title: A retrospective study of HIV antiretroviral treatment persistence in a commercially insured population in the United States.
abstract: This study examined factors associated with persistence (time from initiation to discontinuation of treatment) on initial antiretroviral (ARV) therapy in commercially insured HIV patients in the United States, a population not well researched. This retrospective analysis of US health insurance claims data from 1 January 2003 to 30 June 2008 included treatment-naive patients aged 18-65 years with an HIV diagnosis 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. Descriptive statistics, Kaplan-Meier survival estimation, and Cox proportional hazards regression models were completed. Patients were considered persistent until any component of the regimen was modified or there was a gap in treatment >90 days. A total of 2460 patients met full inclusion criteria (1388 NNRTI and 1072 PI). 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. Relative to NNRTI-based regimens, PI-based regimens demonstrated a greater risk of discontinuation (hazard ratio [HR], 1.32; p<0.001). 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.
authors.affiliation: Bristol-Myers Squibb Research and Development, Plainsboro, NJ, USA. timothy.juday@bms.com
authors.forename: Timothy
authors.initials: T
authors.lastname: Juday
authors.forename: Kristy
authors.initials: K
authors.lastname: Grimm
authors.forename: Annette
authors.initials: A
authors.lastname: Zoe-Powers
authors.forename: James
authors.initials: J
authors.lastname: Willig
authors.forename: Edward
authors.initials: E
authors.lastname: Kim
mesh_terms: D000328:Adult; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage*; D015497:HIV-1; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D008297:Male; D055118:Medication Adherence; D012044:Regression Analysis; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D012307:Risk Factors; D019438:Ritonavir / Q000008:administration & dosage*; D014481:United States
chemical_list: D004338:Drug Combinations; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; D019438:Ritonavir