With modern antiretroviral (ARV) regimens, HIV infection has evolved into a manageable chronic condition. The ultimate goal of treatment is to maximize the virologic suppression of HIV virus while minimizing intolerability, toxicity, drug-to-drug interactions, and non-compliance. The objectives of this study were to describe clinical characteristics and treatment history of currently treated HIV-1 patients in commercial and Medicare Advantage health plans in the United States.
A retrospective cohort study of adults (≥18 years) with ≥1 ARV pharmacy claim from 01/01/2012 to 03/31/2017 and ≥1 HIV-1 diagnosis code in the Optum Research Database. A claims-based algorithm was used to identify lines of therapy (LOT), including the most recent LOT (LOT0) and previous LOTs dating back to 01/01/2007. Subjects were continuously enrolled 12 months prior to the start of LOT0 (baseline) and comorbidities assessed. Treatment-naïve subjects were defined as having LOT0 only during baseline, while subjects with >1 LOT were defined as treatment-experienced. Study variables were summarized descriptively and results were stratified by treatment status, insurance type, and age groups.
There were 18,699 eligible subjects, of whom 27% were treatment-naïve. Average age was 47 years (±12), 84% were male, 51% Caucasian, and 82% had commercial insurance. Common baseline comorbidities among subjects were hyperlipidemia (41%), cardiovascular disease (41%), hypertension (34%), and depression (17%). Most comorbidities increased with age except for depression and anxiety, which were mostly constant across age groups. Among all subjects, the average cumulative proportion of days covered with an ARV was 85%. Average total pills per day, ARV and non-ARV, increased with age corresponding with Medicare subjects having 9.2 and commercial subjects having 3.7 pills per day.
As ARV regimens have improved the life expectancy for patients with HIV, management of comorbidities and overall medication burden has become increasingly complex. HIV treatment guidelines suggest streamlined ARV regimens may be considered as patient complexity evolves over time to decrease disease burden taking into account co-morbidities, drug-drug interactions and total pill burden.
C. Blauer-Peterson, Optum: Employee , Salary . ViiV: Research Contractor , Consulting fee .
K. Andrade, Optum: Employee , Salary . Viiv: Research Contractor , Consulting fee .
A. Oglesby, ViiV Healthcare: Employee and Shareholder , Salary .