Antiretroviral Treatment Switch Among Treatment-Experienced People with HIV

Background: HIV requires lifelong continuous antiretroviral therapy (ART) to prevent morbidity and mortality and to reduce onward transmission. People with HIV (PWH) may switch ART regimens for various clinical and nonclinical reasons. Identifying patterns of ART switching can inform shared decision-making and optimize regimen selection among treatment-experienced PWH. Objectives: To describe and compare treatment switching among PWH by regimen in a large US claims database, including a subset of PWH enrolled in Medicare Advantage. Methods: A retrospective analysis of closed US medical and pharmacy claims data was conducted in treatment-experienced PWH with commercial insurance or Medicare Advantage with Part D coverage from the Optum Research Database. PWH who switched to an ART regimen of interest (bictegravir/emtricitabine/tenofovir alafenamide [B/F/TAF], dolutegravir/lamivudine, dolutegravir/abacavir/lamivudine, dolutegravir + emtricitabine/tenofovir alafenamide, dolutegravir + emtricitabine/tenofovir disoproxil fumarate, and cabotegravir + rilpivirine) between July 1, 2017, and November 30, 2023, were included. Baseline characteristics were balanced across regimens in the overall study population using inverse probability treatment weighting. Time to switch/add-on was estimated using Kaplan-Meier analyses. Adjusted hazard ratios for the entire follow-up period were calculated using multivariable Cox proportional hazards models. Outcomes were assessed in the overall population and in the subset enrolled in Medicare Advantage. Results: ≤ .001). Findings were similar for the subset of Medicare Advantage enrollees. Discussion: Due to more effective treatments, PWH have increased life expectancy, and a growing proportion are qualifying for Medicare coverage. This analysis showed that PWH taking B/F/TAF, both in the overall population and the Medicare Advantage subset, maintained their initial treatment regimen longer and had a reduced risk of treatment switch/add-on compared with the other regimens of interest. Conclusions: These findings suggest that B/F/TAF has a lower likelihood of treatment switch/add-on for treatment-experienced PWH than other current ART regimens.