Antiretroviral therapy persistence among treatment-experienced people with HIV and mental health disorders and/or substance use disorders in the USA (2017–2024): a retrospective cohort study
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: There are limited studies of antiretroviral therapy persistence among people with HIV (PWH) who have a mental health disorder and/or substance use disorder (MHD/SUD). This real-world study analyzed persistence among treatment-experienced PWH who had an MHD/SUD or suboptimal adherence (proportion of days covered [PDC] < 85%). Materials & methods: In this retrospective cohort study of claims from the Optum Research Database, nonpersistence (i.e., discontinuation, switch, add-on or death) was assessed in treatment-experienced PWH who switched to or restarted an antiretroviral therapy regimen of interest (i.e., bictegravir [B]/emtricitabine [F]/tenofovir alafenamide [TAF], dolutegravir [DTG]/lamivudine [3TC], DTG/abacavir [ABC]/3TC, DTG + F/TAF, DTG + F/tenofovir disoproxil fumarate [TDF] or cabotegravir + rilpivirine) from 1 July 2017 to 30 November 2023. Baseline characteristics across regimens were balanced by inverse probability treatment weighting. Kaplan–Meier analysis was conducted on weighted data to examine regimen persistence at 12 months. Adjusted Cox proportional hazards models assessed nonpersistence throughout follow-up. Results: Overall, 14,826 PWH were eligible and treatment experienced; 5310 had an MHD/SUD and 4090 had PDC < 85% during follow-up. Among treatment-experienced PWH who received B/F/TAF, persistence at 12 months was 80.3% for those with an MHD/SUD and 78.6% for those with PDC < 85%; this was greater compared with PWH who received DTG/3TC (76.7% and 70.8%), DTG/ABC/3TC (68.9% and 66.3%), DTG + F/TAF (62.4% and 58.9%) and DTG + F/TDF (36.7% and 41.9%; all p < 0.05). Compared with B/F/TAF, nonpersistence risk was greater with DTG/3TC, DTG/ABC/3TC, DTG + F/TAF and DTG + F/TDF in the MHD/SUD (all p < 0.05) and PDC < 85% (all p < 0.05 except DTG/3TC) groups. Conclusion: These results indicate that B/F/TAF may offer greater likelihood of persistence and emphasize the importance of regimen selection to optimize outcomes in treatment-experienced PWH with an MHD/SUD or suboptimal adherence.
Plain Language Summary: How many people with HIV & mental health or substance use issues stay on antiretroviral therapy after restarting or switching their regimen?
Why is this important?
People with HIV often face challenges that make it hard to stay on their HIV treatment, such as mental health issues and problems with alcohol or drugs. Discontinuing treatment can lead to negative health outcomes. In this study, we looked at how long people stayed on different HIV treatment combinations when they had these challenges.
What was done?
We used health insurance records from July 2017 through November 2023 to find people with HIV who switched to or restarted 1 of 6 modern treatment regimens. We then measured how many people were still taking their treatment after 12 months. We compared groups in a way that balanced factors such as age, race and other characteristics across the six regimens.
What were the results?
Out of 14,826 people with HIV, 5310 had mental health or substance use issues. After 12 months, 80% of those with HIV and mental health or substance use issues who were taking the combination of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) were still on treatment. This rate was higher than rates for the other regimens studied, including several dolutegravir-based regimens.
What do these results mean?
These findings suggest that the B/F/TAF combination may help people with HIV with mental health or substance use issues to stay on their treatment longer. Choosing the right treatment plan can improve long-term health for people with HIV.
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Received: 1 August 2025
Accepted: 23 March 2026
Published online: 23 April 2026
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Antiretroviral therapy persistence among treatment-experienced people with HIV and mental health disorders and/or substance use disorders in the USA (2017–2024): a retrospective cohort study. (2026) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2025-0124
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