bluuebunny/crossref_metadata_2025 huggingface dataset:
P-331. Patient Perspectives Regarding the Use of Contact Precautions for Methicillin-Resistant Staphylococcus aureus in a VA Acute Care Hospital
Authors: O’Hara Lyndsay M , Bahr-Robertson Mary , Newman Michelle , Pineles Lisa , Rubin Michael , Khader Karim , Nelson Richard , Baracco Gio , Goetz Matthew B , Evans Martin , Linder Kathleen A , Perencevich Eli N , Harris Anthony
Published: January 2025

Background

The optimal approach to using contact precautions for patients known to be colonized or infected with MRSA remains unclear despite knowledge that transmission risk varies by healthcare personnel role and care activity being performed. Additionally, the patient perspective is not routinely represented in infection control policies. The aim of this study was to assess patient perspectives on risk-based application of MRSA contact precautions in VA hospitals.

Methods

We conducted an in-person 75-minute focus group with seven Veteran patients colonized with MRSA. The session was audio recorded and transcribed verbatim. We developed a codebook based on the interview guide and used Nvivo 9 for analysis. One research team member coded the transcripts. Thematic analysis was utilized to summarize the findings. Emergent themes and patterns were identified by initial inductive analysis and themes were condensed into overarching categories.

Results

All patients agreed that they would prefer if healthcare workers wore gloves and a gown the entire time when providing care to all patients with MRSA. As shown in Table 1, participants identified three themes related to perceived advantages to the use of contact precautions for all care of patients with MRSA. The most frequently mentioned advantage was that doing so aligns with the premise that protecting patients and making them feel safe while in hospital should be the top priority. Participants also acknowledged five themes describing disadvantages to contact precautions such as the environmental impact and cost but stressed that these disadvantages should not be used to rationalize provision of what they viewed as suboptimal care. Most participants were open to a risk-tailored approach instead of total removal of all contact although some articulated concerns this may make patients may feel less safe and feel like they are not being treated equally.

Conclusion

These qualitative findings suggest that Veteran patients with MRSA support the use of contact precautions and are willing to consider a risk-tailored approach to glove and gown use if this is accompanied by education for healthcare personnel, patients, and families.

Disclosures

Anthony Harris, MD, MPH, Innoviva: Advisor/Consultant|UpToDate: Infection Control Editor
P-349. Identification and Control of a Candida auris Outbreak in an Acute Spinal Cord Injury Unit at a Veterans Affairs Medical Center
Authors: Hitchcock Matthew M , Fleming Michele S , Poe Shaunta , Knowlson Shelley , Christian Melanie , Eckert Angela , Hill Emily , Markley John D
Published: January 2025

Background

Candida auris is an emerging pathogen that spreads easily in healthcare settings and can cause severe infections. In Dec. 2022, C. auris was identified at the Richmond VA Medical Center (VAMC) in an acute care spinal cord injury unit (SCIU). The SCIU is a regional SCI center in a 300-bed VAMC that provides medical and rehabilitation services to patients from multiple states.Figure 1.Point prevalence testing results and timeline of interventions during the outbreak investigation.

Methods

C. auris was identified in 1 urine culture from a SCIU patient, triggering an outbreak investigation. The Infection Prevention (IP) team performed point prevalence (PP) testing via superficial swabs of axilla and groin sent for polymerase chain reaction (PCR) testing. Initial screening included 31 unique patients in 2 units, A (n=16) and B (n=15). Admission testing was also initiated. Patients were isolated until tests resulted. Surveillance PP testing was performed biweekly and ceased after consecutive rounds of negative results. The IP team evaluated infection control practices in the SCIU that could contribute to transmission.

Results

The initial screening of 31 patients yielded 5 positives (16%; Figure 1). Overall, 92 PCR tests were completed on 51 unique patients for a positivity rate of 9.8% (n=5). Positive results occurred only during the initial testing. Positive patients were admitted for a median of 36 days (range: 16-412). No C. auris was isolated in culture and no invasive infections developed. Records and interviews revealed complex movement between healthcare facilities for the colonized patients. Multiple lapses in infection control practice were found. Admission testing with repeat testing at 90 days was implemented longitudinally, along with enhanced cleaning measures and reinforcement of transmission-based precautions (Figure 1). No new positive results were found over the subsequent 9 months.

Conclusion

PP testing for C. auris in an SCIU identified 5 colonized patients. As no isolates were recovered beyond the index case, IP could not determine whether this outbreak was due to intra-unit transmission versus multiple introductions. Improvements in infection control practices, along with implementation of surveillance testing, contributed to control of the outbreak. The SCIU remains vulnerable to C. auris due to the complex, multidisciplinary care needs of the patient population.

