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Background Despite effectiveness of antiretroviral therapy (ART), some people living with HIV (PLHIV) still face barriers to daily oral ART adherence, including inconvenient scheduling, food requirements, adverse effects, and privacy concerns. We characterized treatment-related physical, emotional, and psychosocial challenges among PLHIV from 25 countries. Methods 2389 PLHIV adults on ART were surveyed in the 2019 Positive Perspectives Study, a standardized, self-reported survey of HIV patients aged 18-84 years on treatment. Data were collected on ART-related perceptions and behaviors. Descriptive and multivariable analyses were performed. Results Most participants were male (67.9%), aged &amp;lt; 50 years (70.7%), and reported viral suppression (74.1%). ART-related challenges included cueing of bad memories (58.4%), disguising HIV pills (57.9%), stress (33.3%), and difficulty swallowing pills (33.1%). Privacy and emotional challenges were generally similar between the USA and Canada (Figure 1). In the pooled sample, those who felt limited by their ART had higher odds of reporting suboptimal overall health (AOR 1.90, 95%CI:1.57-2.29), treatment dissatisfaction (AOR 2.21, 95%CI:1.82-2.69), and suboptimal adherence (AOR 1.90, 95%CI:1.57-2.29). Difficulty swallowing, any side effects, and privacy concerns were associated with increased odds of suboptimal overall health (AOR 2.10, 1.88, and 1.43, respectively) and suboptimal adherence (AOR 2.51, 1.50, and 1.87, respectively; all P&amp;lt; 0.05); results for other outcomes are in Figure 2. Overall, 12.6% (302/2389) had shared their HIV status solely with their primary HIV provider, whereas 6.8% (163/2389) “always” shared their HIV status. Only 52.0% were comfortable discussing ART-related privacy concerns with providers, although 29.0% overall missed ≥1 ART dose in the past month from privacy concerns. Overall, 54.7% preferred a nondaily regimen if their HIV stays suppressed, while 72.3% were open to ART with fewer therapies. Figure 1 Figure 2 Conclusion This study identified several challenges with ART among PLHIV, underscoring the need for increased flexibility of ART delivery to meet diverse patient needs. Addressing these needs may improve overall health outcomes for more PLHIV on therapy. Disclosures Patricia De Los Rios, MSc, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Chinyere Okoli, PharmD, MSc, DIP, ViiV Healthcare (Employee) Benjamin Young, MD, PhD, ViiV Healthcare (Employee) Garry Brough, BA Joint Hons in French/Italian, ViiV Healthcare (Employee, Independent Contractor, Other Financial or Material Support, Speakers Fees and Honoraria) Anton Eremin, MD, ViiV Healthcare (Advisor or Review Panel member) Marvelous Muchenje, BSW, MSc. in Global Health, ViiV Healthcare Canada (Employee) Nicolas Van de Velde, PhD, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee)

1045. Treatment-Related Physical, Emotional, and Psychosocial Challenges and their Impact on Indicators of Quality of Life