Real-World Persistence in Adults with HIV and Mental Health or Substance Use Disorders After Restarting Antiretroviral Therapy in the United States.

IF 4 3区医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL

Advances in Therapy Pub Date : 2025-10-25 DOI:10.1007/s12325-025-03379-1

Amanda M Kong, Jacqueline Lucia, Mary J Christoph, Uche Mordi, Daisha Joseph, Gulce Askin, Daniela Yucuma, Neia Prata Menezes, Peter McMahon, Travis Lim

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引用次数: 0

Abstract

Introduction: Lifelong antiretroviral therapy (ART) persistence prevents the progression of human immunodeficiency virus (HIV)-related illnesses and reduces HIV transmission. People with HIV who have a mental health disorder or substance use disorder (PWH-MHD/SUD) often face persistence challenges. This real-world study compared ART persistence among PWH-MHD/SUD who restarted various ART regimens after a treatment interruption.

Methods: This observational, retrospective cohort study analyzed US claims data from the HealthVerity Marketplace from January 2015 through February 2024. PWH aged ≥ 18 years who restarted the same ART regimen they had previously discontinued for > 90 days were included. The population of PWH-MHD/SUD was analyzed. Pairwise comparisons were conducted for those who received bictegravir (B)/emtricitabine (F)/tenofovir alafenamide (TAF) versus dolutegravir (DTG)/lamivudine (3TC), DTG/abacavir (ABC)/3TC, and DTG-based multitablet regimens [MTRs; i.e., DTG + F/TAF or DTG + F/tenofovir disoproxil fumarate (TDF)]. Baseline characteristics were balanced using inverse probability of treatment weighting. Time to nonpersistence (i.e., ART regimen discontinuation or switching) was depicted using Kaplan-Meier plots. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using weighted Cox proportional hazards models.

Results: Among all the PWH who restarted a previously discontinued ART regimen (n = 20,623), 43.4% had an MHD or SUD. Compared with PWH-MHD/SUD who received B/F/TAF, those receiving DTG/ABC/3TC and DTG-based MTRs were significantly more likely to be nonpersistent [weighted HR (95% CI) 1.18 (1.09-1.29) and 1.19 (1.06-1.34), respectively], while there was no significant difference for those receiving DTG/3TC. Compared with those receiving B/F/TAF, the risk of switching was significantly higher for PWH-MHD/SUD receiving DTG/3TC, DTG/ABC/3TC, or a DTG-based MTR [weighted HR (95% CI) 1.68 (1.08-2.63), 2.67 (2.23-3.19), and 2.88 (2.32-3.58), respectively]. These results were generally consistent among the broader population of restarters.

Conclusion: For PWH-MHD/SUD who restarted ART after a treatment interruption, B/F/TAF was associated with longer persistence and the lowest risk of switch compared with other guideline-recommended therapies.

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在美国，重新开始抗逆转录病毒治疗后，成人艾滋病毒和精神健康或物质使用障碍的现实世界持续性

终生坚持抗逆转录病毒治疗（ART）可防止人类免疫缺陷病毒（HIV）相关疾病的进展并减少HIV传播。患有精神健康障碍或物质使用障碍（PWH-MHD/SUD）的艾滋病毒感染者经常面临持续性挑战。这项现实世界的研究比较了在治疗中断后重新开始各种ART方案的PWH-MHD/SUD患者的ART持久性。方法：这项观察性、回顾性队列研究分析了2015年1月至2024年2月HealthVerity市场上的美国索赔数据。年龄≥18岁的PWH，重新开始他们之前停止的相同抗逆转录病毒治疗方案100 - 90天。分析PWH-MHD/SUD人群。对接受比替重力韦(B)/恩曲他滨(F)/替诺福韦·阿拉法胺（TAF）与多替重力韦(DTG)/拉米夫定（3TC）、DTG/阿巴卡韦(ABC)/3TC和DTG为基础的多片方案进行两两比较；即DTG + F/TAF或DTG + F/富马酸替诺福韦二吡酯（TDF）]。使用治疗加权的逆概率来平衡基线特征。到非持续性的时间（即ART治疗方案停止或切换）用Kaplan-Meier图来描述。使用加权Cox比例风险模型估计风险比（hr）和95%置信区间（ci）。结果：在所有重新开始先前停止的抗逆转录病毒治疗方案的PWH中（n = 20,623）， 43.4%发生MHD或SUD。与接受B/F/TAF的PWH-MHD/SUD相比，接受DTG/ABC/3TC和基于DTG的MTRs的患者非持续性的可能性显著增加[加权HR （95% CI）分别为1.18（1.09-1.29）和1.19(1.06-1.34)]，而接受DTG/3TC的患者无显著差异。与接受B/F/TAF的PWH-MHD/SUD患者相比，接受DTG/3TC、DTG/ABC/3TC或基于DTG的MTR的PWH-MHD/SUD患者转换的风险明显更高[加权HR （95% CI）分别为1.68（1.08-2.63）、2.67（2.23-3.19）和2.88(2.32-3.58)]。这些结果在更广泛的再起动者群体中普遍一致。结论：对于PWH-MHD/SUD在治疗中断后重新开始抗逆转录病毒治疗，与其他指南推荐的治疗方法相比，B/F/TAF与更长的持续时间和最低的转换风险相关。

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来源期刊

Advances in Therapy 医学-药学

CiteScore

7.20

自引率

2.60%

发文量

353

审稿时长

6-12 weeks

期刊介绍： Advances in Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all therapeutic areas. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Advances in Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.