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Abstract

We analyzed nationally representative medical record data from the Medical Monitoring Project (MMP) to estimate prevalence of antiretroviral (ARV) agents prescribed for US adults with diagnosed HIV and to examine recent changes in prescribing practices. The MMP uses a multi-stage sample survey methodology to produce nationally representative annual estimates of characteristics of adults with diagnosed HIV in the US and Puerto Rico. We compared weighted prevalence of most recent ARV prescriptions from 3368 adults interviewed during June 2015–May 2016 and from 3717 adults interviewed during June 2016–May 2017. We also compared weighted prevalence of the first ARV prescriptions among those who initiated ART during these time periods. Among patients initiating antiretroviral therapy (ART), prescription of non-nucleoside reverse transcriptase inhibitors (NNRTIs) as part of initial regimen decreased across the time periods from 38.5% to 26.6% (P = 0.01). Prescription of protease inhibitors (PI) did not change (17.0% and 14.5%). Prescription of integrase strand transfer inhibitors (INSTIs) increased (54.7 to 70.2%, P = 0.004) due mostly to increased prescription of dolutegravir (13.9% to 32.5%). Among all patients, prescription of NNRTIs remained stable across (44.5% and 43.2%). Prescriptions of PIs decreased significantly, from 36.5% to 32.4% (P = 0.006), as did prescription of individual PIs except darunavir. In contrast, prescription of INSTIs increased from 43.4% to 50.7% (P < 0.001), due mostly to increased prescription of dolutegravir and elvitegravir. ART prescribing practices changed rapidly across the examined time periods. Following guidelines, INSTI prescription increased significantly among all U.S adults with diagnosed HIV, including adults initiating ART.

Keywords

Antiretroviral agent prescription HIV integrase inhibitor protease inhibitor reverse transcriptase inhibitor

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Changes in HIV antiretroviral prescribing practices in the United States

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References