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Study Finds Increased Rate of Patients Switching HIV Treatments

The HIV treatment landscape has changed repeatedly over the past decade as integrase inhibitors have arrived on the market and many drug regimens have been reformulated into a single tablet. With all these changes, people initiating HIV treatment are now 50% more likely to modify their antiretroviral therapy (ART) regimen than they were a decade ago, according to a recent study.

The study, soon to be published in the journal AIDS, tracked 5,373 HIV-positive adults from across the U.S. who initiated HIV treatment between 2007 and 2015. During this period, 43% of individuals modified their initial ART regimen after an average of 4 years on that treatment. Compared to individuals who started treatment in 2007 – 2009, the rate of treatment modification rose 20% between 2010 – 2012 and another 30% between 2013 – 2015.

Ellen Eaton, the lead author of the study and assistant professor at the University of Alabama School of Medicine, emphasized that switching HIV treatments is often due to personal preference (e.g. convenience) rather than treatment failure.

 “We have more work to do to understand why patients are more likely to switch their HIV treatment now than they were 5 years ago, but we think a majority of these switches are what we call regimen simplifications,” said Eaton. “In other words, patients are switching for convenience (e.g., from a 3-pill regimen to a once daily regimen), but we also suspect there are some subtle side effects such as headache or stomach upset that are driving these trends.”

Although the newest ART regimens are not perfect, there has been a steady decrease in the rate of treatment failure over the past decade. Only 12% of individuals switching treatments in 2015 had an undetectable viral load compared to 56% in 2007, which supports Eaton’s assertion that recent treatment switching is due to convenience rather than problems with current ART effectiveness.

Changes in prescribing practices by physicians over the past decade may also account for the increase in ART switching. Integrase inhibitors have eclipsed other drug classes, such as non-nucleoside reverse transcriptase inhibitors and protease inhibitors, in popularity despite the effectiveness of those drug types. Moreover, patients who are prescribed integrase inhibitors are less likely to switch to other ART regimens. Regarding changes in the popularity of various drug classes, Dr. Eaton offered some practical advice for those considering switching treatment regimens:

“It is important to be mindful that when patients change their regimen, there is always a cost,” noted Eaton. “They may request to switch to a new regimen today and discard their existing pills even though they have a month supply left. That may be the right decision if they are having intolerable side effects but, in many cases, the switch can wait until the existing prescription has run out. Patients who are virally suppressed, feeling well, and are considering switching to a new, simpler regimen should finish their current prescription if possible.”

Many newer treatment regimens are also more expensive, so it is important for researchers to compare the efficacy of new drugs to old ones to maximize cost effectiveness for patients. The cost of bringing patients back into the clinic to evaluate them for tolerance and resistance following an ART switch also can add up. In short, individuals who are virally suppressed and feeling well should consider the costs before switching to a newer ART regimen.