Longitudinal trends in base antiretroviral therapy utilization for human immunodeficiency virus from 2000 to 2016

Abstract

ObjectiveThe aim of this retrospective, observational study was to describe utilization trends in the base antiretroviral therapy (ART) for management of human immunodeficiency virus in United States Veterans for the time period of 1998 to 2016.MethodsThe Veterans Affairs Informatics and Computing Infrastructure was accessed to obtain ART utilization trends among US Veterans using a national cohort of unique persons within the Department of Veterans Affairs between January 1998 and September 2016. Spaghetti plots of summary statistics were created to visualize the trends in ART across time. For each month, the percentage that each regimen or individual drug constitutes for each ART during that particular month was calculated.ResultsA total of 38 347 patients and 3 714 472 patient‐months were eligible for the study. ART base drug utilization patterns have undergone numerous changes over the past 18 years and the utilization patterns consistently coincided with treatment guideline updates. Among the specific ART regimens, the boosted protease inhibitor (PI) regimen had a total of 17 372 patients and 1 126 708 patient‐months; the integrease strand transfer inhibitors (ISTIs) regimen had 6666 patients and 197 265 patient‐months; the non‐nucleoside reverse transcriptase inhibitors regimen had 17 449 patients and 1 001 606 patient‐months; the PI regimen had 11 367 patients and 571 589 patient‐months; and the single tablet regimen had a total of 18 034 patients and 817 304 patient‐months.ConclusionPatients were initially managed in 1998 with multiple tablet regimens consisting of a base PI. Many changes to base ART utilization subsequently occurred over the next 18 years. Examples of changes include the advent of boosted therapy, once‐daily dosing, single tablet regimens, and ISTIs.