Antiretroviral therapy among people with HIV with comorbidities in the United States: a retrospective cohort study

Abstract

Objectives

To describe patterns of antiretroviral medications among people with HIV (PWH) who also have common comorbid conditions in a United States cohort.

Methods

This retrospective cohort study used Optum Research Database claims data from 01/01/2017 through 01/31/2019 to identify adult PWH (≥18 years) based on pharmacy claims for ART during 2018. The index date was defined as the first date of an ART claim. Study inclusion required ≥1 HIV/AIDS diagnosis code during the study period, and continuous health plan enrollment 12 months prior to and at least 30 days after the index date. Descriptive statistics were used to report study results.

Results

The study population consisted of 17,694 PWH; mean (SD) age 52.2 (12.8) years; 62.0% were ≥ 50 years old. About 50.6% of the study sample had ≥2 comorbidities at baseline. The most prevalent comorbid conditions were hypertension (33.2%), hyperlipidemia (29.7%), neuropsychiatric conditions (26.9%), and cardiovascular disease (11.5%). Most (93.5%) of PWH received a nucleotide reverse transcriptase inhibitor (NRTI) backbone regimen, including tenofovir alafenamide (41.6%), tenofovir disoproxil fumarate (28.1%), and abacavir (22.0%). The most commonly used anchor agents, 62.6%, were integrase strand transfer inhibitors (INSTIs): dolutegravir (30.4%), elvitegravir (24.2%), and raltegravir (7.3%). The proportion of PWH using specific ARTs did not vary significantly with the presence and type of comorbidities.

Conclusion

From our analyses, ART prescribing did not appear to vary with the presence of comorbidities and potential medication contraindications. ART regimens may have comparable efficacy profiles; however, selection should be guided by each patient’s comorbidities to prevent potential comedication drug toxicities.

Keywords:

• Antiretroviral therapy (ART)
• comorbidity
• HIV
• people living with HIV

Transparency

Declaration of funding

This work was funded by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc, Rahway, NJ, USA.

Declaration of financial/other relationships

G.P. and B.K.T. are employees of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc, Rahway, NJ, USA (Merck). S.G. was working under an internship with Merck & Co., Inc., Rahway, NJ, USA in partnership with The University of Mississippi, University, MS. During the study, M.P., E.K.B., and K.M. were employed with Optum Inc., which was paid to conduct the study under contract with Merck. M.P. is now employed by the Henry M. Jackson Foundation, Bethesda, MD, USA. P.K. reports grant/research support from GSK, Merck, and Gilead; stock ownership with Merck, Pfizer, Johnson & Johnson, GSK, and Gilead; and service as consultant/advisory board member with AMGEN, GSK, Merck, and Gilead. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, contributed to the writing and reviewing of the manuscript, and have given final approval of the version to be published. M.P., G.P., S.G., J.M., and P.K. were involved in the conception and design of the study and data interpretation. E.K.B. and K.M. were involved in the acquisition of data. M.P., G.P., E.K.B., K.M., and P.K. were involved in the data analysis. B.K.T. was involved in the interpretation, writing and critical review of the manuscript.

Acknowledgements

Writing, editorial support, and formatting assistance were provided by Caroline Jennermann, MS, Gayle L. Allenback and Bernard Tulsi, all employees of Optum. Optum was contracted and compensated for conducting the study by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc, Rahway, NJ, USA. Results in part were presented at the 18th European AIDS Conference, European AIDS Clinical Society, October 27–30, 2021. Online and London, United Kingdom.

Data availability statement

Data used to generate these results cannot be disclosed publicly. Proprietary data obtained from the Optum Research Database may be accessed only with strictest data security and privacy protocols, and oversight with a restrictive license agreement.

Human subjects’ protection

The database for this study was statistically certified as de-identified, was accessed in compliance with Health Insurance Portability and Accountability Act (HIPAA) and included no identifiable protected health information. Institutional Review Board approval and informed consent was not required for this study.