586. The Aging Epidemic: Virologic Control, Immunologic Recovery, Treatment Regimens, and Clinical Outcomes Among Older Adults Living with HIV in Washington, DC

Background As the number of older people living with HIV (PLWH) in the US rises, there is a need to identify factors that lead to poorer clinical outcomes. This study aimed to identify age-based disparities in virologic, immunologic, and clinical disease control. Methods We analyzed data from the DC cohort, a longitudinal observational cohort of patients receiving HIV care at 15 clinics in 2011–2016 in Washington, DC. We compared 608 patients aged ≥60 years with 832 patients aged 18–35 years. t-Test and Wilcoxon rank-sum test were conducted for continuous variables, and chi-square or Fisher’s exact tests for categorical variables. Results Older patients reported less MSM-related (25% vs. 60%, P < 0.0001) and more IDU-related (18% vs. 0.5%, P < 0.0001) HIV acquisition than younger patients. The proportion of older patients with CD4 >500 cells/μL was higher at enrollment (56% vs. 53%, P = 0.0067), but lower at CD4 nadir (18% vs. 21%, P < 0.0001) and at most recent recording (60% vs. 69%, P = 0.0003). Younger patients were more likely to have HIV VL >200 copies/mL at enrollment (35% vs. 11%, P < 0.0001), recently (18% vs. 6%, P < 0.0001), and peak VL >100,000 copies/mL during the study period (15% vs. 4%, P < 0.0001). Viral re-emergence after initial suppression was less common in older PLWH overall (27% vs. 39%, P < 0.0001), but more common in older patients infected for ≥10 years (29% vs. 22%, P = 0.0607). There was a shift toward novel ART regimens (TAF and INSTI) during the study period, with more older patients on an INSTI by its end (59% vs. 50%, P = 0.0007). Among older patients, 23% had chronic kidney disease (CKD), and 24% had a serum creatinine rise of ≥150% during the study period. Of patients with CKD, 16% remained on TDF. The incidence of malignancies during the study period was 3.5% among younger and 14.3% among older patients). These were mainly (92.2%) non-AIDS-defining cancers. Conclusion Older PLWH in DC have a high burden of complications related to renal dysfunction, lower CD4 counts, and non-AIDS-defining malignancies; those with longer duration of infection also had more viral re-emergence. Opportunities to improve care include closer monitoring for resistant virus and new cancers, and consideration of ART regimens with high efficacy and better renal safety profiles. Disclosures All authors: No reported disclosures.