Antiretroviral therapy persistence among treatment-experienced people with HIV and mental health disorders and/or substance use disorders in the USA (2017-2024): a retrospective cohort study.

Aim: There are limited studies of antiretroviral therapy persistence among people with HIV (PWH) who have a mental health disorder and/or substance use disorder (MHD/SUD). This real-world study analyzed persistence among treatment-experienced PWH who had an MHD/SUD or suboptimal adherence (proportion of days covered [PDC] < 85%). Materials & methods: In this retrospective cohort study of claims from the Optum Research Database, nonpersistence (i.e., discontinuation, switch, add-on or death) was assessed in treatment-experienced PWH who switched to or restarted an antiretroviral therapy regimen of interest (i.e., bictegravir [B]/emtricitabine [F]/tenofovir alafenamide [TAF], dolutegravir [DTG]/lamivudine [3TC], DTG/abacavir [ABC]/3TC, DTG + F/TAF, DTG + F/tenofovir disoproxil fumarate [TDF] or cabotegravir + rilpivirine) from 1 July 2017 to 30 November 2023. Baseline characteristics across regimens were balanced by inverse probability treatment weighting. Kaplan-Meier analysis was conducted on weighted data to examine regimen persistence at 12 months. Adjusted Cox proportional hazards models assessed nonpersistence throughout follow-up. Results: Overall, 14,826 PWH were eligible and treatment experienced; 5310 had an MHD/SUD and 4090 had PDC < 85% during follow-up. Among treatment-experienced PWH who received B/F/TAF, persistence at 12 months was 80.3% for those with an MHD/SUD and 78.6% for those with PDC < 85%; this was greater compared with PWH who received DTG/3TC (76.7% and 70.8%), DTG/ABC/3TC (68.9% and 66.3%), DTG + F/TAF (62.4% and 58.9%) and DTG + F/TDF (36.7% and 41.9%; all p < 0.05). Compared with B/F/TAF, nonpersistence risk was greater with DTG/3TC, DTG/ABC/3TC, DTG + F/TAF and DTG + F/TDF in the MHD/SUD (all p < 0.05) and PDC < 85% (all p < 0.05 except DTG/3TC) groups. Conclusion: These results indicate that B/F/TAF may offer greater likelihood of persistence and emphasize the importance of regimen selection to optimize outcomes in treatment-experienced PWH with an MHD/SUD or suboptimal adherence.