The "ART review": formalizing a process to document complex HIV treatment histories and to support treatment optimization.

Abstract

Contemporary antiretroviral therapy (ART) is well-tolerated, safe and has simple dosing schedules. Here we evaluate a clinic wide initiative that uses detailed ART reviews when switching highly treatment-experienced individuals with or without HIV viremia to new regimens. We hypothesized that viral suppression post-switch would be maintained or improved. Persons who had a comprehensive ART review performed between March 2016 and December 2020 for optimization or virologic failure in an urban HIV clinic were included. Primary outcome was viral suppression at 6 months post-switch, and secondary outcomes included sustained viral suppression at 2 years, ART regimen characteristics and metabolic-associated changes. In patients with suppressed HIV-RNA who optimized therapy, 43 (96%) of 45 remained suppressed at 6 months. Among people switching for virologic failure, 16 (84%) of 19 achieved viral suppression at 6 months. Two years post-switch, 44 (88%) of 50 people were still in care on the optimized regimen and had viral suppression. Multiple different ART regimen characteristics improved as well. The use of ART reviews to assist in regimen recommendations for people with HIV who are highly treatment experienced is safe and effective. HIV clinicians should consider using detailed ART reviews in highly treatment-experienced individuals to facilitate optimization and record this critical medical history.