Disclosures

All Authors: No reported disclosures
P-370. Impact of a Multidisciplinary Intervention to Reduce Infection after Prostate Biopsy at a Veterans Affairs Medical Center
Authors: Whitman Melissa , Sabo Roy T , Eckert Angela , Hitchcock Matthew M , Hill Emily , Krzastek Sarah , grob baruch , Markley John
Published: January 2025

Background

Infection after prostate biopsy (IAPB) occurs in 2-6% of cases. Due to fluoroquinolone resistance at our facility, preprocedural prophylaxis for prostate biopsy was switched from Ciprofloxacin to Fosfomycin in 2017. However, the rates of IAPB at our facility increased from 0.93% to 4.27% between 2021 and 2022 (Figure 1). Herein we describe the impact of a series of interventions aimed at reducing the IAPB rate.

Table One

Methods

A multidisciplinary workgroup including infection control, antimicrobial stewardship, nursing, and urology was convened in February 2022. An outbreak investigation ensued utilizing active surveillance, direct procedural observation, and chart review for epidemiologic commonalities and appropriateness antibiotics (Table 1). Based on these findings, several interventions were implemented (Table 1). IAPB rates were modelled over time using a generalized additive spline model with 2 knots. Data analysis took place between Oct 2018 to Sept 2023 using SAS Statistical Software (version 9.4. Cary, NC, USA).

Figure One

Results

A total of 2,295 prostate biopsies and 37 infections were identified from Oct 2018 to Sept 2023. Numerous bacterial pathogens were implicated, and no point source of infection was identified. Multilocus sequence-typing of three Klebsiella pneumoniae isolates did not suggest a single-organism outbreak. Pseudomonas was implicated in 4 infections. Fosfomycin minimum inhibitory concentrations were elevated in 6/9 isolates available for testing (range 32 to >1024 ug/mL). Three periods with different infection rates were identified (Figure 2). Mean infection rates were 1% (0.6%-1.7%) for the first period (Oct 2018 to Aug 2021), 4.4% (2.8%-6.7%) for the second (Sept 2021 to Oct 2022), and 0.7% (0.2%-2.0%) for the third (Nov 2022 to Sept 2023). Periods one and three had statistically significant lower infection rates than period two (p=0.0002 and p=0.004, respectively).

Conclusion

A multidisciplinary workgroup applying a series of interventions was associated with a significant reduction in IABP. In the context of evolving antimicrobial resistance and variable procedural practices, elevated IABP should prompt a systematic evaluation of antimicrobial prophylaxis and procedural practices.

Disclosures

All Authors: No reported disclosures
P-375. Long-Term Suppressive Antimicrobial Therapy in Prosthetic Vascular Graft Infection: a Five-Year Retrospective Evaluation
Authors: Imeneo Alessandra , Alessio Grazia , Ferrari Ludovica , Mulas Tiziana , Marco Iannetta , Marchetti Andrea Ascoli , Ippoliti Arnaldo , Sarmati Loredana
Published: January 2025

Background

Prosthetic vascular graft infection (PVGI) is a rare but life-threatening complication of surgery. Complete removal and replacement of the endograft is the only curative strategy but is frequently impracticable for the high mortality risk, therefore, suppressive antimicrobial therapy (SAT) is the best treatment option.

This retrospective study aimed to describe the indication and outcome of SAT in patients with a PVGI evaluated since 2019 at Tor Vergata Hospital in Rome.

Methods

Patients with a PVGI (no cardiac valve replacement infections) were enrolled. The outcome was defined based on the latest available outpatient evaluation. PVGI was stratified as early/late and suspected/diagnosed according to guidelines.

Results

Twenty-one patients were enrolled (Tab. 1-3). At least one causative organism was identified in 41% of cases, mainly through blood samples (57%): 38% were Gram positive (GPB) and 29% were Gram negative (GNB) bacteria. Unexpectedly, early PVGI were more frequently caused by GNB than GPB (p-value 0.006).

All patients were SAT treated; only 3 patients underwent surgery without reaching source-control. Several options, including long-acting antibiotics (LAA), were available for GPB, while cotrimoxazole, ciprofloxacin and ertapenem were the principal long-term SAT for GNB.

The CT-PET scan monitoring was done after a median follow-up (FU) time of 90 [IQR 90-180] days; a positive early CT-PET FU (≤3 months from the first test) was associated with treatment failure needing a modification of SAT (p-value 0.003). Drug adverse effects occurred in 38% of cases and were followed by a change in SAT.

Subsequently to clinical/radiological improvement (71%) or patient decision (29%), SAT was discontinued in 7 patients after a median time of 336 [292-404] days. Patients who experienced SAT discontinuation were younger, with fewer comorbidities, early infections, known pathogen and LAA therapy, although no statistically significant association was observed. Two patients showed a radiological failure needing to resume treatment; 3 patients (14%) successfully suspended SAT currently without relapse.

Conclusion

Our results support SAT as a suitable option for patients with PVGI at high surgical risk. Larger prospective studies are needed to guide empirical practice.

Disclosures

All Authors: No reported disclosures
P-390. Burden of Surgical Site Infections with pathogens resistant to perioperative prophylaxis in orthopedic tumor surgery: Secondary analysis of the PARITY trial
Authors: Kuster Sabine , Ghert Michelle , O’Shea Timothy , Gottlich Caleb , Mertz Dominik
Published: January 2025

Background

Treatment of malignant bone tumors of the lower extremity often requires complex surgical reconstruction with the use of endoprostheses. These procedures are associated with an increased risk for surgical site infection (SSI). Here, we describe the risk factors for microbial resistance, characteristics and microbiology of SSIs in this population in a secondary analysis of the PARITY trial.

