Clinical and Health Care Resource Use Outcomes Associated With Resistance to Antiretroviral Therapy Among Veterans With HIV

Background This study evaluated clinical and economic outcomes associated with antiretroviral therapy (ART) resistance among people with HIV (PWH) within a nationally representative database. Methods Retrospective claims data were extracted from the Veterans Affairs Informatics and Computing Infrastructure. PWH receiving testing for resistance-associated mutations (RAMs) between 2003 and 2023 were categorized as resistant if they had ≥1 documented RAM in integrase strand transfer inhibitor, protease inhibitor, or reverse transcriptase genes. Results Among 7746 veterans with interpretable resistance tests, 1875 had no detectable resistance, 4466 had ≥1 major or minor RAM (any RAM), and 1405 had ≥1 major RAM. The median CD4 count was highest for those without RAMs (357 cells/mm3) and lowest for those with major RAMs (285 cells/mm3). Opportunistic infections during the 1-year follow-up were present in 3.8% without RAMs as compared with >5% for both RAM groups. Hospitalizations were more frequent in the major RAM and any RAM cohorts vs the no resistance cohort (P < .001 for both). Total all-cause costs averaged $45 476 for those without RAMs as compared with $49 945 for those with any RAM and $48 392 for those with a major RAM. Among PWH initiating ART after resistance testing (n = 3522), those without RAMs had the longest persistence, while those with RAMs had shorter persistence (P < .0001). PWH prescribed ART at the time of resistance testing who had RAMs were most likely to switch to a regimen based on an integrase strand transfer inhibitor or protease inhibitor. Conclusions In this real-world analysis, PWH with detectable resistance had lower CD4 counts, more frequent hospitalizations and opportunistic infections, greater economic costs, and increased discontinuation of ART.