens. The study's primary objective was to identify factors influencing regimen persistence, especially considering the increasing life expectancy for PWH and their growing enrollment in Medicare.
Methodology
The study leveraged closed US medical and pharmacy claims data from the Optum Research Database. It focused on treatment-experienced PWH covered by commercial insurance or Medicare Advantage with Part D coverage.
Participants and Regimens:
Participants initiated one of several ART regimens between July 1, 2017, and November 30, 2023. These regimens included:
- Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF)
- Dolutegravir/lamivudine
- Dolutegravir/abacavir/lamivudine
- Dolutegravir + emtricitabine/tenofovir alafenamide
- Dolutegravir + emtricitabine/tenofovir disoproxil fumarate
- Cabotegravir + rilpivirine
Outcome Measurement:
The main outcome measured was the time to treatment switch or add-on.
Statistical Analysis:
Statistical methods employed included inverse probability treatment weighting, Kaplan-Meier analyses, and multivariable Cox proportional hazards models to thoroughly assess differences between the various regimens.
Key Findings
The study included a substantial cohort of 14,826 treatment-experienced PWH.
- PWH taking B/F/TAF maintained their initial treatment regimen longer and had a significantly reduced risk of treatment switch/add-on compared to those on other regimens of interest (all P < .001).
- These findings were consistent across both the overall study population and the specific subset of Medicare Advantage enrollees.
- Among all PWH who switched or added on to their regimen, B/F/TAF was the most common subsequent regimen they transitioned to, with rates ranging from 25.4% to 42.8% depending on their initial regimen.
- Conversely, for those initially on B/F/TAF who later switched, dolutegravir/lamivudine was identified as the most common subsequent regimen (22.7%).
Conclusion
This analysis suggests that B/F/TAF is associated with a lower likelihood of treatment switch or add-on for treatment-experienced PWH compared to other contemporary ART regimens.
The study further highlights B/F/TAF as a common therapy PWH switch to, even for those previously on other integrase strand transfer inhibitor-based regimens. These insights can inform shared decision-making and optimize regimen selection to help achieve and maintain viral suppression.