Methods

The PARITY trial assessed the effect of short-term (24 hours) versus long-term (5 days) postoperative antibiotic prophylaxis with cefazoline or cefuroxime on SSI incidence in orthopedic oncology. Here, we evaluated the proportion of pathogens with presumed resistance to cephalosporine prophylaxis in this cohort. Resistance was defined either based on susceptibility testing, presence of intrinsic resistance mechanisms and/or based on the chosen antibiotics to treat a SSI episode.

Results

SSI were diagnosed in 96 of 604 patients (15.9%; Table 1). On average, SSIs occurred 77.4 days (IQR 81.25) after surgery. Among these, cultures were positive in 73 (76.0%). The most common pathogens were coagulase negative staphylococci (34.4%), followed by S. aureus (24.0%), and Enterobacterales (22.9%; Table 2). In 68.5% (n=50) SSI episodes, at least one pathogen was resistant to the prophylactic regimen. Polymicrobial infections were detected in 41.1% (n=30). Antibiotic cement was used in 40 (41.7%) patients, with resistance against the used antibiotic in 34 (85.0%). In the short-term group the proportion of resistant pathogens was lower (65.9% versus 71.9%; OR 0.75, CI 0.27, 2.06, p=0.385; Table 3). Proportionately more resistance was seen in patients with neutropenia (91.7% vs. 64.9%; OR 5.95, CI 0.72, 49.44, p=0.062), re-operation (80.0% vs. 66.7%; OR 2.00, CI 0.39, 10.27, p=0.328) and in those on postoperative antibiotics for more than 7 days prior to SSI diagnosis (75.8% vs. 62.5%; OR 1.88, CI 0.67, 5.21, p=0.169).Table 3:Risk factors for SSI caused by cephalosporin-resistant pathogens (univariate analysis)

Conclusion

SSI due to pathogens resistant to the systemic or local prophylactic agents used are common in patients undergoing reconstruction for bone tumors. Several potential risk factors associated with resistance were evaluated, but the sample size limited our ability to draw final conclusions.

Disclosures

Sabine Kuster, MD, Takeda Canada: Honoraria Michelle Ghert, MD, FRCSC, Stryker: Advisor/Consultant|Stryker: Grant/Research Support Dominik Mertz, MD, MSc, KCI Inc. USA: Grant/Research Support
P-391. Infections in Gender-Affirming Surgery: A Single-center Experience with Gender-affirming Vaginoplasty
Authors: Sheth Radhika , Bhaskara Apoorva , Brown Haley M , Varley Cara D , Streifel Amber C , Maier Marissa , Sikka Monica K , Evans Christopher
Published: January 2025

Background

There are an estimated 1.3 million transgender adults in the US and about 25% undergo some form of gender-affirming surgery (GAS). Data on infectious complications following GAS is limited. We describe the epidemiology and incidence of infections following gender-affirming vaginoplasty (GAV). We also describe HIV screening and pre-exposure prophylaxis (PrEP) use in this population as transwomen are disproportionately affected by HIV and have the highest prevalence compared to any other group of US adults.

Methods

In this single-center retrospective cohort study, we identified 398 patients aged ≥18 years who underwent GAV at Oregon Health & Science University from 2016 to 2023. We reviewed medical records up to 6 months from the initial surgery and used standardized criteria to diagnose surgical site infections (SSI), urinary tract infections (UTI), and sexually transmitted infections (STI). Data around HIV screening and PrEP use was also obtained.

Results

381 patients underwent primary vaginoplasty and 17 underwent revision of the primary surgery. 332 had standard penile inversion, 64 had robotic vaginoplasty, and 2 patients had intestinal vaginoplasty. UTI was the most common postoperative complication (incidence 13.8 per 100 individuals; n=55), followed by SSI (incidence 5.5 per 100 individuals; n=22). We identified 4 episodes of bacteremia related to surgery- all due to E coli- and one case of pelvic abscess. Only 2 STIs were identified and neither involved the neogenitalia- 1 was primary syphilis and the other was gonococcal urethritis.

16 patients had positive HIV serostatus. All 16 were prescribed ART and 11/16 had an undetectable viral load at the time of surgery. Only 22.5% of HIV seronegative patients had screening within a year before surgery and only 6% were on PrEP at the time of surgery.

Conclusion

In our study, UTIs and SSIs were the most common infections post-GAV. Serious infections were rare.

We also identified a significant gap in HIV screening and PrEP uptake in this especially vulnerable group. Transgender surgery programs should incorporate HIV screening and counseling around PrEP.

