ART Resistance Associated with Higher Hospital Costs Despite Lower Pharmacy-Related Expenses | AMCP Annual 2025

United States military veterans with antiretroviral therapy (ART) resistance cost more when it comes to healthcare resource utilization, according to a new study that found 26.6% of veterans with resistance were hospitalized for HIV-related complications when compared to veterans with no resistance, 21.3% of whom were hospitalized. However, pharmacy costs for both cohorts were similar, with HIV-specific costs higher in the group with no ART resistance. In the nonresistant cohort, patients cost an average of $12,384, compared with patients in the resistance cohort who cost an average of $12,595. The study was presented in a poster at the Academy of Managed Care Pharmacy (AMCP) conference last week.

Corresponding author Woodie Zachry, the senior director of virology and United States medical affairs at Gilead Sciences Inc., and a team of researchers used the Veterans Affairs Informatics and Computing Infrastructure to find retrospective medical and pharmacy claims data. They identified 7,746 veterans, 5,871 of whom had at least one resistance-associated mutation.

“ART resistance was associated with greater HCRU and costs despite lower HIV pharmacy-related costs, driven by higher inpatient and outpatient costs and more frequent and longer hospital admissions,” Zachry and his colleagues wrote in the abstract.

ART access has more than tripled in the past decade, up from 7.7 million in 2010 to 29.8 million at the end of 2022, according to the World Health Organization (WHO). However, increased use of HIV medication has been accompanied by an increase in HIV drug resistance.

Resistance-associated mutations to ART are an ongoing threat to HIV treatment, according to the WHO's HIV drug resistance report. HIV drug resistance occurs when the genetic structure of the virus changes and is no longer responding to treatment, so it begins to multiply. One of the best ways to prevent drug resistance in HIV is to take antiretrovirals as prescribed, because even occasionally skipping a dose can lead to mutations, according to the WHO.

Care for veterans with resistance also cost more for inpatient and outpatient services (inpatient costs were an average of $78,995, and outpatient costs were $40,541). Nonresistant patients paid an average of $66,539 for inpatient and $28,826 for outpatient services, according to the abstract.

To prevent ART resistance, information on the U.S. Department of Veterans’ Affairs website recommends veterans contact their pharmacy when they still have a one-week supply, having an emergency dose set aside and setting alarms as a reminder to take the medication. Patients may be hesitant to take the medication because they see it as a reminder of a chronic disease or because they are hesitant of side effects, the information on the website also suggests.

Post-traumatic stress disorder (PTSD) is another potential reason for ART nonadherence in veterans, increasing nonadherence by 6%, according to a separate study published in AIDS in January. The study studied 3206 veterans receiving ART from the VA who had been deployed in Afghanistan or Iraq. The research also found that PTSD affected ART modifications by 38% and multiple deployments amplified nonadherence by 14%.

“Sticking to your treatment is hard work, but the payoff is high: you'll be able to watch your immune system get stronger and your viral load stay low,” the VA website says. “Keeping HIV under control with the use of powerful drugs and adhering carefully to the regimen is the best way to ensure a long and healthy life.”