HIV & Aging

Among people with HIV (PWH), virological suppression through antiretroviral therapy (ART) is key to good clinical outcomes and is the foundation of public health efforts focused on ending the AIDS epidemic. But it is often difficult for people to adhere to their ART regimen. Adherence problems may cause some HIV strains to become resistant to ART, making treatment more difficult. Some studies indicate that with the newer ART regimens, patients may not have to be perfectly adherent to be virally suppressed, but research in real-world settings is lacking.

The purpose of this project was to study how different ART regimens and a patient’s level of adherence affect their viral suppression and healthcare use. The project also considered how some patient experiences may affect their level of adherence, such as having mental health conditions, having unstable housing, being transgender or gender non-conforming, and growing older. Better understanding the components of ART forgiveness is critical in improving rates of virological suppression in populations of PWH with known difficulties in medication adherence.

This study is a collaboration between Brookdale and Amida Care, a managed care special needs plan for people with or at risk for HIV, involving a retrospective chart review and data analyses of Amida Care members who were continuously enrolled from 2017 through 2019.  The analysis resulted in five groups with distinct ART medication patterns over three years. These medication patterns varied in number of tablets (single-tablet, 3-tablet) and in drug class (containing integrase strand transfer inhibitors [INSTIs], boosted protease inhibitors [PIs], and nucleoside reverse transcriptase inhibitors [NRTIs]).

When we looked at each of the ART medication groups in terms of ART forgiveness, we found that the groups did not differ in maintaining viral suppression with at least 80% adherence, compared to 90% adherence. For example, medication patterns described by boosted PIs were generally as effective as patterns described by medications containing INSTIs. These findings can help healthcare providers communicate with patients about their medications, especially those who have difficulty maintaining near-perfect adherence.

Dr. Mark Brennan-Ing, director of research and evaluation at Brookdale, and Dr. Jerome Ernst, chief medical officer at Amida Care, are the Principal Investigators on this study, which was funded by Gilead Sciences.

Findings from this project were presented in a poster at the Society for Behavioral Medicine Annual Meeting in April 2023. Additional findings on older adults were presented in a poster at the Gerontological Society of America Annual Scientific Meeting in November 2023.