550. Adherence and Persistency with Modern Single vs Multi-Tablet Antiretroviral (ARV) Regimens in 1st treatment of HIV in Clinical Practice.
Session: Poster Abstract Session: HIV: Antiretroviral Therapy
Thursday, October 4, 2018
Room: S Poster Hall
Background: Prior studies have reported improved adherence, persistency, virologic outcomes and lower risk of hospitalizations with single tablet (STR) vs multi tablet regimens (MTR) in HIV treatment. However, most studies were conducted using prescription and medical claims data limited to EFV-based therapies. In this study, we utilized EMR, prescription, and pharmacy dispensing data to assess STR and MTR adherence and persistency as observed in a network of clinical practices.

Methods: Data were collected for HIV-infected patients in care at 6 US-based HIV treatment centers. Patients eligible for the study initiated their 1st ARV between Jan 2015 and Dec 2016. First ARV regimen was assigned based on absence of prior ARV prescriptions and a 30-day pre-treatment period with no ARV dispensed or for rapid starts, a high baseline viral load (>= 10,000 copies/ml). Adherence was assessed using Proportion of Days Covered (PDC). Follow up was ≥365 days with duration capped at 365 days for persistency comparisons.

Results: 1499 patients met the criteria for the study; 66% (982/1499) received STR and 34% (517/1499) MTR. Top STRs were EVG/c/TDF/FTC (265/982, 27%), EVG/c/TAF/FTC (250/982, 26%), and DTG/ABC/3TC (171/982, 17%). Top MTRs were DTG + TDF/FTC (69/517, 13%), DRV + RTV + TDF/FTC (60/517, 12%), and DRV/c + TDF/FTC (40/517, 8%). Average persistency for STRs was significantly longer at 252 days vs 233 days for MTRs (p= 0.002). Average PDC adherence rates were significantly higher for STRs at 91% vs 83% for MTRs (p<0.001). Within the STR group, older age was significantly associated with greater adherence (average age: 45 in 80%+ adherent group vs 42 in <80% adherent group, p= 0.012). In both the STR and MTR groups, the percentage of black patients was significantly higher in the non-adherent group (45% in STR, 42% in MTR) compared to the adherent group (24% in STR, 32% in MTR) (p< 0.001 in STR, p=0.027 in MTR).

Conclusion: This study of adherence with STR vs MTR HIV therapy is novel, as it uses more currently relevant HIV regimens and was conducted utilizing EMR, prescription, and dispensing data. The results of better adherence and persistency with STR ART underscores the ongoing importance of simpler treatment for HIV care.

Anthony Mills, MD1, Julie Priest, MSPH2, Alexander Musallam, MPH3, Keri Althoff, PhD4, Joseph Eron, MD5, Greg Huhn, MD6, Dushyantha Jayaweera, MD, MRCOG, FACP7, Karam Mounzer, MD8, Graeme Moyle, MD9, Joe Mrus, MD, MSc10, Moti Rampogal, MD11, Steven Santiago, MD12, Paul Sax, MD13, Gene Voskuhl, MD14, Alan Oglesby, MPH2 and Richard Elion, MD15, (1)Men’s Health Foundation, Los Angeles, CA, (2)ViiV Healthcare, Durham, NC, (3)Analytics, Trio Health Analytics, La Jolla, CA, (4)Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (5)Division of Infectious Diseases, UNC Center for AIDS Research, Chapel Hill, NC, (6)The Ruth M. Rothstein Core Center - Rush University Medical Center, Chicago, IL, (7)University of Miami, Miami, FL, (8)Philadelphia Field Initiating Group for HIV Trials, Philadelphia, PA, (9)Chelsea and Westminster Hospital, Glen Iris,Victoria, Australia, (10)North American Medical Affairs, ViiV Healthcare, Durham, NC, (11)Midway Immunology and Research, Fort Pierce, FL, (12)Care Resource, Miami, FL, (13)Brigham and Women's Hospital, Boston, MA, (14)Prism Health- Baylor University Medical Center, Dallas, TX, (15)Whitman Walker Clin., Washington, DC

Disclosures:

A. Mills, ViiV: Investigator and Scientific Advisor , Consulting fee and Research support . Gilead: Investigator , Scientific Advisor and Speaker's Bureau , Consulting fee , Research support and Speaker honorarium . Merck: Investigator and Scientific Advisor , Consulting fee and Research support .

