Work

Real-World Persistence in Adults with HIV and Mental Health or Substance Use Disorders After Restarting Antiretroviral Therapy in the United States

Year: 2025

Type: article

Abstract: INTRODUCTION: Lifelong antiretroviral therapy (ART) persistence prevents the progression of human immunodeficiency virus (HIV)-related illnesses and reduces HIV transmission. People with HIV who have a mental health disorder or substance use disorder (PWH-MHD/SUD) often face persistence challenges. This real-world study compared ART persistence among PWH-MHD/SUD who restarted various ART regimens after a treatment interruption. METHODS: This observational, retrospective cohort study analyzed US claims data from the HealthVerity Marketplace from January 2015 through February 2024. PWH aged ≥ 18 years who restarted the same ART regimen they had previously discontinued for > 90 days were included. The population of PWH-MHD/SUD was analyzed. Pairwise comparisons were conducted for those who received bictegravir (B)/emtricitabine (F)/tenofovir alafenamide (TAF) versus dolutegravir (DTG)/lamivudine (3TC), DTG/abacavir (ABC)/3TC, and DTG-based multitablet regimens [MTRs; i.e., DTG + F/TAF or DTG + F/tenofovir disoproxil fumarate (TDF)]. Baseline characteristics were balanced using inverse probability of treatment weighting. Time to nonpersistence (i.e., ART regimen discontinuation or switching) was depicted using Kaplan-Meier plots. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using weighted Cox proportional hazards models. RESULTS: Among all the PWH who restarted a previously discontinued ART regimen (n = 20,623), 43.4% had an MHD or SUD. Compared with PWH-MHD/SUD who received B/F/TAF, those receiving DTG/ABC/3TC and DTG-based MTRs were significantly more likely to be nonpersistent [weighted HR (95% CI) 1.18 (1.09-1.29) and 1.19 (1.06-1.34), respectively], while there was no significant difference for those receiving DTG/3TC. Compared with those receiving B/F/TAF, the risk of switching was significantly higher for PWH-MHD/SUD receiving DTG/3TC, DTG/ABC/3TC, or a DTG-based MTR [weighted HR (95% CI) 1.68 (1.08-2.63), 2.67 (2.23-3.19), and 2.88 (2.32-3.58), respectively]. These results were generally consistent among the broader population of restarters. CONCLUSION: For PWH-MHD/SUD who restarted ART after a treatment interruption, B/F/TAF was associated with longer persistence and the lowest risk of switch compared with other guideline-recommended therapies.

Source: Advances in Therapy

DOI: 10.1007/s12325-025-03379-1