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CDC HIV/AIDS/Viral Hepatitis/STD/TB Prevention News Update
UNITED STATES: A Retrospective Study of HIV Antiretroviral Treatment Persistence in a Commercially Insured Population in the United States
Timothy Juday; Kristy Grimm; Annette Zoe-Powers; James Willig;
October 13, 2011
AIDS Care Vol. 23; No. 9: P. 1154-1162 (09..11) - Thursday,

In the current study, the researchers examined factors associated with persistence on initial antiretroviral therapy (the time from ARV treatment initiation to discontinuation) in commercially insured US HIV patients.

The research involved a retrospective analysis of US health insurance claims data from Jan. 1, 2003, to June 30, 2008. It included treatment-naive patients ages 18 to 65 diagnosed with HIV and receiving ARV therapy consisting of at least two individual nucleoside reverse-transcriptase inhibitors (NRTIs) or one fixed-dose combination NRTI, plus at least one nonnucleoside reverse transcriptase inhibitor (NNRTI) or one protease inhibitor (PI), with or without ritonavir. The patients were considered persistent until any component of the regimen was modified or there was a gap in treatment of more than 90 days. Descriptive statistics, Kaplan-Meier survival estimation and Cox proportional hazards regression models were completed.

In all, 2,460 patients (1,388 NNRTI and 1,072 PI) met full inclusion criteria. The mean (SD) time to discontinuation for NNRTI- vs. PI-based regimens was 370 (346) vs. 295 (338) days (p<0.001). "Female sex, substance use, low comorbidity score, index year before 2007, geographical region, and taking a lopinavir/ritonavir regimen predicted discontinuation," the team reported.

"Relative to NNRTI-based regimens, PI-based regimens demonstrated a greater risk of discontinuation (hazard ratio [HR], 1.32; p<0.001)," the authors concluded. "The fixed-dose efavirenz/emtricitabine/tenofovir combination yielded the lowest risk of discontinuation (HR, 0.39; p<0.001). HIV treatment persistence was longer with NNRTI-based regimens than PI-based regimens. The fixed-dose regimen of once-daily efavirenz/emtricitabine/tenofovir had the lowest risk of discontinuation."