Definition, Burden, and Predictors of HIV-Associated Wasting and Low Weight in the OPERA Cohort

Abstract

We aimed to describe the prevalence, incidence, and predictors of HIV-associated wasting (HIVAW)/low weight among people with HIV (PWH) in the United States. We conducted an observational, clinical cohort analysis, utilizing prospectively collected electronic health record data obtained from the Observational Pharmaco-Epidemiology Research & Analysis (OPERA^®) cohort. HIVAW/low weight included a wasting or low body-mass index (BMI)/underweight diagnosis (ICD codes and title search) or BMI <20 kg/m². Prevalence was estimated among adult PWH in care from 2012 to 2015 and 2016 to 2020. Incidence from January 1, 2016, to October 31, 2021, was estimated using univariate Poisson regression among eligible PWH without prior HIVAW/low weight. Demographic and clinical predictors of incident HIVAW/low weight were included in multivariable logistic regression models, stratified by antiretroviral therapy (ART) experience. The period prevalence of HIVAW/low weight was 12% in both 2012-2015 and 2016-2020. Among 67,119 PWH without any prior HIVAW/low weight, 7% experienced incident HIVAW/low weight a median 64 months from HIV diagnosis. In multivariable regression models, similar predictor patterns were observed among ART-naïve and ART-experienced PWH without any prior HIVAW/low weight: lower odds of HIVAW/low weight with older age, female sex, Black race, and Hispanic ethnicity and higher odds with Medicaid. Notably, there was a dose-response relationship between increasing Veterans Aging Cohort Study Mortality Index scores and incident HIVAW/low weight in both groups. Wasting/low weight remains a challenge for PWH and may be underappreciated by providers. Advanced HIV and comorbidities significantly predict incident HIVAW/low weight. Increasing awareness of HIVAW, especially among frailer PWH, could improve the care of affected PWH.

Keywords: HIV wasting syndrome; comorbidity; incidence; prevalence; weight loss.

FIG. 1.

Predictors of incident HIV-associated wasting/low weight among ART-naïve (triangle; N = 11,525)^a and ART-experienced (circle; N = 39,166)^b people with HIV in OPERA^® (January 2016–October 2021). ^aA total of 3,507 (23%) ART-naïve PWH were excluded from the model due to missing data in the following variables: sex (n = 5; < 1%), race (n = 426; 3%), ethnicity (n = 479; 3%), CD4 cell count (n = 1,941; 13%), and VACS score (n = 3,315; 22%). ^bA total of 7,865 (17%) ART-experienced PWH were excluded from the model due to missing data in the following variables: sex (n = 4; < 1%), race (n = 1,425; 3%), ethnicity (n = 1,529; 3%), CD4 cell count (n = 3,219; 7%), and VACS score (n = 7,251; 15%). ^cAdjusted for all variables in the model. ^dVACS Mortality Index: composite index used to estimate a 5-year risk of all-cause mortality; a higher VACS score is associated with a higher risk of mortality. aOR, adjusted odds ratio; AIDS, acquired immunodeficiency syndrome; ART, antiretroviral therapy; CI, confidence interval; Dx, diagnosis; INSTI, integrase strand transfer inhibitor; PI, protease inhibitor; PWH, people living with HIV; VACS, Veterans Aging Cohort Study.