Prescribing Disparities for Integrase Strand Transfer Inhibitors in Patients With HIV Infection

Prescribing patterns for integrase strand transfer inhibitors (INSTIs) differed on the basis of patients’ gender, age, and treatment location, according to results of secondary data analysis published in Open Forum Infectious Diseases. The US Department of Health and Human Services currently recommends INSTIs as first-line therapy for patients with HIV infection.

Investigators analyzed data obtained from the DC Cohort and the Johns Hopkins HIV Clinical Cohort on patients with HIV infection. Patients included in the analysis were aged 18 years and older, had visited an HIV clinic at least once between April 2017 and March 2019, and had been prescribed antiretroviral therapy (ART) before their most recent clinic visit. The investigators used prescription data obtained from electronic health records to determine whether patients’ INSTI prescription status was current vs previous, or if they had any history of treatment with an INSTI. The investigators evaluated demographic, HIV-related, and clinical covariates among the included patients, and descriptive statistics were used to compare demographic and clinical characteristics. In addition, they used adjusted multivariable logistic regression to evaluate associations between demographic and clinical data.

Of 9558 patients included in the study, 71.5% were currently prescribed an INSTI and 7.9% were previously prescribed an INSTI, for a total of 79.4% who had ever been prescribed an INSTI. There were 1965 (20.6%) patients who had never received an INSTI prescription.

The youngest patient age group (18-24 years) comprised the highest proportion (81.1%) of current INSTI prescriptions. Patients aged between 40 and 49 years had the lowest proportion of INSTI prescriptions (68.2%; P <.0001 across age groups).

Stratification of patients by gender showed that transgender women had the lowest proportion of current INSTI prescriptions (57.6%; P =.0017). There was no significant difference noted between INSTI prescriptions and race.

In regard to geographic disparities, patients included in the Johns Hopkins cohort were more likely to have an INSTI prescription compared with those included in the DC cohort (adjusted odds ratio [aOR], 1.97; 95% CI, 1.69-2.29). Moreover, patients aged 18 to 24 years were more likely to have an INSTI prescription compared with those aged 50 and older (aOR, 2.15; 95% CI, 1.42-3.26). Patients who were less likely to have an INSTI prescription included transgender women (aOR, 0.62; 95% CI, 0.43-0.89) and those with increased durations of HIV care (aOR, 0.98 per each 5-year increase; 95% CI, 0.97-0.99).

A current or previous prescription for an INSTI was found to be associated with alcohol use disorder (aOR, 1.29; 95% CI, 1.12-1.47), as well as the presence of mutations resistant to nucleoside reverse transcriptase inhibitors (NRTI) (aOR, 1.85; 95% CI, 1.50-2.27) and non-NRTIs (aOR, 1.50; 95% CI, 1.25-1.82).

The study was limited by its lack of information on patients who either discontinued or switched their treatment regimen for HIV infection.

“Transgender women may be hesitant to use newer ART agents and/or prescribers may be more hesitant to prescribe [ART agens] because of concerns about ART-hormone interactions,” the investigators concluded.

Reference

Monroe AK, Levy ME, Greenberg AE, et al. Integrase inhibitor prescribing disparities in the DC and Johns Hopkins HIV cohorts. Open Forum Infect Dis. Published online July 27, 2021. doi:10.1093/ofid/ofab338