P-350. Prescription of Weight Loss Medications in HIV Patients at a Rural Federally Funded Clinic: A Retrospective Study

Abstract Background Obesity in people with HIV (PWH) has increased from 13.4% in 2014 to 21.5% in 2020. The usage of weight loss medications (WM) has expanded, and their potential in PWH remains underexplored. This study aimed to evaluate the factors affecting WM prescription in PWH at a non-academic Ryan White clinic in rural Pennsylvania. Methods A retrospective study including PWH on antiretroviral therapy with a BMI ≥ 25, and with at least 1 month of follow-up, was included. In this cohort, 88.4% received integrase-based triple therapy. Descriptive statistics and Fisher’s exact test were performed. Multivariate regression was conducted to identify factors. A p-value ≤ 0.05 was adopted. Results Of 69 patients included, 44.9% were on WM. In this, 14.5% were on semaglutide, 7.3% tirzepatide, and 23.2% bupropion. In this cohort, middle-aged patients (45-65 years) were higher than in younger patients (25-45 years), 60% vs 25%, p ≤ 0.01. Males were more than females (50% vs 37%, p > 0.1), and African Americans (AA) were less than American Whites (AW) to be on WM (25% vs 59.5%, p ≤ 0.01). Medicare patients were higher than those with Medicaid or commercial insurance (70.6% vs 26.7% vs 21.4%, p ≤ 0.05). Patients with hypertension, hyperlipidemia, or diabetes were more often on WM than those without (63.3% vs 30.8%, p < 0.01; 72.2% vs 35.3%, p = 0.01; 50% vs 43.6%, p > 0.1). The averages of BMI, weight (lbs), and HbA1c (SI) before treatment were 34.2 ± SE 1.3, 215.6 ± SE 11.1, and 6.6 ± SE 0.4, respectively. The mean BMI difference, mean weight change, and HbA1c change after WM were 0.2 ± SE 0.5, 0.7 ± SE 2.7, and -0.3 ± SE -0.4, respectively. Multivariate regression revealed that middle-aged patients had higher odds of being on WM than younger patients (OR 3.6, 95% CI 0.9-14.9, p < 0.1). AA had decreased odds of being on WM than AW (OR 0.2, p < 0.1). Patients with Medicaid (OR 0.1, 95% CI 0.0-0.6, p = 0.01) and commercial insurance (OR 0.04, 95% CI 0.0-0.4, p < 0.01) were less likely to receive WM than Medicare patients. Conclusion Our study revealed that race and insurance play a significant role in access to weight loss management in HIV patients. These disparities affect access to these medications in rural centers. Long-term studies are needed to evaluate the efficacy of weight loss medications in this population. Disclosures All Authors: No reported disclosures