441. Association between Incident HIV-Associated Wasting/Low Weight and All-Cause Mortality in the OPERA® Cohort

Abstract Background HIV-associated wasting (i.e., progressive, involuntary weight loss with both fat and lean tissue loss; HIVAW) is an under-appreciated AIDS-defining illness; the 2012-2018 period prevalence was reported as 18% in a recent claims study United States. We aimed to assess association between incident HIVAW/low all-cause mortality era of modern combination antiretroviral therapy (ART). Methods In Observational Pharmaco-Epidemiology Research & Analysis (OPERA®) cohort, PWH without (a) any prior weight, (b) malignancy within 3 years, (c) opportunistic infection 1 year who were active care 2016 2020 followed through death, follow-up, or end (31OCT2021). included low BMI/underweight diagnosis (ICD codes, title search) BMI < 20 kg/m2. Hazard ratios (HR) 95% confidence intervals (CI) for time-dependent (exposure) (outcome) estimated extended Cox regression models. The adjusted model age at baseline, race, ethnicity, covariates (log10 viral load, Veterans Aging Cohort Study [VACS] Mortality Index score). Viral load VACS score surrogate markers ART use comorbidities, respectively. Linear quadratic terms continuous variables included. Results Of 67,119 OPERA®, 62,314 (93%) had non-missing covariate data models; baseline characteristics did not differ full populations (Table 1). Over median follow-up 45 months (interquartile range: 27, 65), there 4,755 (8%) cases 1,354 (2%) deaths. model, experienced significantly increased risk death over than those experience (HR: 1.96; CI: 1.68, 2.27) 2). Conclusion this analysis care, associated twice era. Particular attention needs be paid among restore health potentially reduce death. Disclosures Rachel P. Weber, PhD, AIDS Healthcare Foundation: Client my employer|EMD Serono: employer|Gilead Sciences: employer|Janssen: employer|Merck Co.: employer|TheraTechnologies: employer|ViiV Healthcare: employer Laurence Brunet, Co: Javeed Siddiqui, MD, MPH, Abbvie: Advisor/Consultant|Abbvie: Honoraria|Cumberland pharmaceuticals: Advisor/Consultant|Cumberland Honoraria|EMD serono: Advisor/Consultant|EMD Honoraria|Merck: Advisor/Consultant|Merck: Honoraria Michael Harbour, FACP, EMD Employee Amy L. Phillips, PharmD, Serono, Inc.: Employment Brooke Hayward, SM, MBA, Jennifer S. Fusco, BS, Ricky K. Hsu, Gilead: Honoraria|ViiV: Advisor/Consultant|ViiV: Grant/Research Support|ViiV: Gregory employer|EMD: Support|Gilead employer|Theratechnologies: employer.