Prevalence of and Time to Suboptimal Treatment Patterns Among People with HIV on Antiretroviral Therapy in the United States.

Modern antiretroviral therapy (ART) regimens have increased life expectancy and improved quality of life in people with HIV (PWH). However, the necessity for lifelong ART use presents adherence and persistence challenges. Recent population-level data regarding such challenges with contemporary daily oral ART regimens are limited, particularly in the United States. This observational, retrospective, noncomparative cohort study used data from HealthVerity MarketPlace closed medical and pharmacy claims from PWH ≥ 18 years of age (treatment naive or treatment experienced) who were insured in the United States. Eligible PWH had ≥ 2 pharmacy refills for a Department of Health and Human Services (DHHS) guideline-recommended complete daily oral ART regimen between January 1, 2016, and November 30, 2023, with ≥ 365 days of continuous baseline enrollment and ≥ 180 days of follow-up. The index date was the date of the first recorded pharmacy claim for a complete ART regimen, regardless of prior treatment experience. Rolling adherence was measured using the Continuous, Multiple Interval Measure of Medication Acquisition method that compared the timing of prescription fills versus the number of days the prescription was intended to last, within blocks of 90 days. Suboptimal adherence was defined as proportion of days covered < 85%. Treatment interruption was defined as a gap in ART medication supply of > 90 days, followed by resumption of ART at any point, with combined treatment interruption/discontinuation defined as a > 90-day gap in ART medication supply, regardless of whether ART was restarted. Switching between DHHS guideline-recommended ART regimens and from DHHS guideline-recommended to nonguideline-recommended ART regimens was also evaluated. A total of 73,533 PWH were included in the study (60,062 [81.7%] treatment naive and 13,471 [18.3%] treatment experienced). The proportion of PWH on treatment for ≥ 1 year who remained adherent during all 90-day blocks decreased from 40.2% (95% confidence interval [CI], 39.6%-40.8%) by the end of Year 1, to 24.2% (95% CI, 23.7%-24.6%) at the end of Year 2, and to 17.7% (95% CI, 17.3%-18.1%) at the end of Year 3 when standardized by age group-sex-region. The standardized annual prevalence of suboptimal adherence remained relatively constant between 2017 and 2022 (46.7%-53.2%). The standardized proportion of PWH who persisted on daily oral ART without treatment interruption was 81.2% (95% CI, 80.8%-81.6%) after 1 year, 74.1% (95% CI, 73.7%-74.6%) after 2 years, and 70.6% (95% CI, 70.1%-71.1%) after 3 years. Switching between DHHS guideline-recommended daily oral ART regimens remained below 10% between 1 and 3 years of follow-up and was similar for switches from guideline-recommended to nonguideline-recommended daily oral ART regimens. The findings of this study suggest that suboptimal adherence to daily oral ART remains a challenge, even with the availability of modern regimens.