Disclosures

Monica K. Sikka, MD, F2G: Grant/Research Support Christopher Evans, MD, ViiV: Grant/Research Support
P-393. Examining Breast Surgical Site Infections: A Case-Control Study on the Effect of Skin Antisepsis Agents and Other Contributing Factors
Authors: Anic Sonja , Loisy Denice S , Knepper Bryan
Published: January 2025

Background

Postoperative surgical site infections (SSI) in breast mastectomy and reconstruction cases persist despite efforts to control extrinsic factors. SSI may lead to prolonged hospitalization, increased costs of patient and hospital, and patient hardship. Current skin antisepsis practices warrant strict observation, application, and exploration of efficacy, as Gram-positive microorganisms are most commonly associated with breast surgery. The use of an alcohol-based skin preparation has proven to be more effective than those that are aqueous-based, We evaluated potential patient and procedure risk factors for SSI, including the perioperative skin prep used in breast mastectomy, breast plastic reconstructive, and combination breast and plastic cases.

Methods

A case-control study of breast procedures was performed. Procedures were identified between January 1, 2022 and December 31, 2023 from two campuses in the same health system. Procedures were divided into three case types: breast-only, plastics-only, and combination of breast and plastics. In addition to skin prep solution, factors assessed for SSI risk were: age, in-patients, out-patients, body mass index, diabetes mellitus, duration of procedure, wound class, and ASA.

Results

45 SSI cases were identified, and 92 controls were randomly selected. Factors associated with SSI included duration of case, BMI, case type, inpatient procedure, emergent procedure, and wound class. Most SSIs were superficial with Staphylococci the most common organism isolated. Iodophor paint and/or scrub were used in the majority of cases and controls; Chloraprep was used in 0 SSI cases and 3 controls.

Conclusion

Attention should be focused on the prevention of SSI due to its serious nature. Multiple factors can contribute to the development of SSI and its prevention. The incidence of SSI was higher in patients who underwent either plastics-only or a combination breast/plastics procedures; iodophor skin prep may also be an area of concern. Next steps include implementing a trial of Chloraprep skin prep for all breast procedures, continuing to evaluate other known risk factors, and investigating other potential opportunities, including postoperative patient management.

Disclosures

All Authors: No reported disclosures
P-401. Cost-Effectiveness of Different Screening Strategies to Control the Spread of Carbapenemase-producing Organisms
Authors: Phua Hwee Pin , Beh Darius , Ang Brenda , Lim Wei-Yen
Published: January 2025

Background

The transmission of carbapenemase-producing organisms (CPO) in healthcare facilities is associated with increased morbidity and mortality. Recommended control measures include early detection of asymptomatic carriers coupled with isolation and contact precautions. Such measures can be costly and need to be balanced against the disruption of hospital operations. We assessed the effectiveness of different screening strategies at averting potential CPO infections and the corresponding cost savings.

Methods

A basic infectious disease transmission model was used to characterize colonization and transmission with inputs parameterized based on 2023 data from a 1700-bed academic teaching hospital (Fig. 1). Three strategies were compared to the baseline viz. high-risk screening (HRS) but at 70% compliance (based on previous audits) (Fig. 2): (i) HRS at 100% compliance (cHRS); Universal screening on admission (US); Long-stayer screening (LSS) of all inflight patients at every 10 days of stay till 30 days (where applicable) on top of HRS. Once CPO carriage is identified, we assumed no onward transmission, as per institution policy, timely isolation with contact precautions would be implemented. Outcomes included the monthly number of CPO infections and estimated cost of screening (using rapid PCR) and treatment. All costs were converted to US dollars at an exchange rate of USD$1 = SGD$1.343.

Results

The baseline strategy resulted in 17 infections/month with an estimated cost of USD$443,000 (Fig. 3). Among the three strategies, cHRS gave the best value with potential cost savings USD$39,000/month and 5 infections averted/month. In comparison, LSS in addition to HRS would similarly avert 5 infections/month but at an estimated cost of USD$74,000 (Fig. 4). For US, 8 infections/month would be averted at a cost of USD$79,000 (Fig. 4).

Conclusion

Improving compliance to HRS was the most cost-effective option to limit the spread of CPO.

Disclosures

Darius Beh, MBBS (S'pore) MMed (Int Med) MRCP (UK), AstraZeneca: Conference Sponsorship|Gilead: Conference Sponsorship
P-406. Implementation of an Initial Specimen Blood Culture Diversion Device to Reduce Blood Culture Contamination: Lessons Learned
Authors: Touzard-Romo Francine , Auld Diane , Deabreu Alison , Roberts Kimberly , Jackson Gail , Valerie Whitehead , O’Rourke Emerald , Has Phinnara , Mermel Leonard
Published: January 2025

Background

Blood culture (BCx) contamination (BCxC) leads to unnecessary antibiotic exposure, increased hospital stay, and cost. Despite best practices, our health system’s BCxC rates remain above the 1% benchmark. Implementation of an initial specimen diversion device (ISDD) have demonstrated reduced BCxC rates. 3,4 We assessed the impact of the Kurin Lock® ISDD on BCxC and vancomycin utilization in adult emergency departments (EDs), intensive care and step-down units (ICU/SD).

