Clinical Characteristics, Healthcare Utilization, and Treatment Patterns Among People Living with HIV by Antiretroviral Therapy Use in the USA, 2021–2024

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INTRODUCTION: Despite advances in antiretroviral therapy (ART), real-world data remain limited regarding clinical characteristics and healthcare utilization according to ART use among people living with human immunodeficiency virus (PLWH), as well as patterns of ART use in this population. METHODS: This retrospective cohort study used a US healthcare claims database to identify adult PLWH from 2021 to 2024. Primary cohort included those with ≥3 human immunodeficiency virus (HIV)-1 diagnosis codes within 3 years (third code defined the index date). A nested cohort included PLWH with ≥1 ART prescription claim(s) within 180 days of follow-up. All-cause and HIV-related inpatient hospitalizations and emergency room (ER) visits were assessed before and after index date. Pharmacotherapy change within 180 days after index was assessed for the nested cohort. RESULTS: In the primary cohort of 51,837 PLWH, mean age was 46.5 years; 17.5% were women, and 57.1% resided in the southern USA. Notably, 6.5% had no observed ART claim (never ART), and 92.5% had an observed ART claim at some point (ever ART). The never ART group had significantly higher hospitalizations (8.3% versus 5.2%; P value < 0.0001) and ER visits (23.6% versus 17.5%; P value < 0.0001), and fewer other drug prescriptions (antidiabetics, 3.4% versus 9.8%; antihypertensives, 9.7% versus 34.5%; statins, 5.2% versus 23.7%; P value < 0.0001 each) versus the ever ART group. Among 35,591 PLWH prescribed ART, 2% were newly observed ART initiators with first-line ART and 98% were prevalent users. Newly observed ART initiators had higher rates of all-cause inpatient hospitalizations (63.7 versus 39.9 per 1000 person-years) versus prevalent users. Overall, 32.3% of PLWH discontinued their index ART regimen within 180 days and did not restart ART during the analysis period. CONCLUSIONS: Nearly one-third of PLWH discontinued their initial ART, and 6.5% were not on ART in the study period. PLWH without documented ART claims have greater healthcare utilization than those who received ART. Enhancing ART tolerability, dosing modalities, and convenience may improve treatment coverage and viral suppression outcomes, and reduce discontinuation rates.

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