Issue: May 2021
Disclosures: The authors report no relevant financial disclosures.
April 19, 2021
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People experiencing homelessness less likely to use INSTI-based ART for HIV

Issue: May 2021
Disclosures: The authors report no relevant financial disclosures.
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People living with HIV and experiencing homelessness were less likely to use an integrase inhibitor-based regimen for ART, according to a study conducted in San Francisco.

Researchers found that use of the preferred regimens “rose dramatically” overall, however.

Inhibitor ART infographic
Source: Spinelli MA, et al. Open Forum Infect Dis. 2021;doi:10.1093/ofid/ofab139.

The analysis, which was published in Open Forum Infectious Diseases, found that older people living with HIV (PLWH) were more likely to use integrase inhibitors.

“Integrase inhibitors have been a very exciting development in antiretroviral therapy — particularly the second-generation integrase inhibitors. That is important because they are quite potent and also have a high barrier to resistance,” Matthew Spinelli, MD, MAS, assistant professor of Medicine at the University of California, San Francisco, told Healio.

Matthew Spinelli

“It is conceivable that some clinicians may not offer them to certain groups that they have concerns will not adhere well to the drugs,” Spinelli said. “I think that is changing with time and there is greater comfort, but to some degree, people experiencing homelessness are being left behind and are remaining on legacy or older classes of ART.”

Spinelli and colleagues’ study included 3,255 PLWH with ART prescriptions in the San Francisco Department of Public Health HIV surveillance case registry who initiated ART between 2009 and 2016. Among these patients, 38% initiated ART with an integrase inhibitor-based regimen and 13% experienced homelessness.

According to the researchers, participants experiencing homelessness were less likely to use an integrase inhibitor-based regimen than other participants (31% vs. 39%; P = .01). People who injected drugs were less likely than men who have sex with men to initiate integrase inhibitor-based treatment (30% vs. 40%; P = .001), and people with public or no insurance were less likely than those with private insurance to be on one of the regimens (35% and 34% vs. 42%; P < .001). Patients aged 50 years or older were more likely than patients aged younger than 30 years to initiate integrase inhibitor-based treatment (adjusted HR = 1.16; 95% CI, 1.01-1.34), the researchers found.

Spinelli said future research will help close the gap in integrase inhibitor use among people experiencing homelessness.

“I'm hopeful that this disparity will narrow over time. There is a need for more research looking at the differences in viral suppression and other health outcomes among people experiencing homelessness,” Spinelli said. “I am ultimately hoping to see additional research and programs to offer supportive housing to people living with HIV who are experiencing homelessness.”