More than two-thirds of Medicaid patients living with HIV fail to adequately adhere to their antiretroviral medications, according to a new study, raising concerns that it could make those patients increasingly difficult to treat.
A new analysis presented this week at the International AIDS Society Conference in Paris examining Medicaid claims in six states between 2012 and 2015 found that 70% of beneficiaries being treated for HIV had either poor or suboptimal adherence to their antiretroviral treatment.
An optimal threshold of adherence for HIV patients is around 95% to ensure medications remain effective.
The study found 51% of Medicaid patients had poor adherence, or adherence rates under 80%, while 19% had suboptimal levels, categorized as adherence rates between 80% and 95%.
Medicaid populations were nearly twice as likely to have low medication adherence than HIV patients in commercial health plans, the researchers said.
Patients with lower medication adherence rates tended to be younger, have no prior experience using antiretroviral drugs, or showed no HIV symptoms before the study. Younger HIV patients accounted for nearly a quarter of all new infections in 2015, according to the Centers for Disease Control and Prevention.
The study also found patients with lower adherence used more healthcare services, with longer hospital stays and more long-term-care admissions, which led to higher medical costs compared with patients who had high adherence levels.
"There are many possible reasons for nonadherence that doctors need to consider in order to limit the risk of virologic failures and the consumption of healthcare resources," said study investigator Keith Dunn, associate medical director of infectious diseases at Janssen Pharmaceuticals.
Regularly taking antiretroviral medications is a lifelong commitment for patients to keep HIV at undetectable levels. Adherence lowers the risk of spreading the disease, lowers patients' risk of developing other infections and makes it less likely for the body to become resistant to antiretroviral drugs, according to Dr. Nancy Glick, an infectious disease specialist at Sinai Health System in Chicago.
"We really spend a great deal of time with people around adherence because it's really what makes or breaks successful treatment," Glick said.
The study was not able to determine what role social factors, such as income or housing, played in the outcome of the results.
More than 1.2 million people are currently living with HIV in the U.S., according to the CDC. Glick said many advances have been made in antiretroviral medications over the past two decades that have helped lessen the pill burden many patients in the early days of the disease often faced.
