Changes in HIV antiretroviral prescribing practices in the United States
International Journal of STD & AIDS Dec 14, 2019
Vu QM, et al. - From the Medical Monitoring Project (MMP), researchers assessed nationally representative medical record data to determine the prevalence of antiretroviral (ARV) agents prescribed for US adults with diagnosed HIV. Further, they investigated recent changes in prescribing practices. Undertaking a multi-stage sample survey methodology, MMP yielded nationally representative annual estimates of characteristics of adults with diagnosed HIV in the US and Puerto Rico. Comparison of 3,368 adults interviewed during June 2015–May 2016 with 3,717 adults interviewed during June 2016–May 2017 was done for the weighted prevalence of most recent ARV prescriptions. Across the time periods, they observed a decrease in the prescription of non-nucleoside reverse transcriptase inhibitors (NNRTIs) as part of the initial regimen from 38.5% to 26.6% among patients initiating antiretroviral therapy (ART). No change in the prescription of protease inhibitors (PI) (17.0% and 14.5%) was observed. An increase in the prescription of integrase strand transfer inhibitors (INSTIs) was observed (54.7 to 70.2%); this increase is mostly due to heightened prescription of dolutegravir (13.9% to 32.5%). Prescription of NNRTIs among all patients remained stable across the time period (44.5% and 43.2%). They observed a significant decrease in prescriptions of PIs, from 36.5% to 32.4%, as noted for prescription of individual PIs except for darunavir. In contrast, there was an increase in the prescription of INSTIs from 43.4% to 50.7%, which is mostly due to increased prescription of dolutegravir and elvitegravir. The examined time periods thus indicated a rapid change in ART prescribing practices. Following guidelines, all U.S adults with diagnosed HIV, including adults initiating ART, had significantly increased INSTI prescription.
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