581. Do Comorbidities and Polypharmacy Lead to Virologic Failure in All Populations Living with HIV?

Abstract

Background As HIV antiretroviral therapy (ART) becomes increasingly more simplified and effective, many patients living with HIV benefit with reduced ART pill burden and longer life expectancy. As this patient population ages, the prevalence of comorbidities increases the likelihood of polypharmacy. This study assessed if comorbidities and their associated polypharmacy affect the success of HIV management in our patients. Methods A retrospective analysis of patients living with HIV receiving care at an urban clinic in New Jersey was performed. Eligible patients were ≥18 years old, had ≥2 visits in 2017 with laboratory data ≥24 weeks apart. These patients were divided into three arms: those without any comorbid conditions, a single comorbidity, and patients with multiple comorbidities. The primary endpoints were to determine the effect of comorbid conditions and polypharmacy on viral suppression (defined as HIV RNA <20 copies/mL). Secondary assessments accounted for the impact of age and race/ethnicity on HIV management. Results There were 318 patients included in the analysis: 156 with multiple comorbidities, 76 with one, and 86 without any. Most patients were male (58%) and the mean age was 49 years old. The population was 52% Black, 32% Hispanic, and 15% White. Most patients (72%) had undetectable virus, and 92% had a CD4 count >200 cells/mm3. Patients with multiple comorbidities were more likely to be virologically suppressed than patients with one comorbidity (80% vs. 59%, P = 0.0014) and those without (80% vs. 67%, P = 0.0413), despite having a higher pill burden per day (7.0 vs. 3.7 vs. 2.2, P = 0.0001). Although age was not an independent predictor of viral suppression, patients with multiple comorbidities were older (55 yo) than those with one comorbidity (48 yo) and without any (41 yo) (both P < 0.0001). Hypertension (39%), diabetes mellitus (16%), dyslipidemia (31%), and psychiatric disorders (14%) were the most common comorbidities. Patients with hypertension were more likely to be virologically suppressed than those without (80% vs. 67%, P = 0.0229). Conclusion Patients with multiple comorbidities and a greater daily pill burden at our clinic were more likely to achieve virologic suppression. Multiple comorbidities and polypharmacy were not major drivers of virologic failure in our clinic cohort. Disclosures All authors: No reported disclosures.