ART Approaches Differ Depending on the Patient

Antiretroviral therapy (ART) was prescribed in various ways by health care providers in the US, according to a survey of health care providers, results from which were recently published in AIDS Research and Therapy.¹ Patient needs are often used to cater treatment more effectively to each individual, the authors explained.

Simple guidelines for HIV now exist due to treatment progress that has been made. This includes using ART regimens in people newly diagnosed with HIV or who have not previously taken ART. Also, people living with HIV (PLHIV) are now able to lead far longer lives when using ART, even though the incidence of other conditions, like diabetes and cardiovascular disease, remains higher in these individuals.² These conditions, which can also include pregnancy, or comorbidities frequently require their ART regimens to be altered. This study aimed to assess ART use strategies through hypothetical case-scenarios for PLHIV who have comorbidities or are pregnant.

Data on potential participants were collected from professional network societies and contacts found through academic institutions, with an email including an electronic survey received from the participants between August 26, 2022, and December 11, 2022. Participants were given 6 of 36 randomized case studies in the survey that focused on approaches to HIV resistance, co-occurring conditions, and comorbidities. Participants could choose to fill out up to all 36 cases.

Prescription of antiretroviral therapy could differ based on a patient's medical history. | Image credit: alimyakubov - stock.adobe.com

There were 119 providers who filled out the survey and were included in the study. Physicians made up the majority of the participants (73.1%) and a sizeable portion of the participants had at least 10 years of clinical experience (42.9%). The majority of the providers were also specialists in infectious disease (82.4%) and practiced in an academic setting (90.8%). A total of 65.6% of the participants spent 50% of their time or less caring for PLHIV.

Participants primarily prescribed bictegravir/tenofovir alafenamide (TAF)/emtricitabine (62.3%) and dolutegravir/lamivudine (17.3%) in the case studies that included patients with cardiometabolic syndrome, hypertension, and/or hyperlipidemia. The remaining choices included 3-drug regimens or a regimen including integrase-strand transfer inhibitors (INSTIs).

Participants prescribed doravirine/tenofovir disoproxil fumarate (TDF)/lamivuidine (17.7%), rilpivirine/TAF/emtricitabine (16.5%), and bictegravir/TAF/emtricitabine (13.9%) in the case study of a woman concerned about gaining weight. A case with a woman who had gained weight on a previous medication was primarily prescribed either darunavir/cobicistat/TAF/emtricitabine (22.8%) or switched to doravirine/TDF/Lamivudine (21.1%).

A case of a pregnant woman in her first trimester was commonly given dolutegravir (77.3%) but some prescribed bictegravir/TAF/emtricitabine (13.6%). TAF was prescribed to the woman in 53% of the responses. Dolutegravir was offered as part of the regimen in 73.6% of cases when the woman expressed a desire to be pregnant but was not currently pregnant.

Bictegravir/TAF/emtricitabine (38.9%) was the most commonly prescribed regimen for a case study on a patient with end-stage renal disease who was newly diagnosed with HIV. A regimen that spared tenofovir was also common among the participants (38.9%) whereas lamivudine was included in 20.4% of the prescriptions. Regimens that did not include tenofovir were also chosen in patients with chronic kidney disease who needed to switch from bictegravir/TAF/emtricitabine (31.6%).

There were some limitations to this study. All cases were hypothetical and may not be accurate to real-life practice. Also, shared-decision making would not be able to be accounted for in this survey, and most of the participants were providers in the infectious disease space and practiced in an academic or research setting, which could make the results not generalizable to the rest of the population. Guidelines also have since been updated since the survey was conducted.

The researchers concluded that the “responses provide insight into provider practice patterns and the survey responses could be used [as] an educational tool for ART decision making for HIV providers when faced with co-occurring conditions in real life practice.”

References

1. Krishnan S, Martinez Rivera MB, Lippincott CK, Shah M. A United States HIV provider survey of antiretroviral therapy management in people living with HIV with co-occurring conditions. AIDS Res Ther. 2025;22:27. doi:10.1186/s12981-025-00724-w

2. Other health issues of special concern for people living with HIV. HIV.gov. Updated February 22, 2024. Accessed March 4, 2025. https://www.hiv.gov/hiv-basics/staying-in-hiv-care/other-related-health-issues/other-health-issues-of-special-concern-for-people-living-with-hiv