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

TL;DR

This study found that race and insurance type influence access to weight loss medications for HIV patients in a rural clinic.

Contribution

The study highlights disparities in weight loss medication access among HIV patients in a rural, federally funded clinic.

Findings

Middle-aged patients and those with Medicare were more likely to receive weight loss medications.

African American patients and those with Medicaid or commercial insurance were less likely to be prescribed these medications.

Weight loss medications showed minimal changes in BMI and weight in this cohort.

Abstract

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.

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.

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.

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.

All Authors: No reported disclosures

Figures