Methods

The Kurin Lock® was implemented in 3 Lifespan health system hospitals (The Miriam Hospital [TMH] ED October2022; Rhode Island Hospital [RIH] and Newport Hospital [NH] EDs January 2023, and in all 3 hospital’s ICU/SD units June 2023). We included adult BCx obtained by nurses (all hospitals) or phlebotomists (NH only). BCx were drawn per protocol; growth was monitored with the BioMérieux VIRTUO System. BCxC rates were calculated dividing the number of contaminated cultures (per CDC NHSN commensal list) by the total number of BCxs/month. Mean BCxC rates prior to Kurin Lock® implementation (6 months) and after implementation (subsequent months through December 2023), excluding the month of implementation, were compared using the Wilcoxon rank-sum test. An interrupted time-series analysis was performed using binomial regression models; vancomycin days of therapy (DOT) for ’bacteremia’ was analyzed using generalized linear models.

Results

Overall mean BCxC rates for all hospitals and locations decreased from 3% to 1.9% after ISDD implementation (P=0.009). This decline was observed in all EDs but only statistically significant in RIH ICUs/SDs. In the time-series analysis, an abrupt 65% decline in BCxC was observed immediately after implementation in all hospitals and locations (P = 0.04). Lower BCxC rates were sustained after 200 days in the ICUs/SDs and 400 days in the EDs; however, an upward trend was observed with time. Vancomycin DOT was not significantly different pre- vs. post-Kurin Lock® implementation (41/1000 patient days vs. 37/1000 patient days, P=0.9).

Conclusion

A sustained decline in BCxC is achievable with the Kurin Lock® ISDD in academic and community hospital settings. But consistent education on best practices is key to guarantee the efficacy and cost-effectiveness of this intervention.

Disclosures

Leonard Mermel, DO, ScM, Citius Pharmaceuticals: Advisor/Consultant|CorMedix Pharma: Advisor/Consultant|Destiny Pharma: Advisor/Consultant|Lightline Medical: Advisor/Consultant|Lightline Medical: Stocks/Bonds (Private Company)|Pristine Access Technologies: Advisor/Consultant|Pristine Access Technologies: Stocks/Bonds (Private Company)
P-433. Impact of Tesamorelin on Cardiovascular Disease Risk Prediction Scores in Phase 3 Studies Treatment Arms: Subanalysis
Authors: Grinspoon Steven K , Fourman Lindsay , Stanley Takara , McGary Colleen , Benkeser David , Cash R Brandon
Published: January 2025

Background

The risk of cardiovascular disease (CVD) is nearly twice as high for persons with HIV (PWH) as the general population. Excess visceral abdominal fat (EVAF), the key characteristic of central adiposity, has also been associated with an increased risk of CVD in PWH. Tesamorelin, a growth hormone-releasing hormone analog, has previously demonstrated significant reductions in EVAF in two phase 3 randomized controlled trials in PWH. Yet, the impact of the reduction of EVAF from tesamorelin on CVD outcomes has been unknown.

Tesamorelin Treatment Effect on CV Risk Score

Methods

To assess this impact, combined datasets from the phase 3 studies’ treatment arms were utilized to calculate 10-year atherosclerotic cardiovascular disease (ASCVD) risk scores at baseline and 26 weeks. A mediation analysis was conducted to characterize the significance of treatment impact via intermediate variables that factor into ASCVD risk prediction changes. Modifiable variables included systolic and diastolic blood pressure, total cholesterol (TC), high-density and low-density lipoprotein (HDL, LDL).

The analysis population included 543 subjects randomized to tesamorelin treatment, 86% of which were male and 22% non-white; the median age was 47 years old. The percentage of subjects on lipid-lowering therapies, hypertension treatment, or diabetic were 46%, 37%, and 18%, respectively.

Results

Although the majority had low CVD risk at baseline, 44% had borderline to high CVD risk. Participants in the tesamorelin treatment arm tended toward a modest reduction in 10-year ASCVD risk prediction with estimated decrease in ASCVD risk of -0.40% (95% CI -0.89%, 0.05%). The reduction in CVD risk was relatively larger among subjects with higher CVD risk at baseline (p=0.038 for overall trend among all participants). Reductions in ASCVD risk score were driven predominantly by reductions in TC, independent of lipid lowering therapies.

Conclusion

In summary, this analysis provides evidence that reductions in excess visceral fat with tesamorelin lead to a significant reduction in forecasted CVD risk in PWH, resulting from reduction in TC even among a group heavily treated with lipid-lowering therapy. Given the increasing prevalence of obesity and central adiposity in PWH, more attention should be given to targeting visceral fat when considering CVD risk management.

