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Observational Study
. 2022 Jun 14;17(6):e0269779.
doi: 10.1371/journal.pone.0269779. eCollection 2022.

Characteristics of 2-drug regimen users living with HIV-1 in a real-world setting: A large-scale medical claim database analysis in Japan

Daniel J Ruzicka  1 , Mayuko Kamakura  1 , Naho Kuroishi  1 , Nobuyuki Oshima  1 , Miyuki Yamatani  1 , Jingbo Yi  2 , Bruce Crawford  2 , Kunihisa Tsukada  3 , Shinichi Oka  3
Affiliations
Observational Study

Characteristics of 2-drug regimen users living with HIV-1 in a real-world setting: A large-scale medical claim database analysis in Japan

Daniel J Ruzicka et al. PLoS One. .

Abstract

Background: Regimen simplification to 2-drug antiretroviral therapy (2-ART) may address potential tolerability issues, increase adherence, and reduce toxicity and potential drug-drug-interactions among people living with HIV-1 (PLWH). However, real-world treatment patterns and characteristics of 2-ART users are unclear.

Methods: This retrospective observational cohort study employed a large-scale medical claim database of Japanese hospitals to extract data on 4,293 PLWH aged ≥18 years with diagnosis of HIV and treated with any ART regimens between April 2008 and April 2019. A 2-ART cohort was compared with a 3-drug antiretroviral therapy (3-ART) cohort in terms of population characteristics, comorbid conditions, and treatment patterns. Treatment switching rates were calculated for each cohort followed by sensitivity analysis to confirm the robustness of the findings.

Results: There were 94 individuals identified in the 2-ART cohort. Compared to the standard 3-ART cohort (n = 3,993), the 2-ART cohort was older (median age 53 [IQR 44-64] vs 42 years [IQR 35-50]), with a lower proportion of males (87.2% vs 93.8%), higher Charlson Comorbidity Index (CCI) (median score 6 [IQR 5-8] vs 5 [IQR 4-6]), more co-medications (median 6 [IQR 4-11] vs 3 [IQR 2-7]), and a higher percentage of AIDS-defining conditions (66.0% vs 42.8%). The most common 2-ART were protease inhibitor (PI) + integrase strand transfer inhibitor (INSTI) and non-nucleoside reverse transcriptase inhibitor (NNRTI) + INSTI (33.0% and 31.9%, respectively). Overall, most of the regimens were nucleoside reverse transcriptase inhibitor (NRTI)-sparing (71.3%), with a decreasing trend over time (76.2% to 70.2%). ART regimen switch occurred more often in the 2-ART cohort than in the 3-ART cohort (33.0% vs 21.2%).

Conclusion: The profiles of individuals on 2-ART in Japan were demonstrated to be complex. Most were treated with NRTI-sparing regimens which may reflect an effort to reduce treatment-related toxicities.

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Conflict of interest statement

This study is a company sponsored study, employed authors DJR, NK, NO, MK, MY received salaries and the manuscript was reviewed by company to meet scientific criteria and meet with our areas of interest as a company. SO received research budget from ViiV healthcare and Gilead Sciences, and honorarium for lectures from ViiV Healthcare, Gilead Sciences, and MSD K.K.. Authors contribution for authors employed by the funding organization is described in "Author Contributions". The funding organization did not interfere with study design, data collection and analysis, nor the decision to publish and has an ethical guideline to always publish after a study has been conducted regardless of the outcome of the results. This does not alter our adherence to PLOS ONE policies on sharing data and materials

Figures

Fig 1
Fig 1. Flow chart of cohort attrition.
*Individuals in this study were selected from a hospitals-based database, thus are referred to as “patients” in this context.
Fig 2
Fig 2. Analysis of 2-ART drug regimens.
(a.) Treatment patterns by drug combination regimen at index date. (b.) Drug combinations over three periods for the 2-drug cohort.
See this image and copyright information in PMC

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