HIV-associated wasting prevalence in the era of modern antiretroviral therapy: a claims database study (2012-2018).

OBJECTIVE To understand the prevalence of HIV-associated wasting (HIVAW) in the US. DESIGN Medical and pharmacy claims study using IBM® MarketScan® Commercial, Medicare Supplemental and Medicaid Databases. METHODS Study period: 7/2012-9/2018 (first HIV diagnosis claim = HIV index date). People living with HIV (PLWH) were excluded if they were aged < 18 years, had any malignancy claim or had <6 months of enrollment data pre- or post-HIV index date. HIVAW was defined by proxy using claims for weight loss-related diagnoses, appetite stimulant/non-testosterone anabolic agents or enteral/parenteral nutrition. Prevalence was reported cumulatively, by insurance type and antiretroviral therapy (ART) pharmacy claims (defined as ≥1 pharmacy claim of any ART within 12 months post-HIV index date). Statistical analysis assessed factors potentially associated with HIVAW. RESULTS The study population comprised 42 87 PLWH (64.6% male, mean age 44 years, 67.5% on Medicaid, 63.9% on ART). Cumulative HIVAW prevalence (2012-2018) was 18.3% (n = 7804) for all PLWH (17.9% on ART, 19.1% not on ART). HIVAW prevalence by payer was 7.5% for Commercial and Medicare Supplemental and 23.5% for Medicaid. The strongest associations with the likelihood of meeting the definition of HIVAW were for individuals with Medicaid and hospitalization(s) post-HIV index date; race and ART status were not associated. CONCLUSIONS Findings suggest HIVAW remains prevalent in PLWH. ART use was not found to be associated with HIVAW. HIVAW was highest among those with Medicaid coverage or any hospitalization(s). Further research is needed to better understand additional factors associated with and contributing to HIVAW.