OBJECTIVES:  Anabolic androgenic steroids (AAS) are a potential treatment for muscle wasting, a common consequence of advanced HIV. Prevalence of use and health outcomes associated with AAS are not well understood for HIV patients. The purpose of this study was to evaluate economic and health outcomes of HIV patients receiving AAS therapy compared to non-AAS treated HIV patients. METHODS:  A retrospective cohort analysis was conducted with a large commercial claims database (2009-2014). HIV patients (ICD-9-CM: 042, 043, and 044) who received their first AAS treatment between January 2010 and June 2013 were identified. Patients without AAS treatment were selected if they had a primary diagnosis of HIV between January 2010 and June 2013. For analysis, a 6-month pre-period and a 24-month post-period were used to assess disease related utilization and cost. AAS treated and non-AAS treated patients were matched 1:1 using Greedy propensity score matching. RESULTS:  663 HIV patients were identified in the time window, of which 45 (6.8%) received AAS. There were disparities between the AAS and non-AAS groups in age (47.7 ± 7.61 vs 44.9 ± 9.93; p=0.028), proportion that were male (100% vs 81%; p=0.0012), HIV medication days’ supply (305.4 ± 237.6 vs 233.6 ± 218.2; p=0.035), and HIV medication cost ($9192.30 ± 5981.40 vs $6506.90 ± 5337.00; p=0.001). Fifty-eight patients were matched on demographic and severity indices. Age, gender, and pre-index costs were not different between groups. In 2 years of follow up, healthcare utilization costs were not different. AAS-treated patients tended to have fewer emergency room visits (0.76 ± 1.77 vs 1.21 ± 1.97; p=0.16). CONCLUSIONS:  HIV patients taking AAS therapy were older, male, and were taking larger amounts of HIV medication. Additionally, AAS-treated HIV patients tended to have less healthcare resource utilization. This study is limited by the small population of HIV patients receiving AAS therapy.