2502. Impact of Pharmacist-Led Antiretroviral Therapy Simplification Initiative in Heavily Treatment-Experienced Patients on Virologic Control

BACKGROUND: It is well established that antiretroviral therapy (ART) with a lower pill burden are associated with better virologic suppression. However, many HIV providers are cautious when considering ART changes in heavily treatment-experienced patients for a variety of reasons: accumulation of complex resistance patterns, intolerance concerns with new agents, drug-interaction concerns, and a paucity of data on ART simplification in this population. The objective of our study was to evaluate the impact of pharmacist-led initiative to simplify ART among heavily treatment-experienced patients with high pill burdens on virologic control. METHODS: This was a prospective, observational cohort at a clinic in Paterson, NJ, USA. Patients were eligible if: heavily treatment experienced (≥10 years on ART with history of failure or resistance), ART with ≥ 4 pills daily, ≥ 48 weeks of data, and at clinic from September 2016 to present. The primary endpoint was to measure the effect of ART simplification (decrease of ≥ 2 pills daily) on virologic response (HIV RNA < 200 copies/mL) compared with continuation of regimens with a high pill burden. Secondary endpoints included difference in antiretroviral pill burden and monthly cost, based on average wholesale price (AWP). RESULTS: There were 94 patients eligible for the analysis. Most patients were male (65%), and either Black (53%) or Latinx (35%). The simplification and continuation groups had similar baseline characteristics: mean age (50 vs. 50 years old), daily pill burden (4.77 vs. 4.95), virologic response (82% vs. 87%), CD4 count (459 ± 265 vs. 528 ± 273), monthly ART cost ($4,585 vs. $4,159). M184V (50.0%) and K103N (23.4%) were the most commonly documented mutations. Thymidine-analog, atazanavir-associated, and darunavir-associated mutations were documented in 28.7%, 24.5%, and 11.7% of patients, respectively. Patients with ART simplification were more likely to have virologic response than patients continued on the baseline regimen (97% vs. 76%, P = 0.0126), and had a significantly lower daily pill burden (2.05 vs. 4.95, P = 0.001). CONCLUSION: Pharmacist-led ART simplification in heavily treatment experienced patients can dramatically reduce pill burden while achieving better virologic success. [Image: see text] DISCLOSURES: All authors: No reported disclosures.