Patient and Physician Preferences for Regimen Attributes for the Treatment of HIV in the United States and Canada.

Heather Gelhorn,Bertrand Lebouché,Erik Lowman,Frank Spinelli,Hannah Collacott,Katelyn Cutts,Cindy Garris,Erin Arthurs,Gin Nie Chua,Sebastian Heidenreich,Howard Rice

doi:10.3390/jpm12030334

Abstract

A long-acting injectable (LAI) antiretroviral therapy (ART) regimen is now available as a treatment option for virologically suppressed adults with HIV-1. This study assessed preference for a LAI regimen using an online survey of virally suppressed people living with HIV (PLWH) and physicians treating HIV in the US and Canada. Preference was elicited in a discrete choice experiment (DCE) with three choice options (switch to a LAI regimen, switch to another daily oral ART regimen, or stay on their current daily oral ART regimen) and four treatment attributes. A total of 553 PLWH and 450 physicians completed the survey. From the DCE results, 59% of PLWH were predicted to prefer a LAI over an alternative oral ART or staying on their current oral treatment, and 55–66% of physicians were predicted to recommend LAI for PLWH, depending on the treatment challenge scenario presented. PLWH indicated LAI would remove daily reminders of HIV (75%) and reduce feelings of being stigmatized (68%). A majority of PLWH and physicians preferred a LAI over oral ART to overcome treatment challenges such as daily pill burden and adherence. These benefits of LAI ART along with preferences of PLWH and physicians can help to inform ART choice.

Highlights

Advances in antiretroviral therapy (ART) for the treatment of human immunodeficiency virus (HIV) have significantly improved outcomes for people living with HIV (PLWH), with projected life-expectancy for PLWH approaching 90% of that of the general population in some countries [1]
In the participant information section of the survey, PLWH and physicians were provided with an overview of long-acting injectable (LAI) ART, including administration, and assumptions around efficacy and injection site reactions
62% of PLWH identified as heterosexual, while 29% PLWH identified as lesbian gay, bisexual, transgender, or queer (LGBTQ) and an additional 8% identified as men having sex with men (MSM)

Summary

Introduction

Advances in antiretroviral therapy (ART) for the treatment of human immunodeficiency virus (HIV) have significantly improved outcomes for people living with HIV (PLWH), with projected life-expectancy for PLWH approaching 90% of that of the general population in some countries [1]. The standard of care for HIV therapy has been a once daily oral combination ART regimen, which requires continuous high adherence to maintain viral suppression [6]. Socioeconomic status, poor health literacy, drug abuse, ART-associated side-effects, cumulative drug toxicity, and pill-burden resulting from taking daily ART pills have all been associated with suboptimal adherence [7,8,9]. Poor adherence to ART among PLWH is associated with reduced viral suppression, increased drug-resistance and more hospitalizations compared with adherent PLWH [10,11].

Methods

Results

Discussion

Conclusion