Real-World Persistence After Starting Bictegravir- or Dolutegravir-Based Regimens Among Adults Aged ≥50 Years with HIV in the United States.

BACKGROUND

Persistence and adherence to antiretroviral therapy (ART) are crucial for effective viral suppression and may be impacted by comorbidities and polypharmacy in older people with HIV (PWH). This study compared ART persistence among treatment-naive and treatment-experienced PWH aged ≥50 years who received bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) versus dolutegravir (DTG)-based regimens.

METHODS

This observational, retrospective study utilized US medical and pharmacy claims data from HealthVerity Marketplace (1 January 2015 to 29 February 2024). PWH were aged ≥50 years and received B/F/TAF, dolutegravir/lamivudine (DTG/3TC), dolutegravir/abacavir/lamivudine (DTG/ABC/3TC), or DTG-based multitablet regimens (MTRs). Baseline characteristics were balanced using inverse probability of treatment weighting. Time to nonpersistence (i.e., discontinuation or switching) was depicted using Kaplan-Meier plots. Risk of nonpersistence was modeled using weighted Cox proportional hazards models.

RESULTS

Overall, 32,448 PWH aged ≥50 years were included in the analysis; 77% were treatment experienced. Among treatment-experienced PWH, those who received B/F/TAF had significantly lower adherence during the baseline period than those who received DTG/3TC and significantly higher adherence during the baseline period than those who received DTG/ABC/3TC and DTG-based MTRs. Nonetheless, persistence on B/F/TAF was longer than DTG/ABC/3TC and DTG-based MTRs in both subgroups. Treatment-naive and treatment-experienced PWH who received B/F/TAF had significantly lower hazards of nonpersistence versus those who received DTG/ABC/3TC and DTG-based MTRs (all p < 0.001), as did treatment-naive PWH who received B/F/TAF versus DTG/3TC (p = 0.031).

CONCLUSIONS

B/F/TAF was associated with higher persistence than other ART regimens among older PWH. Findings underscore the importance of tailored ART selection to address the unique challenges faced by older PWH.