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

Abstract

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.

Risk Factors for Suboptimal Adherence Identified by Patient-Reported Outcomes Assessments in Routine HIV Care at 2 North American Clinics

“…[29][30][31] Using proportion of days covered, one US claims database study reported that 52% to 64% of PWH had ≥95% adherence, while another reported that 58% had ≥80% adherence. 32,33 By contrast, other Canadian and US claims database studies reported 86% to 93% of PWH had ≥80% adherence using proportion of days covered, similar to the ≥80% adherence rates observed in the present study. 31,32 Thus, adherence rates reported across studies using different adherence measurements vary widely, and comparisons between such studies should be interpreted with caution.…”

Long-Acting Injectable Therapy for People with HIV: Looking Ahead with Lessons from Psychiatry and Addiction Medicine

“…There are important distinctions between the potential benefits of LAI ART as compared to LAIs for mental illness and SUD . ART adherence has been estimated at 63.4% worldwide and 74.1% in the U.S. [ 34 , 35 ]. This adherence rate is higher than estimates for patients taking oral buprenorphine (37.1–41.3%) and among patients with schizophrenia taking antipsychotics (31.5–68.7%) [ 24 , 36 ].…”

Human Immunodeficiency Virus Type 2: The Neglected Threat

“…Among protease inhibitors (PIs), only darunavir, lopinavir, and saquinavir are fully active. Atazanavir, fosamprenavir, indinavir, nelfinavir, and tipranavir have reduced antiretroviral activity against HIV-2 [24, [70][71][72][73][74][75][76][77][78][79]. Effective drugs against HIV-2 are reported in Table 2.…”

“…Moreover, K65R and Q151M generate a high level of resistance for most NRTI drugs, leading to a high level of cross-resistance [89]. Regarding PI drugs, V47A is very common in the case of treatment failure with lopinavir, while V47A, I82F, and I54M have been described to cause a high level of phenotypic resistance to lopinavir and I54M for darunavir [75,76].…”