Persistence in treatment-experienced people with HIV switching anti-retroviral therapy regimens since 2018

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Aim: This study examined antiretroviral therapy (ART) persistence in treatment-experienced people with HIV (PWH) who switched or restarted guideline-recommended, integrase strand transfer inhibitor (INSTI)-based multi-tablet (MTR) and single tablet regimens (STR).Methods: Claims data from the Optum Research Database (01/01/2010-03/31/2020) was used to identify lines of therapy (LOTs) for treatment-experienced adults who switched or restarted INSTI-based regimens between 01/01/2018-12/31/2019, excluding drugs approved late in the study. LOT duration and reason for LOT cessation were compared for INSTI-based MTR vs. STR and among individual INSTI-based regimens. Adjusted hazard ratios (HR) were examined following propensity score weighting to control for differences.Results: In the sample, 3625 started STRs and 626 started MTRs including: bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) (STR) (64.2%), dolutegravir/abacavir/lamivudine (DTG/ABC/3TC) (STR) (21.1%), dolutegravir + emtricitabine/tenofovir alafenamide (DTG + FTC/TAF) (MTR) (12.7%) and dolutegravir + emtricitabine/tenofovir disoproxil fumarate (DTG + FTC/TDF) (MTR) (2.1%). Discontinuation (11 vs. 15%, p = 0.003) and switching (7 vs. 25%, p < 0.001) were less common for STRs vs. MTRs. After adjusting, discontinuation and switching rates were higher for DTG/ABC/3TC, DTG + FTC/TAF and DTG + FTC/TDF compared with B/F/TAF.Conclusion: PWH treated with INSTI-based STRs discontinued or switched regimens less than those on MTRs. B/F/TAF was associated with less switching and discontinuation.

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