1516. Characteristics of Treatment-Experienced HIV-1-Infected Patients Switching from Multi-Tablet to Single-Tablet Regimens in the Veterans Affairs Health Care System
Session: Poster Abstract Session: HIV: Antiretroviral Therapy
Friday, October 28, 2016
Room: Poster Hall
Background: Few studies have characterized real world treatment patterns in ART experienced patients. We characterized treatment experienced veterans switching from multi-tablet regimens (MTR) to single-tablet regimens (STR), and compared characteristics of virologically stable (<50 copies/mL) and non-stable switchers.

Methods: HIV+ veterans age ≥18 years who switched to an STR (index date) between 7/1/2007-9/30/2014 after receiving ≥1 MTR and had VA benefits for ≥18 months prior to initiating STR (baseline) were identified from Veterans Health Administration electronic medical records. Veterans were classified as virologically stable, non-stable, or of unknown status based on recent viral load results prior to STR initiation. Baseline demographic and clinical characteristics were compared between stable and non-stable switchers using Wilcoxon rank-sum tests for continuous variables and chi square tests for categorical variables.

Results: Of 3,806 veterans switched to STR (i.e., efavirenz (EFV)/tenofovir (TDF)/emtricitabine (FTC), dolutegravir (DTG)/abacavir (ABC)/lamivudine (3TC), elvitegravir/cobicistat/TDF/FTC, rilpivirine/TDF/FTC), 1,803 (47.3%), 1,258 (33.1%), and 745 (19.6%) were classified as virologically stable, non-stable, or of unknown status. Compared to non-stable switchers, stable switchers were slightly older (55 vs 53 years), less likely to be homeless (7.3% vs 12.2%) or Black (42.3% vs 51.3%), and had higher median baseline CD4 count (573 vs 373 cells/mm3) (all p<0.05). A lower proportion of stable than non-stable switchers were co-infected with hepatitis C (18.6% vs 23.2%, p=0.002) and diagnosed with substance abuse disorders (19.7% vs 30.0%, p<0.001). The 3 most common MTRs preceding STR were EFV + TDF/FTC, EFV + zidovudine/3TC, ritonavir-boosted atazanavir + TDF/FTC, comprising only 35.4% and 31.0% of prior regimens in stable and non-stable switchers, respectively. Median time to switch was 375 days in stable and 258 days in non-stable switchers (p<0.001).

Conclusion: Significant variations in demographic and clinical characteristics and prior therapy exist in stable and non-stable switchers to STR. Understanding these differences will inform policies for addressing barriers to optimal therapy.

Maral Dersarkissian, PhD1, Kathy Schulman, MA2, Susan Zelt, DrPH, MBA3, Ronald D’Amico, DO, MSc3, Rachel Bhak, MS, BS1, Michael Hellstern, BA1, Antonia Altomare, DO, MPH4, Ellyn Ercolano, MS5, Mei Sheng Duh, ScD, MPH1 and Yinong Young-Xu, ScD, MS, MA5, (1)Analysis Group, Inc., Boston, MA, (2)Outcomes Research Solutions, Inc., Waltham, MA, (3)ViiV Healthcare, Inc., Research Triangle Park, NC, (4)Veterans Affairs Medical Center, White River Junction, VT, (5)Clinical Epidemiology Program, Veterans Affairs Medical Center, White River Junction, VT

Disclosures:

M. Dersarkissian, Viiv Healthcare, Inc.: Research Contractor , Research grant

K. Schulman, Viiv Healthcare, Inc.: Consultant and Research Contractor , Consulting fee and Research grant

S. Zelt, Viiv Healthcare, Inc.: Employee , Salary and Stock options

R. D’Amico, Viiv Healthcare, Inc.: Employee , Salary and Stock options

R. Bhak, Viiv Healthcare, Inc.: Research Contractor , Research grant

M. Hellstern, Viiv Healthcare, Inc.: Research Contractor , Research grant

A. Altomare, Analysis Group, Inc.: Investigator , Analysis Group, Inc. receives research grants from Viiv Healthcare, Inc. and Research grant

E. Ercolano, Analysis Group, Inc.: Investigator , Analysis Group, Inc. receives research grants from Viiv Healthcare, Inc. and Research grant

M. S. Duh, Viiv Healthcare, Inc.: Research Contractor , Research grant

Y. Young-Xu, Analysis Group, Inc.: Investigator , Analysis Group, Inc. receives research grants from Viiv Healthcare, Inc. and Research grant

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