Biktarvy Improves ART Persistence for People With HIV and Mental Health Disorders

The antiretroviral (ART) regimen bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF; Biktarvy) was associated with lower rates of switching and higher 1-year persistence among treatment-experienced people with HIV, particularly those with mental health or substance use disorders, according to 2 posters presented at the Academy of Managed Care Pharmacy Nexus 2025 meeting in National Harbor, Maryland.

B/F/TAF showed higher 1-year ART persistence and lower switch rates among people with HIV, especially those with comorbid mental health conditions. | Image Credit: alexskopje - stock.adobe.com

Key Trends in ART Switching Among Patients With HIV in Medicare

People with HIV enrolled in Medicare often have a higher prevalence of comorbidities, such as mental health or substance use disorders, which may negatively impact treatment adherence and persistence, first poster highlighted.1 To better understand treatment patterns, the researchers conducted a retrospective cohort study examining ART switches, defined as initiating a new regimen within 90 days of ending the index regimen, among Medicare beneficiaries with HIV.

Using claims data, the study included treatment-experienced people with HIV aged 18 or older covered by Medicare fee-for-service or Medicare Advantage who initiated ART between January 2018 and September 2022. The index date was the earliest initiation of the following regimens: B/F/TAF, dolutegravir/lamivudine (DTG/3TC), DTG/abacavir/3TC (DTG/ABC/3TC), and multi-tablet regimens (MTRs) of DTG plus emtricitabine/tenofovir alafenamide (DTG+FTC/TAF) or DTG plus FTC/tenofovir disoproxil fumarate (DTG+FTC/TDF).

Patients were followed from the index date until switch, discontinuation, death, end of Medicare enrollment, or December 2022, whichever came first. Adjusted HRs for switch were estimated using Cox models with inverse probability treatment weighting to account for baseline characteristics, both overall and among those with mental health or substance use disorders.

The study population included 30,205 people with HIV, with most (71.6%) being male; the average age ranged from 54.1 to 61.7. Of these patients, 22,312 (74%) were indexed on B/F/TAF, 4523 (15%) on DTG/ABC/3TC, 2605 (9%) on DTG/3TC, and 765 (3%) on MTRS. The DTG/3TC group had a higher proportion of non-Hispanic White patients and a lower prevalence of Medicaid eligibility and Part D low-income subsidy than other regimens.

Unadjusted analyses showed the lowest switch rates among people receiving B/F/TAF, both overall and among those with mental health or substance use disorders (P < .0001). In adjusted analyses, the risk of switch was higher for people receiving DTG/3TC (aHR, 1.28; 95% CI, 1.13-1.44), DTG/ABC/3TC (aHR, 2.33; 95% CI, 2.15-2.52), and MTRs (aHR, 4.5; 95% CI, 4.08-5.55) compared with those on B/F/TAF, both overall and among those with mental health or substance use disorders (P < .05 for all).

“These findings may inform targeted strategies for optimal treatment selection for [people with HIV] given that treatment switch may be associated with increased health care costs and poor clinical outcomes,” the authors concluded.

Closer Look at ART Persistence Among People With HIV and Mental Health or Substance Use Disorders

Building on these findings, a second poster more closely examined people with HIV who have mental health or substance use disorders, analyzing ART persistence among this group.2 The researchers emphasized that lifelong ART is necessary for HIV care, but concurrent mental health or substance use disorders may create challenges in maintaining therapy.

To address this, they conducted a retrospective study comparing ART persistence after switching or restarting therapy among people with mental health or substance use disorders, as well as those with low adherence. The analysis used medical and pharmacy claims data from the Optum Research Database for people with HIV covered by commercial insurance or Medicare Advantage with Part D coverage.

Eligible patients were indexed at the first claim for B/F/TAF, DTG/ABC/3TC, DTG/3TC, DTG plus emtricitabine/tenofovir disoproxil fumarate (DTG+F/TDF), DTG+F/TAF, or cabotegravir plus rilpivirine (CAB+RPV) between July 2017 and November 2023.

Persistence was defined as the time until ART discontinuation (gap of 90 or more days), switch or add-on therapy, death, or end of available data. Additionally, adherence was measured as the proportion of days covered (PDC). The researchers used inverse probability treatment weighting to adjust for demographics, clinical characteristics, and health care costs and utilization, with a Kaplan-Meier analysis assessing the effect of regimen selection on 1-year ART persistence.

Among 14,826 eligible patients, 5210 had mental health or substance use disorders, and 3815 had low adherence (PDC < 85%). Mean follow-up varied by regimen, with people with mental health or substance use disorders on B/F/TAF having the longest mean follow-up (18.5 months), followed by DTG/ABC/3TC (18.1 months), DTG+F/TAF (15.8), DTG/3TC (13.4), CAB+RPV (9.3), and DTG+F/TDF (9.7). Among those with low adherence, DTG+F/TAF had the longest mean follow-up (15.2 months), followed by B/F/TAF (14.9), DTG/ABC/3TC (14.4), DTG/3TC (10.7), CAB+RPV (8.8), and DTG+F/TDF (7.3).

“The analysis showed that B/F/TAF had higher rates of persistence compared with other ARTs at 1 year,” the authors said in an exclusive statement shared with The American Journal of Managed Care®.

Specifically, the weighted Kaplan-Meier analyses showed that among people with mental health or substance use disorders, 1-year persistence was significantly higher (P < .05) for B/F/TAF (80.3%) compared with DTG/3TC/ABC (68.9%), DTG+F/TAF (62.4%), and DTG+F/TDF (36.7%). Persistence was also higher for B/F/TAF (80.3%) than DTG/3TC (76.7%) and CAB+RPV (70.4%), though not statistically significant.

Among people with low adherence, 1-year persistence was higher for B/F/TAF (78.6%) vs DTG/ABC/3TC (66.3%), DTG+F/TAF (58.9%), and DTG+F/TDF (41.9%). One-year persistence was also higher among patients receiving B/F/TAF vs DTG/3TC (70.8%) or CAB+RPV (68.5%), but these differences were not statistically significant. Therefore, the overall risk of nonpersistence was significantly higher for DTG-based regimens vs B/F/TAF in both subgroups.

Together, these posters suggest that B/F/TAF may support more stable treatment outcomes for people with HIV, especially those with comorbid mental health or substance use conditions.

References

1. Cristoph MJ, Mordi U, Li S, et al. Treatment switch among United States Medicare beneficiaries with human immunodeficiency virus. Presented at: AMCP Nexus; October 27-30, 2025; National Harbor, Maryland. Poster 253.
2. Mordi U, Chastek BS, Cristoph MJ, et al. Antiretroviral therapy persistence among treatment-experienced people with human immunodeficiency virus and mental health disorders in the United States. Presented at: AMCP Nexus; October 27-30, 2025; National Harbor, Maryland. Poster 254.