Introduction

Recent changes in antiretroviral therapies (ARTs) may have affected medication adherence of people living with human immunodeficiency virus-1 (HIV-1). In this study adherence to ART regimens among patients with HIV-1 (PWH) across the US during a recent time period was examined and study findings were stratified by US region and state.

Methods

A retrospective observational study using the Symphony Health Solution Integrated Dataverse database was conducted. Patients ≥ 18 years of age who had a diagnosis of HIV-1 (without an HIV-2 diagnosis) and who were treated with ART between July 2017 and September 2018 (first pharmacy record: index date) were selected from the data source. Both patients who had not been previously treated with ART and those who were treatment experienced were included. Patients were required to have ≥ 1 medical/pharmacy record ≥ 12 months after their index date (follow-up period). Patient characteristics were examined during a 12-month pre-index period. During the follow-up, medication adherence, measured as the proportion of days covered (PDC), was examined for all patients and stratified by US region and state.

Results

Among 206,474 adult PWH treated with ART, mean age was 47.9 years, 73.4% were male, and 30.0% were Caucasian. The most prevalent comorbid conditions were hyperlipidemia (25.1%), depressive disorders (14.8%), and type 2 diabetes (12.1%). During the follow-up period, mean (standard deviation) PDC was 74.1% (25.9%) among PWH across the US [Midwest: 74.4% (25.5%); Northeast: 74.3% (26.1%); South: 73.2% (26.3%); West: 76.4% (24.8%)]. Across all US regions, > 60% of PWH had adherence < 90% and > 40% had adherence < 80%; the West had the highest adherent population.

Conclusions

Among PWH treated with ART across the US, a majority had suboptimal adherence. Implementation of strategies to improve ART adherence, including clinical consideration of ARTs with high genetic barriers to resistance, is needed in the US.

中文翻译：

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美国各地 HIV-1 患者对抗逆转录病毒治疗的真实依从性

介绍

最近抗逆转录病毒疗法 (ART) 的变化可能影响了人类免疫缺陷病毒 1 (HIV-1) 患者的药物依从性。在这项研究中，检查了最近一段时间内美国各地 HIV-1 (PWH) 患者对 ART 方案的依从性，并按美国地区和州对研究结果进行了分层。

方法

使用 Symphony Health Solution Integrated Dataverse 数据库进行了一项回顾性观察研究。从数据源中选择 2017 年 7 月至 2018 年 9 月（第一次药房记录：索引日期）期间被诊断为 HIV-1（没有 HIV-2 诊断）并接受 ART 治疗的 18 岁以上的患者。既往未接受过 ART 治疗的患者和接受过治疗的患者均包括在内。要求患者在索引日期后 ≥ 12 个月（随访期）有 ≥ 1 份医疗/药房记录。在 12 个月的索引前期间检查了患者特征。在随访期间，对所有患者的服药依从性（以覆盖天数（PDC）的比例衡量）进行了检查，并按美国地区和州进行了分层。

结果

在接受 ART 治疗的 206,474 名成人 PWH 中，平均年龄为 47.9 岁，73.4% 为男性，30.0% 为白种人。最普遍的合并症是高脂血症（25.1%）、抑郁症（14.8%）和2型糖尿病（12.1%）。在随访期间，美国 PWH 的平均（标准差）PDC 为 74.1%（25​​.9%）[中西部：74.4%（25.5%）；东北：74.3%（26.1%）；南部：73.2%（26.3%）；西部：76.4% (24.8%)]。在美国所有地区，> 60% 的 PWH 的依从性 < 90% 和 > 40% 的依从性 < 80%；西方的信徒人数最多。

结论

在美国各地接受 ART 治疗的 PWH 中，大多数人的依从性不佳。在美国，需要实施提高抗逆转录病毒治疗依从性的策略，包括临床考虑具有高耐药遗传障碍的抗逆转录病毒疗法。