71. Increasing Trends in Multimorbidity and Polypharmacy Over a 5-Year Period in People Living with HIV in the United States

Abstract Background Advances in antiretroviral therapies (ART) have resulted in people living with HIV (PLWH) living longer with higher risk for age-related comorbid conditions and polypharmacy. The aim of this study was to describe trends in comorbidity and comedication burden in PLWH over a 5-year time period. Methods A retrospective analysis of commercial and Medicare Advantage enrollees from the Optum Research Database was conducted. Annual cohorts of PLWH were constructed for each calendar year from 2014-2018 and included adults (≥ 18 years) with ≥ 1 pharmacy claim for an ART or medical claim with an HIV/AIDS diagnosis code (index date=earliest claim date in each calendar year). Continuous health plan enrollment of 12 months prior to (baseline), and 30 days after index date was required for each annual cohort. Comorbidities were identified using ICD-9/10 diagnosis codes from medical claims during baseline period and comedications from pharmacy/medical claims in the 90-days prior to index using National Drug Codes. Charlson Comorbidity Index (CCI) was computed excluding HIV/AIDS. P-for-trend values accounting for clustering by patients across calendar years were assessed. Results Overall, 14,222 - 20,249 PLWH who were enrolled in commercial (80.7%-65.4%) or Medicare Advantage (19.3%-34.6%) plans were identified in 2014 - 2018 calendar years. Notable trends in demographics of PLWH were observed across years, including increases in mean age (48.9 to 52.4 years), proportion of females (17.2% to 20.3%) and Black race (25.9% to 29.0%), all p-trend< 0.001. Mean CCI scores increased across years (0.72 to 0.93), p-trend< 0.001. Multimorbidity (≥2 non-HIV conditions) and polypharmacy (≥ 5 non-ART medications) prevalence increased over 5 years (Figure 1). Hypertension, hyperlipidemia, neuropsychiatric conditions and Type 2 diabetes mellitus were the most prevalent comorbid conditions with statistically significant upward trends in prevalence across years (Figure 1). Conclusion Multimorbidity and polypharmacy are common in PLWH and have been increasing in prevalence over the past 5 years. Study findings highlight the importance of an individualized approach to care for a diverse PLWH population, in order to minimize drug-drug interactions and adverse events and thereby improve patient outcomes. Figure 1. Comorbidity and Comedication Trends by Index Year among People Living with HIV Disclosures Misti Paudel, PhD, Merck (Other Financial or Material Support, This study was funded by Merck & Co.) Girish Prajapati, M.B.B.S., MPH , Merck & Co., Inc. (Employee, Shareholder) Erin K. Buysman, MS, Merck & Co., Inc. (Other Financial or Material Support, I am an employee of Optum, which was contracted by Merck to complete the research described in this abstract) Jianbin Mao, PhD, Merck & Co. (Employee, Shareholder) Kimberly McNiff, MPH, Merck (Other Financial or Material Support, Merck funded the research project) Princy N. Kumar, MD, Amgen (Consultant)Eli Lilly (Grant/Research Support)Gilead (Consultant, Grant/Research Support, Shareholder)GSK (Consultant, Grant/Research Support, Shareholder)Merck (Consultant, Grant/Research Support, Shareholder, Honoraria)

Background. Advances in antiretroviral therapies (ART) have resulted in people living with HIV (PLWH) living longer with higher risk for age-related comorbid conditions and polypharmacy. The aim of this study was to describe trends in comorbidity and comedication burden in PLWH over a 5-year time period.
Methods. A retrospective analysis of commercial and Medicare Advantage enrollees from the Optum Research Database was conducted. Annual cohorts of PLWH were constructed for each calendar year from 2014-2018 and included adults (≥ 18 years) with ≥ 1 pharmacy claim for an ART or medical claim with an HIV/AIDS diagnosis code (index date=earliest claim date in each calendar year). Continuous health plan enrollment of 12 months prior to (baseline), and 30 days after index date was required for each annual cohort. Comorbidities were identified using ICD-9/10 diagnosis codes from medical claims during baseline period and comedications from pharmacy/medical claims in the 90-days prior to index using National Drug Codes. Charlson Comorbidity Index (CCI) was computed excluding HIV/AIDS. P-for-trend values accounting for clustering by patients across calendar years were assessed.
Conclusion. Multimorbidity and polypharmacy are common in PLWH and have been increasing in prevalence over the past 5 years. Study findings highlight the importance of an individualized approach to care for a diverse PLWH population, in order to minimize drugdrug interactions and adverse events and thereby improve patient outcomes.

Massive Weight Gain in People with HIV (PWH) Starting Initial Antiretroviral Therapy (ART): Risk Factors and Predictive Ability of Early Weight Gain
Tanit Phupitakphol, MD 1 ; Dean McEwen, n/a 2 ; Kellie Hawkins, MD 3 ; Edward Gardner, MD 3 ; 1 University of Colorado, Denver, CO; 2 Denver Public Health, Denver, Colorado; 3 Denver Health and Hospital Authority, Denver, Colorado

Session: O-15. HIV Co-infections and Co-morbidities
Background. Using a clinic cohort of ART naïve PWH, we sought to understand factors associated with massive weight gain as well as to assess if early weight gain could help predict massive weight gain at two years.
Methods. This was a retrospective cohort study of PWH from a large, urban clinic initiating first ART from January 2005 through March 2019, who had 21 -27 months follow-up without ART changes, and were suppressed (HIV-RNA < 200 cps/ml) during that time. We defined massive weight gain as the top 20% of weight gainers at two years measured by percent (%) gain compared to baseline. Using bivariate and multivariate logistic regression (including factors in bivariate analysis with p< 0.20), we assessed the association of demographics, ART regimen, baseline CD4 count, HIV viral load, and body mass index (BMI) with weight gain at 2 years. We also assessed early weight gain (between 4 and 12 wks) and its association with massive weight gain at two years.
Results. Of 266 PWH included (table1), the median age was 36 years (IQR 29 -45), 9% were women, 14% black, and 43% Latino. Overall, median % weight gain at 2 years was 4% (-1.1 -11.6) In bivariate analyses, baseline factors significantly associated with massive weight gain included lower CD4 count, higher viral load, and lower baseline BMI. In multivariate analysis the odds of having massive weight gain were higher with lower CD4 count, adjusted odds ratio (aOR) 0.8 (95% CI 0.6 -0.9) per 100 cells/ul increase and higher viral load, aOR 2.6 (95% CI 1.4 -4.6) per 1 log increase. Early weights were available for 217 individuals at a median of 56 days (IQR 44 -63) after ART initiation. Early weight gain correlated with % weight gain at 2 years (R=0.58). Individuals with ≤ 3% early weight gain represented 66% of the population and had a 10% risk (14 of 144) of having massive weight gain at 2 years. In contrast, 43 individuals had > 5% early weight gain and their risk of massive weight gain at 2 years was 56% (24 of 43).