HIV-Associated Wasting Remains Prevalent Despite Antiretroviral Therapy

HIV-associated wasting (HIVAW) remains a common complication in spite of treatment with antiretroviral therapy (ART) and the associated increase in life span, according to a study presented across multiple Centers for Aids Research (CFAR) in the symposium, “HIV & Aging in the Era of ART and COVID-19”, held virtually February 8 and 9 by the Miami CFAR at the University of Miami Miller School of Medicine, Miami Florida.

“People living with HIV are now living longer and there remains a higher risk for age associated comorbidities, including HIV associated wasting, “ Javeed Siddiqui, MD, MPH, Chief Medical of Officer, TeleMed2U, Roseville, CA, said in presenting results from the study, “HIV-Associated Wasting Remains an Underappreciated Comorbidity in Persons Living with HIV in the Era of Modern ART.”

Siddiqui and colleagues conducted a retrospective study of patients with HIV from their medical and pharmacy claims submitted between July 2012 and September 2018, using the IBM Marketscan Research Database, derived from commercial. Medicare Supplemental and Medicaid data. Patients with malignancies and <6 months of enrollment pre-/post-HIV index date (first HIV-related claim) were excluded.

The investigators identified HIVAW through claims for weight loss-related diagnoses, or prescriptions for appetite stimulant/non-testosterone anabolic agents or enteral/parenteral nutrition post-HIV index. They stratified prevalence of HIVAW by whether or not ART was received and by age.

Over the 6-year study period, the overall HIVAW prevalence was 18.3% (n=7,804/42,587). Prevalence in those receiving ART was 17.9%, and 19.1% in those not taking ART.Prevalence was 21.% in those ≥45 years of age, and 15.2% in younger adults.

The wasting syndrome was also more likely to occur among those with other comorbidities, often metabolic disorders (87.5% vs 69.4%).The Charlson Comorbidity Index mean (SD) measure was 3.6 (3.0) in HIVAW vs 2.0 (2.2) in persons living with HIV without associated wasting.Prevalence of HIVAW in persons with pulmonary comorbidity was 45.1% vs 25.2% in matched cohort without comorbidity.Other differences in prevalence were 28.4% in those with diabetes vs 20.4% without; 24.1% with renal comorbidity vs 11.0%; 21.2% with cerebrovascular comorbidity vs 8.9%; and 18.7% with heart failure vs 7.1% without.The investigators also found that the cohort with HIVAW had statistically significantly more opportunistic infections.

“Modern retroviral therapy does not have an impact on the prevalence of HIV associated wasting, and…greater than 1 in 6 people living with HIV and (receiving) medical care had evidence of HIVWA,” Siddiqui said.

“The evidence suggests a need for continuous assessment of people living with HIV for weight loss, and a need to better differentiate HIVAW by antiretroviral therapy status, comorbidities and paratype,” he indicated.

While the strengths of this study include the large population base, Siddiqui pointed out that the limitations of using claims data include a lack of randomization or control over data collection, and less reliability/accuracy than data gathered through randomized controlled trials.

In a statement from the study sponsor, EMD Serono, Siddiqui commented, “many physicians consider HIV-associated wasting no longer an existing comorbidity in the era of modern ART, but the evidence suggests otherwise and the continued need for ongoing assessments of people living with HIV for weight loss.”