Cambio de tratamiento antirretroviral entre beneficiarios de Medicare con VIH

Persistence to antiretroviral therapy (ART) is essential for optimal HIV treatment outcomes. People with HIV (PWH) enrolled in Medicare often have a higher prevalence of comorbidities, which can negatively impact persistence, leading to suboptimal HIV outcomes.

To compare ART switch patterns among PWH insured by Medicare.

Using Medicare Fee-for-Service and Medicare Advantage claims data from January 2017 to December 2022, a retrospective cohort study of treatment-experienced PWH aged 18 years and older and on ART was conducted. ART regimens included bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), dolutegravir/lamivudine (DTG/3TC), dolutegravir/abacavir/lamivudine (DTG/ABC/3TC), or multitablet regimens (MTRs; dolutegravir + emtricitabine/tenofovir alafenamide [DTG + F/TAF] or dolutegravir + emtricitabine/tenofovir disoproxil fumarate [DTG + F/TDF]). An analysis of PWH who had mental health and/or substance use disorders was also conducted. Treatment switch by ART regimen was evaluated using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models after using inverse probability treatment weighting to balance across groups.

A total of 30,205 treatment-experienced PWH were included. PWH who initiated DTG/3TC, DTG/ABC/3TC, and MTRs on the index date had 1.28 (95% CI = 1.13-1.45), 2.67 (95% CI = 2.47-2.89), and 5.37 (95% CI = 4.60-6.26) times higher hazard ratio of switching ART, respectively, compared with PWH indexed on B/F/TAF (all P < 0.0001). Similar results were observed among PWH with mental health and/or substance use disorders.

Medicare-insured PWH indexed on B/F/TAF had lower risk of treatment switch compared with other ART regimens, both overall and in the subgroup with mental health and/or substance use disorders. These findings may inform targeted strategies for optimal treatment selection for PWH.