Medication persistence of people with HIV who restart antiretroviral therapy (ART) varies by treatment regimen, with many of these individuals suffering from mental health or substance use disorders, according to study findings presented at IDWeek 2025.
In the study, researchers analyzed pharmacy and medical claims data of more than 20,600 people between January 2015 and February 2024. All participants had restarted the same ART after a treatment interruption of more than 90 days. Treatment regimens included the following: bictegravir/emtricitabine/tenofovir (B/F/TAF), Dolutegravir/lamivudine (DTG/3TC), dolutegravir/abacavir/lamivudine (DTG/ABC/3TC), or DTG-based multi-tablet regimen (DTG plus TDF/FTC or DTG plus TAF/FTC). Most of the people had Medicaid compared with commercial insurance.
Travis Lim, MSc, DrPH, of Gilead Sciences, Inc., presented the results during a poster session at the conference. Dr. Lim and colleagues compared persistence and adherence by regimen. Treatment interruptions can lead to viremia, drug resistance, clinical progression, and transmission of HIV, the authors noted.
Study participants were required to have continuous enrollment for more than 365 days pre-restart and more than 90 days post-restart. The researchers calculated non-persistence as a discontinuation (medication gap of 91+ days) or regimen switch, and adherence was measured as the proportion of days covered while persistent.
A mental health diagnosis of any kind was observed in 8953 (43.4%) of patients, with 28.4% having a severe mental health disorder. Furthermore, substance use disorder was seen in 4015 (19.5%).
Results showed that persistence was highest among those receiving B/F/TAF, followed by DTG/3TC. It was lowest with DTG/ABC/3TC and DTG-based multi-tablet regimens. Moreover, B/F/TAF was also associated with lower odds of switching therapy compared with DTG/3TC, while adherence rates were similar across all groups.
Based on these findings, clinicians may take into consideration both treatment regimen and coexisting mental health or substance use disorders when managing ART reinitiation for people living with HIV.
Reference
Lim T, Kong A, Christoph MJ, et al. Persistence and adherence of people with HIV (PWH) and mental health disorder diagnosis who restart antiretroviral therapy (ART). P-390. Presented at: IDWeek 2025, Oct. 19-22, 2025, Atlanta, GA.
