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.

Keywords: Adherence; Antiretroviral therapy; HIV-1; Regions; States; United States.

Fig. 1

Patient selection process. ART antiretroviral therapy

Fig. 2

Mean adherence to ART during the 12-month follow-up period stratified by US state. ART antiretroviral therapy, PDC proportion of days covered

Fig. 3

Adherence to ART during the 12-month follow-up period, overall and stratified by US region. ART antiretroviral therapy, PDC proportion of days covered

Fig. 4

Percentage of PWH with poor adherence to ART (PDC < 80%) during the 12-month follow-up period stratified by US state. ART antiretroviral therapy, PWH patients with HIV-1

Fig. 5

Sensitivity analysis of newly^a treated PWH: adherence to ART during the 12-month follow-up period, overall and stratified by US region. ART antiretroviral therapy, PDC proportion of days covered, PWH patients with HIV-1. ^aNewly treated, defined as having no ART medication use during the 12-month baseline period