B32-08 Exacerbations and Biologic Use in Severe Asthmatics Living With HIV

Abstract Rationale Severe asthma in people living with HIV (SA-PLWH) presents unique management challenges, as clinical trials of biologic therapies—such as monoclonal antibodies targeting IgE or interleukin pathways—have historically excluded SA-PLWH, despite emerging evidence of efficacy. Additionally, PLWH have higher rates of smoking, complicating the distinction between asthma, COPD, and asthma-COPD overlap, particularly as biologics were only recently approved for COPD. This study aimed to evaluate the utilization of biologic therapies and exacerbation rates in PLWH with severe asthma compared to matched HIV-negative controls. Methods We conducted a retrospective chart review of asthma patients at a tertiary care center from 2015 to December 2023. We analyzed 807 severe asthma patients, 777 without HIV (SA) and 30 with confirmed HIV (SA-PLWH). Data collected included demographics, smoking history, asthma severity, HIV status, exacerbations, and use of biologics. The primary outcome was the proportion of patients meeting criteria for biologic therapy and receiving a prescription and secondary outcomes included exacerbation rates (stratified by biologic use). Chi-squared tests and regression analysis were used for discrete and continuous variables, respectively. Results Annual exacerbation rates in SA-PLWH were higher than SA, even after controlling for race, age, sex, and smoking status (odds ratio (OR) 2.19). Biologic use was significantly lower in SA-PLWH compared to SA (20% vs 44.9%, p 0.007), even after controlling for race, age, sex, and smoking status (unadjusted OR 0.31, adjusted OR 0.35). Odds of exacerbations declined with biologic use in the severe asthma cohort (OR 0.75 annually) in both SA-PLWH and SA without HIV. Conclusions SA-PLWH patients experience increased exacerbation rates but are less likely to receive biologic therapies compared to SA without HIV, independent of demographic and smoking factors. SA-PLWH who receive treatment with a biologic have reduced exacerbations. These findings highlight a critical gap in the management of severe asthma in PLWH and underscore the need for increased utilization of biologic therapies in this population. This abstract is funded by: None