Antiretroviral Adherence, Drug Resistance, and the Impact of Social Determinants of Health in HIV-1 Patients in the US

Benson, Carmela; Wang, X.; Dunn, Keith; Li, N.; Mesana, Laura; Lai, Jingzhen; Wong, Eric; Chow, Wing; Hardy, Hélène; Song, Ji Young; Brown, Kimberley

doi:10.1007/s10461-020-02937-8

Cited by 41 publications

(44 citation statements)

References 18 publications

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“…A majority (approximately 60%) of PWH had suboptimal adherence (PDC < 90%) to ART and 42% had poor adherence (PDC < 80%). In a prior nationwide US study of 169,545 PWH treated with ART during January 2015 through September 2017 who were also selected from the IDV database, Benson et al [ 16 ] reported an average adherence of 72%. Among this patient population, 25% had optimal adherence, defined as having PDC ≥ 95%, and 45% exhibited poor adherence (PDC < 80%) [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a prior nationwide US study of 169,545 PWH treated with ART during January 2015 through September 2017 who were also selected from the IDV database, Benson et al [ 16 ] reported an average adherence of 72%. Among this patient population, 25% had optimal adherence, defined as having PDC ≥ 95%, and 45% exhibited poor adherence (PDC < 80%) [ 16 ]. Thus, adherence to ART among PWH in the US has remained relatively stable during years 2015 to 2019, with slightly fewer PWH exhibiting poor adherence to ART during the time period of the current study.…”

Section: Discussionmentioning

confidence: 99%

“…A previous US study by Benson et al [ 16 ] examined adherence to ART of PWH treated between January 2015 and September 2017 and found an average adherence level of 72%; their findings were stratified by US state, providing a state- and regional-level depiction of ART adherence for targeting intervention efforts. Since 2017, several ART medications, including STRs, have been developed and approved by the US Food and Drug Administration for the treatment of HIV-1; such changes in the treatment landscape of HIV-1 could potentially affect medication adherence.…”

Section: Introductionmentioning

confidence: 99%

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Real-World Adherence to Antiretroviral Therapy Among HIV-1 Patients Across the United States

McComsey

Lingohr-Smith²,

Rogers

et al. 2021

Adv Ther

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Introduction Recent changes in antiretroviral therapies (ARTs) may have affected medication adherence of people living with human immunodeficiency virus-1 (HIV-1). In this study adherence to ART regimens among patients with HIV-1 (PWH) across the US during a recent time period was examined and study findings were stratified by US region and state. Methods A retrospective observational study using the Symphony Health Solution Integrated Dataverse database was conducted. Patients ≥ 18 years of age who had a diagnosis of HIV-1 (without an HIV-2 diagnosis) and who were treated with ART between July 2017 and September 2018 (first pharmacy record: index date) were selected from the data source. Both patients who had not been previously treated with ART and those who were treatment experienced were included. Patients were required to have ≥ 1 medical/pharmacy record ≥ 12 months after their index date (follow-up period). Patient characteristics were examined during a 12-month pre-index period. During the follow-up, medication adherence, measured as the proportion of days covered (PDC), was examined for all patients and stratified by US region and state. Results Among 206,474 adult PWH treated with ART, mean age was 47.9 years, 73.4% were male, and 30.0% were Caucasian. The most prevalent comorbid conditions were hyperlipidemia (25.1%), depressive disorders (14.8%), and type 2 diabetes (12.1%). During the follow-up period, mean (standard deviation) PDC was 74.1% (25.9%) among PWH across the US [Midwest: 74.4% (25.5%); Northeast: 74.3% (26.1%); South: 73.2% (26.3%); West: 76.4% (24.8%)]. Across all US regions, > 60% of PWH had adherence < 90% and > 40% had adherence < 80%; the West had the highest adherent population. Conclusions Among PWH treated with ART across the US, a majority had suboptimal adherence. Implementation of strategies to improve ART adherence, including clinical consideration of ARTs with high genetic barriers to resistance, is needed in the US. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01883-8.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Real-World Adherence to Antiretroviral Therapy Among HIV-1 Patients Across the United States

