Comorbidities and treatment regimens of HIV-associated lipodystrophy disease among a cohort of persons with HIV in Washington, DC

HIV-associated lipodystrophy (HAL) continues to occur in persons with HIV (PWH) despite use of antiretroviral therapies (ART). The purpose of this study was to compare characteristics of PWH with and without HAL, determine associations between HAL diagnosis and medical comorbidities, describe correlates of HAL treatment and explore use of pre-HAL ART regimens among PWH in a large cohort. Using data from the DC Cohort longitudinal study of PWH in Washington, DC, we identified HAL diagnoses from 2011 to 2024 using ICD-codes and prescription medications from electronic health records. We assessed demographics, HIV measures and comorbidities of PWH with HAL and trends in ART use prior to HAL diagnosis. Among 325 cases of HAL (2.5%), most were male (75%) and non-Hispanic Black (61%). PWH with HAL were more likely to have coronary heart disease, asthma, cancer, diabetes, chronic kidney disease and mental health disorders compared to PWH without HAL. HAL prevalence decreased over time while INSTI - and NNRTI-based regimens increased. Our findings indicate gender, socioeconomic and comorbidity differences among PWH with HAL. Clinician awareness of increased odds for comorbid conditions among PWH with HAL is needed.