Disclosures

Steven K. Grinspoon, MD, Gilead: Grant/Research Support|Kowa: Grant/Research Support|Theratechnologies: Advisor/Consultant|Viiv: Grant/Research Support Lindsay Fourman, MD, Chiesi Farmaceutici: Advisor/Consultant|Chiesi Farmaceutici: Grant/Research Support|Theratechnologies: Advisor/Consultant Takara Stanley, MD, Pfizer: Grant/Research Support Colleen McGary, PhD, Theratechnologies: Employee R Brandon Cash, PharmD, Theratechnologies: Employee
P-448. Contextual assessment and potential barriers and facilitators of a mobile health program to support treatment of tuberculosis and HIV in Kilimanjaro, Tanzania: opportunities for care integration
Authors: Khutsishvili Liza , Fabian Carolin , Ngowi Kennedy , Sariko Margaretha , Wilhelm Krisanta , Mpagama Stellah , Heysell Scott , Boer Marion Sumari-De , Hodges Jacqueline
Published: January 2025

Background

Despite increasing smartphone penetration globally, personalized mobile health (mHealth) care interventions remain largely untapped for people with tuberculosis (TB) in many settings. A smartphone platform adopted to support treatment of human immunodeficiency virus (HIV) in the US was adapted and piloted for HIV/TB care in a distinct urban population, with high usage and improved clinical outcomes. Systematic evaluation of potential contextual influences on mHealth implementation is needed to ensure appropriateness, feasibility, and acceptability of the intervention for HIV/TB care within Kilimanjaro.Table 1:Perspectives on existing HIV and TB care delivery experiences and integration of services

Methods

We conducted semi-structured in-depth interviews at Kilimanjaro Christian Medical Centre and Kibong’oto Hospital with patients (18 y/o+ with drug-susceptible/drug-resistant-TB, with/without HIV, > 1 month on treatment) and providers (e.g. physicians, nurses). Guides were designed using Bury’s Framework for Chronic Illness and the Consolidated Framework for Implementation Research (CFIR). Analysis was performed using a priori open coding/constant comparisons methodology. A preliminary codebook built deductively from frameworks was iterated with inductive codes based on emergent themes.

Results

To date, 12 patient and 12 provider interviews have been conducted; analysis is underway. Specific perspectives demonstrated opportunities for enhancement of HIV/TB care integration (Table 1). Preliminary analysis suggests feature phone access is more common among patients. Additional themes relate to perceptions of an external intervention source (CFIR domain: Intervention Characteristics), compatibility with current provider smartphone access/workload, existing directive nature of patient-provider relationships, and current level of system digitization at sites (workplace internet stability/data access) (Inner Setting).

Conclusion

Analysis to date reveals several prominent themes to consider for adaptation of the intervention: 1) daily life/experiences with TB/HIV 2) determinants of and 3) experiences with TB/HIV care 4) mobile phone ownership, usage 5) perceptions of the intervention within the context and to support 6) home urine testing for personalized dosing of TB medications.

Disclosures

Jacqueline Hodges, MD MPH, Gilead Sciences: Grant/Research Support
P-451. Adherence to Bone Mineral Density Screening Recommendations in Older Adults with HIV
Authors: Martz Madison , Akhverdyan Nazar , Wilson Melissa P , Walker Jacob , Gorvetzian Sarah , Chauhan Lakshmi , Erlandson Kristine M
Published: January 2025

Background

HIV guidelines recommend bone mineral density (BMD) screening by dual-energy x-ray absorptiometry (DXA) for all postmenopausal women and all men ≥50 years. Uptake of these recommendations has been low. This study describes DXA screening practices among people with HIV (PWH) at highest risk for low BMD.

Methods

We conducted a retrospective chart review among PWH aged ≥65 or older who were seen for HIV care at the University of Colorado within the last year. First available and most recent DXA scans were collected; FRAX score was calculated to estimate 10-year risk of major osteoporotic and hip fractures. Demographics and clinical factors were also collected.

Results

We reviewed records of 300 PWH age 65 and older, including 243 (81%) men and 57 (19%) women. The mean age was 69.8 (SD 4.4) years, 62% were non-Hispanic white, 45% had a normal body mass index (18.5-24.9 kg/m2), and 60% reported current/prior tobacco use. 48% had a DXA scan ordered, including 53% of those with previous falls and 54% with prior fracture. Mean age at first DXA scan was 64.9 (SD 6.0) for males and 64.5 (SD 6.4) for women. Of those screened, 13% of women and 27% of men had normal BMD (T-score > -1.0); 45% of women and 53% of men had osteopenia (T-score < -1 to -2.5) and 42% of women and 20% of men had osteoporosis (T-score < -2.5). By FRAX, 10-year probability of major osteoporotic fracture was 9.8% [IQR: 5.7, 13.6] for women and 6.8% [4.7, 11.0] for men. The 10-year probability of hip fracture was 2.2% [0.8, 4.1] for women and 1.4% [0.6, 2.8] for men.

Conclusion

Older PWH are markedly under-screened for low BMD. There was low adherence to screening per current HIV guidelines, even among those with the highest risk. Osteopenia and osteoporosis were common, though FRAX scores suggested only moderate risk. Improved screening for reduced BMD and fracture risk in PWH is urgently needed.