McComsey

Lingohr-Smith²,

Rogers

et al. 2021

Adv Ther

View full text Add to dashboard Cite

show abstract

“…Studies that capture the impact of social determinants of health on viral suppression indicate that factors such as racism, stigma, lack of or poor quality health insurance, and poverty contribute to lower rates of viral suppression [ 22 , 29 , 30 ]. The specific impact of health insurance status on viral suppression is mixed; some studies demonstrate increases in viral suppression rates [ 31 – 33 ] while others have found no association [ 34 ]. Among persons with a history of IDU social determinants of health have been associated with increased rates of virologic failure [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Understanding the Risk of Human Immunodeficiency Virus (HIV) Virologic Failure in the Era of Undetectable Equals Untransmittable

et al. 2021

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The “Undetectable = Untransmittable” campaign indicates that persons living with Human Immunodeficiency Virus (HIV) who maintain a suppressed viral load cannot sexually transmit the virus. However, there is little knowledge of the percent of individuals at a population level who sustain viral suppression long term. The aims of this study were to: (1) establish a baseline of persons living with diagnosed HIV who resided in New York and had consecutive suppressed viral load tests; (2) describe the risk of virologic failure among those who were consecutively suppressed; and (3) gain an understanding of the length of time between consecutive viral suppression to virologic failure. A total of 102,339 New Yorkers aged 13–90 years were living with diagnosed HIV at the beginning of 2012; 47.9% were consecutively suppressed (last two HIV viral load test results from 2010–2011 that were < 420 days apart and < 200 copies/mL). Of consecutively suppressed individuals, 54.3% maintained viral suppression for the entire study period and 33.6% experienced virologic failure during the study period. Among persons who experienced virologic failure, 82.6% did so six or more months after being consecutively suppressed. Our findings support the need for ongoing viral load monitoring, adherence support, and ongoing risk reduction messaging to prevent forward HIV transmission.

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“…23 31 Barriers to sustained undetectable viral load include social determinants of health including racism, homelessness, poverty and access to medical care, which can inhibit one's ability to adhere to a daily medication regimen. [32][33][34][35] Oral HIV pre-exposure prophylaxis (PrEP; 200 mg emtricitabine (FTC) in combination with 300 mg tenofovir disoproxil fumarate (TDF) or 25 mg tenofovir alafenamide (TAF)) has been added to the HIV prevention toolbox within the last decade. When taken daily as an oral medication, PrEP has demonstrated high levels of efficacy (>95%) in preventing HIV transmission among HIV-serodifferent heterosexual couples.…”

Section: Introductionmentioning

confidence: 99%

The Magnetic Couples Study: protocol for a mixed methods prospective cohort study of HIV-serodifferent heterosexual couples’ perspectives and use of pre-exposure prophylaxis (PrEP)

et al. 2021

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IntroductionHIV transmission within serodifferent heterosexual couples plays a key role in sustaining the global HIV pandemic. In the USA, transmission within established mixed-status couples accounts for up to half of all new HIV infections among heterosexuals. Oral HIV pre-exposure prophylaxis (PrEP) is a highly effective prevention method, although underutilised among serodifferent couples. Moreover, there is a dearth of research on US HIV-serodifferent couples’ perspectives and use of PrEP, alone or in combination with other prevention methods. In this paper, we describe the study protocol for the Magnetic Couples Study, designed to fill critical knowledge gaps regarding HIV-serodifferent heterosexual couples’ perspectives, experiences and utilisation of PrEP.Methods and analysisThe Magnetic Couples Study is a mixed methods prospective cohort study designed to describe temporal patterns and identify determinants at multiple levels (individual, couple, HCF) of PrEP outcomes along the care continuum (PrEP awareness, linkage, uptake, retention and medication adherence) among HIV-serodifferent heterosexual couples residing in New York City. The study will also examine clinical management of PrEP, side effects and changes in sexual-related and substance use–related behaviour. A prospective cohort of 230 mixed-status couples already on oral PrEP was recruited, with quarterly assessments over 18 months; in addition, a cross-sectional sample of 150 mixed-status couples not currently on PrEP was recruited. In-depth semistructured qualitative interviews were conducted with a subsample of 25 couples. Actor-partner interdependence modelling using multilevel analysis will be employed for the analysis of longitudinal dyadic data. Framework analysis will be used to analyse qualitative data. A parallel convergent design will be used for mixed methods integration.Ethics and disseminationThe study was approved by the University of Rochester Institutional Review Board (RSRB00052766). Study findings will be disseminated to community members and providers and to researchers and policy makers.

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Antiretroviral Adherence, Drug Resistance, and the Impact of Social Determinants of Health in HIV-1 Patients in the US

Cited by 41 publications

References 18 publications

Real-World Adherence to Antiretroviral Therapy Among HIV-1 Patients Across the United States

Real-World Adherence to Antiretroviral Therapy Among HIV-1 Patients Across the United States

Understanding the Risk of Human Immunodeficiency Virus (HIV) Virologic Failure in the Era of Undetectable Equals Untransmittable

The Magnetic Couples Study: protocol for a mixed methods prospective cohort study of HIV-serodifferent heterosexual couples’ perspectives and use of pre-exposure prophylaxis (PrEP)

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