J. Priest, ViiV Healthcare: Employee , Salary .

A. Musallam, Trio Health: Employee , Salary .

K. Althoff, Gilead: Scientific Advisor , Consulting fee .

J. Eron, ViiV Healthcare: Consultant and Investigator , Consulting fee and Research support . Gilead: Consultant and Investigator , Consulting fee and Research support . Janssen: Consultant and Investigator , Consulting fee and Research support .

G. Huhn, Gilead: Grant Investigator and Scientific Advisor , Consulting fee and Grant recipient . ViiV Healthcare: Grant Investigator and Scientific Advisor , Consulting fee and Grant recipient . Janssen: Grant Investigator and Scientific Advisor , Consulting fee and Grant recipient . Theratechnologies: Scientific Advisor , Consulting fee . Proteus: Grant Investigator , Grant recipient .

D. Jayaweera, Gilead: Grant Investigator , Research grant . ViiV Healthcare: Grant Investigator , Research grant . Janssen: Grant Investigator , Research grant .

K. Mounzer, Gilead: Grant Investigator , Scientific Advisor and Speaker's Bureau , Consulting fee , Research grant and Speaker honorarium . ViiV Healthcare: Grant Investigator and Scientific Advisor , Consulting fee and Research grant . Janssen: Grant Investigator , Scientific Advisor and Speaker's Bureau , Consulting fee , Research grant and Speaker honorarium . Merck: Grant Investigator , Scientific Advisor and Speaker's Bureau , Consulting fee , Research grant and Speaker honorarium .

G. Moyle, Merck: Scientific Advisor and Speaker's Bureau , Consulting fee and Speaker honorarium . Gilead: Scientific Advisor and Speaker's Bureau , Consulting fee and Speaker honorarium . Janssen: Scientific Advisor and Speaker's Bureau , Consulting fee and Speaker honorarium . TheraTechnologies: Scientific Advisor and Speaker's Bureau , Consulting fee and Speaker honorarium .

J. Mrus, ViiV Healthcare: Employee , Salary .

M. Rampogal, Gilead: Consultant , Grant Investigator and Speaker's Bureau , Consulting fee , Research grant and Speaker honorarium . Janssen: Speaker's Bureau , Speaker honorarium . Allergen: Speaker's Bureau , Speaker honorarium . ViiV Healthcare: Consultant and Grant Investigator , Consulting fee and Grant recipient . Merck: Consultant , Consulting fee .

S. Santiago, Gilead: Scientific Advisor and Speaker's Bureau , Consulting fee and Speaker honorarium . Janssen: Speaker's Bureau , Speaker honorarium .

P. Sax, Gilead: Consultant and Grant Investigator , Consulting fee , Grant recipient and Research grant . ViiV Healthcare: Consultant and Grant Investigator , Consulting fee , Grant recipient and Research grant . Merck: Consultant and Grant Investigator , Consulting fee , Grant recipient and Research grant . Janssen: Consultant , Consulting fee . BMS: Grant Investigator , Grant recipient and Research grant .

G. Voskuhl, Gilead: Grant Investigator and Scientific Advisor , Consulting fee , Grant recipient and Research grant . ViiV Healthcare: Grant Investigator , Grant recipient and Research grant . Merck: Grant Investigator , Grant recipient and Research grant . Janssen: Grant Investigator , Grant recipient and Research grant .

A. Oglesby, ViiV Healthcare: Employee and Shareholder , Salary .

R. Elion, Gilead: Investigator , Scientific Advisor and Speaker's Bureau , Consulting fee , Research support and Speaker honorarium . ViiV: Consultant , Consulting fee . Trio Health: Consultant , Consulting fee .

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.