122. Effectiveness of Antiretroviral Therapy in HIV-infected Adults Receiving Medical Care in the United States
Session: Oral Abstract Session: HIV Prevention, Early Diagnosis, STDs
Thursday, October 8, 2015: 11:45 AM
Room: 25--ABC
Background:  U.S. antiretroviral therapy (ART) guidelines issued by the Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents specify recommended initial and not-recommended ART regimens, but nationally representative data on ART prescribing practices and on the effectiveness of guideline-specified ART regimens are sparse.

Methods:  We used data from 18,095 participants in the 2009 through 2012 cycles of the Medical Monitoring Project, a nationally representative sample of HIV-infected adults receiving medical care in the United States. We classified ART regimens according to guidelines. Using multivariable logistic regression, we computed adjusted prevalence ratios (APR) and 95% confidence intervals (CI) to assess the independent associations between ART regimen categories and outcomes: durable viral suppression (all viral load tests <200 copies/ml in past year), self-reported 100% ART dose adherence in past 3 days, and self-reported ART-related side effects.

Results:  Almost all (92%) HIV-infected adults receiving medical care were prescribed ART. Of those prescribed ART, 52% were prescribed recommended regimens, 6% alternative regimens, 29% not-recommended regimens, and 13% other regimens; 66% achieved durable viral suppression, 84% were dose-adherent, and 16% reported side effects. Compared to persons on recommended regimens, persons prescribed not-recommended regimens (APR 0.98, CI 0.96-0.99) and other regimens (APR 0.92, CI 0.88-0.96) were less likely to achieve durable viral suppression and be dose-adherent (APR 0.97, CI 0.95-0.98 for not-recommended regimens; APR 0.93, CI 0.91-0.95 for other regimens). Compared to those prescribed recommended regimens, persons prescribed alternative regimens (APR 1.29, CI 1.11-1.50), not-recommended regimens (APR 1.18, CI 1.07-1.31), and other regimens (APR 1.18, CI 1.05-1.33) were more likely to report side effects.

Conclusion:  One-half of persons on ART were prescribed recommended ART regimens. Persons on not-recommended and other regimens were less likely to achieve viral suppression and more likely to report side effects. HIV providers should continue to be encouraged to prescribe ART according to established guidelines when clinically appropriate.

Yunfeng Tie, PhD1, Emma Frazier, PhD2 and Jacek Skarbinski, MD2, (1)ICF international, Atlanta, GA, (2)Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA


Y. Tie, None

E. Frazier, None

J. Skarbinski, None

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