Incident HIV-Associated Wasting/Low Weight Is Associated with Nearly Doubled Mortality Risk in the Modern ART Era

Area of Science:

• Medical research
• Epidemiology
• Public health

Background:

• HIV-associated wasting (HIVAW) is an underappreciated AIDS-defining illness.
• Highly effective antiretroviral therapy (ART) has reduced but not eliminated HIVAW.
• Understanding the impact of HIVAW on mortality and virologic outcomes is crucial.

Purpose of the Study:

• To assess the association between incident HIVAW/low weight and all-cause mortality in people with HIV (PWH).
• To describe virologic outcomes in PWH who experienced HIVAW/low weight while on ART.

Main Methods:

• Utilized the Observational Pharmaco-Epidemiology Research & Analysis (OPERA) cohort.
• Followed 62,314 PWH from 2016-2020, identifying HIVAW/low weight diagnoses and mortality events.
• Employed extended Cox regression models to estimate hazard ratios for mortality risk.

Main Results:

• 8% of PWH (4,755) experienced HIVAW/low weight during follow-up.
• HIVAW/low weight was associated with a nearly twofold increased risk of death (HR: 1.96; 95% CI: 1.68, 2.27).
• Among those on ART with HIVAW/low weight, 68% had viral suppression, and subsequent virologic failure was uncommon (7%).

Conclusions:

• HIVAW remains a significant challenge for some PWH, impacting mortality risk.
• Close monitoring of HIVAW/low weight and virologic control is essential for PWH on ART.
• Addressing HIVAW can potentially improve health and reduce mortality in the HIV population.