Long-Acting Antiretroviral Therapy Linked to Better Adherence and Persistence in HIV Treatment

Research presented at AMCP Nexus 2024 suggests that switching to long-acting antiretroviral therapy (ART) may significantly improve adherence and persistence in people with HIV (PWH) compared to staying on traditional oral ART, offering a potential alternative for those who struggle with daily dosing.¹

Adherence to ART is crucial in HIV treatment to avoid negative consequences such as loss of viral suppression, increased risk of transmission, and higher health care costs. Cabenuva (CAB+RPV LA) is a long-acting antiretroviral regimen approved for virologically suppressed individuals in the US, offering the benefit of less frequent dosing and potentially improved adherence compared to daily oral therapy.¹

According to a study published in Lancet, researchers conducted a PubMed search using the terms “life expectancy” and “HIV” to identify European or North American studies up until March 30, 2022, that estimated life expectancy in individuals with HIV. Numerous studies revealed that the life expectancy of people with HIV who began antiretroviral therapy (ART) has significantly improved over the past 25 years. This increase is attributed to earlier access to ART and advancements in the side-effect profiles of ART regimens. These studies primarily relied on follow-up data from the initial years after starting ART.²

A meta-analysis estimated the average age at death to be 63.3 years for individuals starting ART with any CD4 cell count. In a prior analysis using data from the second and third years of ART initiation (for patients who began between 1996 and 2013), the estimated age at death was 76.0 years for 20-year-old women and 73.1 years for 20-year-old men. Findings from the Kaiser Permanente California cohort, the UK Collaborative HIV Cohort Study, the Swiss HIV Cohort Study, and other North American cohorts—based on follow-up data from one year after ART initiation or among those starting ART with high CD4 cell counts—reported life expectancy estimates for 20-year-olds ranging from 69 to 83 years. These studies indicate that certain subgroups of individuals with HIV on ART have a life expectancy comparable to that of the general population.²

Data demonstrating the effectiveness of ARTs highlights that the recently published ABOVE Study further confirms their heightened efficacy when patients use long-acting ARTs, especially when it comes to patient adherence. The ABOVE Study, which was a retrospective US cohort study, compared adherence and persistence to CAB+RPV LA vs oral ART in people with HIV. The study utilized administrative claims data from January 1, 2020, to August 31, 2023, and included individuals aged 18 years and older on stable oral ART. Adherence was measured by Proportion of Days Covered (PDC) over a 12-month period, while persistence was determined by the number of days from index date until treatment discontinuation.¹

The study included 58 644 participants in the oral ART cohort and 1245 in the CAB+RPV LA cohort. Before standardized mortality ratio (SMR) weighting, the CAB+RPV LA group was younger and had higher rates of depression, anxiety disorders, and obesity. Adherence over 12 months was significantly higher in the CAB+RPV LA cohort compared to the oral ART cohort. Factors such as low adherence pre-index and substance-related disorders were associated with lower odds of adherence in the CAB+RPV LA cohort, while age, gender, region, and stable oral ART regimen were not significantly linked to adherence.¹

The data showed that individuals with HIV who switched to long-acting ART had better adherence and persistence over 12 months compared to those who stayed on oral ART, while adherence for another cohort remained similar. These differences in adherence and persistence were consistent across different types of payers.¹

Over the past decade, growing evidence has shown that immediate initiation of ARTs following an HIV diagnosis, as opposed to delaying treatment, significantly benefits individuals and greatly reduces HIV transmission within communities.³ The ABOVE Study highlights this sentiment, and demonstrates positive outcomes for ARTs in patients with HIV.

Reference

1. Garris C, Desai R, Chang R, et al. Higher real-world adherence and persistence with long-acting cabotegravir plus rilpivirine (CAB+RPV LA) compared to oral antiretroviral therapy (ART) among people with HIV (PWH) in the United States (US): The ABOVE study. Presented at: AMCP Nexus 2024; October 14-17; Las Vegas, NV.
2. Trickey A, Sabin CA, Burkholder G, et al. Life expectancy after 2015 of adults with HIV on long-term antiretroviral therapy in Europe and North America: a collaborative analysis of cohort studies. Lancet. 2023;10(5) e295-e307.
3. Chow JY, Gao A, Ahn C, Nijhawan AE. Rapid start of antiretroviral therapy in a large urban clinic in the US south: impact on HIV care continuum outcomes and medication adherence. JIAPAC. 2024;23. doi:10.1177/23259582241228164