Disclosures

Kristine M. Erlandson, MD MS, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|ViiV: Advisor/Consultant
P-470. CD4 Testing in HIV Care: Uncovering Patterns of Over-Monitoring
Authors: Almaghlouth Nouf K , Komsani Mallikarjun , Shobayo Anuoluwapo , Ayuninjam Diane , Morel Elena , Garland Joseph M , Gillani Fizza S , Flanigan Timothy P
Published: January 2025

Background

In the realm of HIV care, CD4 monitoring guidelines serve as a cornerstone for managing the health and treatment plans of individuals living with HIV. Various authoritative bodies, including the U.S. Department of Health and Human Services (HHS) offer nuanced guidelines tailored to the latest research and clinical best practices. In our study, we aimed to investigate the frequency of unnecessary CD4 testing and assess healthcare providers' comfort level of less frequent monitoring.Figure 1:Healthcare Provider Comfort Levels with Deferring CD4 Count Testing above 500

Methods

We conducted a retrospective cohort study of HIV patients under active care at the Lifespan Immunology Clinic, Miriam Hospital, Providence, Rhode Island, from 2021 to 2023, with undetectable viral loads (< 200 VL) and CD4 counts over 500. Data were extracted from electronic health records, including demographics and clinical measures. Additionally, we conducted qualitative surveys among key healthcare providers to determine adherence to guidelines and to identify any patterns of unnecessary CD4 testing.Figure 2:Awareness of Costs Associated with CD4 Count and HIV Viral Load Testing Among Healthcare Providers

Results

In our first phase of the study, a cohort of 1,929 active unique patients was monitored for their immunological status in 2021. Among these, 1,226 individuals underwent CD4 testing as the event date, with 825 achieving CD4 counts >500. Further analysis highlighted a subgroup of 712 patients who exhibited undetectable viral loads over a three-year span with CD4 counts >500 in 2021. Additionally, 610 of these patients continued to undergo regular CD4 testing after the event date. This group represents approximately 86% of those who were undetectable from 2021 to 2023. In the second phase of the study, a survey involving 40 healthcare providers at the immunology clinic assessed practices in monitoring with CD4 counts >500. The survey revealed 77% were comfortable not performing further CD4 tests, regardless of the patient's viral load status and 90% preferred not testing patients with undetectable viral loads for 1-2 years.

Conclusion

Our study observed significant increasing frequency with unnecessary monitoring of CD4 above 500 with undetectable viral loads. This highlights the importance of implementing future guidelines for minimizing CD4 testing in stable patients, aligning clinical practices and improving outcomes.

Disclosures

All Authors: No reported disclosures
P-471. Clinical and Laboratory Characteristics of the Stockholm HTLV Cohort
Authors: Svensson Anna-Karin , Vesterbacka Jan , Gredmark-Russ Sara , Petropoulos Alexandros , Nordlander Anna , Nowak Piotr
Published: January 2025

Background

The prevalence of HTLV infection in Sweden is presumed to be low, however the impact of demographic changes during the last 20 years on HTLV prevalence is unknown. In our study we describe clinical and laboratory characteristics of patients with HTLV -infection followed at our outpatient clinic at Karolinska University Hospital.

Methods

The clinical and laboratory data has been extracted from medical records of patient with HTLV infection between 2000-2024. We established a database which included demographics, mode of transmission, proviral HTLV load (PVL), occurrence of HTLV-1 associated myelopathy/tropical spastic paraparesis and Adult T cell leukemia (HAM/TSP and ATL), comorbidities and immunological and routine laboratory markers.

Results

We identified 101 patients with HTLV infection followed at our site (80% HTLV-1, 20% HTLV-2). Fifty-tree percent (n=54) were women. The average age in the cohort was 53,6 years (23-81). Twenty-nine percent (n=29) of the patients were born in Sweden, while the rest had other countries of origin (35% Middle east; 17% South America; 11% Africa ). HTLV infection was predominantly diagnosed through contact testing (34%), blood donor screening (32%), and pre-in vitro fertilization screening (32%), while clinical symptom investigation accounted for 12% of cases. Eleven individuals were HIV positive and predominantly co infected with HTLV-2. Of note, within the subset of patients born in Sweden, we identified four cases of mother-to-child transmission (MTCT) of HTLV.

Until January 2024 ten individuals (10%) were diagnosed with HAM/TSP and two individuals with ATL. Patients with HAM/TSP had a higher average PVL as compared to the rest of the cohort (20,9% vs 7,8%).

Furthermore, we conducted a quantitative analysis of regulatory T-cells in 26 HTLV-1 infected patients in peripheral blood using flow cytometry. Fifteen patients (58%) had elevated T-reg percentage (ranging from 12% to 51%) and higher PVL. Notably all three HAM/TSP patients were in the elevated T reg group.

Conclusion

In our cohort, we report a high percentage of patients with HAM/TSP and ATL. Notably, we found four cases of MTCT in patients born in Sweden. We also found a higher abundance of regulatory T-cells in the patient’s group with higher PVL and more prevalent occurrence of symptoms.

