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Antiretroviral therapy switch among Medicare beneficiaries with HIV

Mary J Christoph1, Uche Mordi1, Suying Li2

  • 1Gilead Sciences, Inc., Foster City, CA.

Journal of Managed Care & Specialty Pharmacy
|February 26, 2026
PubMed
Abstract

Insights

People with HIV (PWH) on Medicare using bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) experienced lower antiretroviral therapy (ART) switch rates. This finding was consistent even for PWH with mental health or substance use disorders, suggesting B/F/TAF may improve ART persistence.

Area of Science:

  • HIV/AIDS research
  • Pharmacoeconomics
  • Public health

Background:

  • Antiretroviral therapy (ART) persistence is crucial for effective HIV management.
  • Medicare-enrolled individuals with HIV often have comorbidities that can hinder treatment adherence.
  • Suboptimal adherence can lead to poorer HIV treatment outcomes.

Purpose of the Study:

  • To compare patterns of ART regimen switching among people with HIV (PWH) insured by Medicare.
  • To evaluate the impact of different ART regimens on treatment persistence in a Medicare population.
  • To assess ART switch patterns in PWH with and without mental health and/or substance use disorders.

Main Methods:

  • Retrospective cohort study using Medicare claims data (2017-2022).
  • Included treatment-experienced PWH aged 18+ on ART.
  • Compared ART switch rates for bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), dolutegravir/lamivudine (DTG/3TC), dolutegravir/abacavir/lamivudine (DTG/ABC/3TC), and multi-tablet regimens (MTRs).
  • Used inverse probability treatment weighting and Cox proportional hazards models.

Main Results:

  • PWH initiating DTG/3TC, DTG/ABC/3TC, and MTRs had significantly higher hazard ratios for switching ART compared to those on B/F/TAF (P < 0.0001).
  • Specifically, MTRs showed the highest hazard ratio for switching (5.37 times higher).
  • Similar trends were observed in the subgroup of PWH with mental health and/or substance use disorders.

Conclusions:

  • Medicare-insured PWH initiating B/F/TAF demonstrated a lower risk of switching ART compared to other regimens.
  • This reduced switching risk was observed both overall and in the subgroup with mental health and/or substance use disorders.
  • Findings support the use of B/F/TAF for potentially improving ART persistence in the Medicare population.

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