Disclosures

All Authors: No reported disclosures
P-482. Evaluating Vitamin B12 Deficiency in People Living with HIV Compared to Metformin Users
Authors: Nguyen Lee , Farihi Bahman , Diamond Catherine
Published: January 2025

Background

Vitamin B12 is a water-soluble vitamin critical for the development and function of the central nervous system, as well as the formation of red blood cells and DNA synthesis. Both HIV and metformin use have been associated with vitamin B12 deficiency. The degree of vitamin B12 deficiency in HV has not been quantified compared to other known causative conditions. Our study aims to describe the incidence of vitamin B12 deficiency in HIV-infected individuals compared to metformin-induced vitamin B12 deficiency. Our secondary goal is to describe the demographics of HIV patients requiring B12 replacement therapy.

Methods

This database study evaluated de-identified medical records from 01/01/2015 to 07/01/2023 at a single large academic institution. We evaluated two study populations: HIV patients and metformin users. For inclusion, both populations required a lab test for vitamin B12 level after starting metformin or the diagnosis of HIV. We defined vitamin B12 deficiency as starting B12 replacement therapy within 4 months of the lab test.

Results

We identified 3,253 HIV and 50,751 metformin-use patients for our study. Among all HIV patients, 717 received a B12 lab test, and 144 (20%, 95% CI 0.173 to 0.232) required replacement therapy. Metformin users had 7773 individuals that received a B12 lab test, and 1187 (15%, 95% CI 0.145 to 0.161) required replacement therapy. The rate of B12 deficiencies was higher among the HIV population (20%) than the metformin (15%), p=0.0007. The relative risk for vitamin B12 deficiency among the HIV population is 1.315 (95% CI 1.126 to 1.536). The number of HIV patients not on metformin with a B12 lab test was 631, and 124 required replacement therapy (19.7%). The HIV population was primarily men (84%), with 50% in the age range of 40-60 years and 63% identified as white.

Conclusion

Vitamin B12 deficiency is a known problem associated with metformin administration and HIV infection. This study identified that our HIV population has higher rates of vitamin B12 deficiency than the metformin group. The cause of this deficiency is unknown. Improved awareness of vitamin B12 deficiency in HIV patients may facilitate improved monitoring and supplementation, which in turn may decrease HIV-associated comorbidities such as dementia and neuropathy.

Disclosures

Lee Nguyen, PharmD, APh, BCPS-AQ ID, BCIDP, Merck & Co: Grant/Research Support
P-483. Late presentation of People Living With HIV in “Treat All” Era in Maputo City, Mozambique
Authors: Chambal Lucia Mabalane , Nilsson Charlotta , Manjate Elias , Tchavana Corssino , Muchangos Vanda dos , Augusto Orvalho , Comiche Esperanca Sevene
Published: January 2025

Background

Advanced HIV disease (AHD), defined as People Living with HIV with a CD4 cell count < 200 cells/mm3 or WHO clinical stage 3 or 4, increases the risk of severe opportunistic infections, hospitalizations, and death. Programmatic data from Mozambique showed a reduction in the prevalence of AHD at ART initiation from 73% to 37% during 2004-2014. Since 2016, Mozambique has adopted the “Treat all” strategy, and data on AHD at presentation for care is limited. We assess the prevalence of AHD in recently diagnosed HIV clients ART naïve.

Relation between Age and Gender and AHD prevalece

Methods

An analysis of baseline data of a prospective cohort study in newly HIV-diagnosed ART naïve at Mavalane Health Centre (MHC) located in a periurban area in Maputo City. April 2021-November 2022, all HIV-1 diagnosed ART naïve above 18 years of age were enrolled. A questionnaire was administered to assess risk factors for HIV infection, and CD4+ T cell counts and HIV viral load were determined.

Results

A total of 1,025 PLHIV were enrolled, of whom 560 (55%) were females, median age of 35 (IQR: 30, 43) years, and mean BMI was 23.7 kg/m2 (SD: 4.48) with 8.1% under 18.5 kg/m2. The overall median CD4 + cell count was 252 (IQR: 140, 421) cells/mm3, with 46.0% (214/465, 95%CI: 41.4-50.7%) and 32.7% (183/560, 95%CI: 28.8-36.7%) of males and females, respectively, below 200 cells/mm3. There was an age-ascending trend (p-value: < 0.001) among females from 15.0% (95%CI: 8.6-23.5%) to 53.7% (95%CI: 43.2-64.0%). There was age dependency among males (p-value: 0.1887). The overall median log10 HIV-RNA was 5.12 (IQR: 4.67, 5.52), 4.41 (IQR: 3.63, 4.94) among AHD and non-AHD, respectively (p-value < 0.001).

Conclusion

This study unveiled a high burden of AHD, showing that even in an era when countries are working on strategies for early HIV diagnosis and treatment to reduce the incidence of HIV and mortality associated with opportunistic infections, clients are still presenting in an advanced stage of the disease.

Disclosures

All Authors: No reported disclosures
P-487. [18F]-labeled J3 Nanobody is a Specific PET Tracer for Molecular Imaging of HIV-1 gp120
Authors: Martinez-Orengo Neysha , Shah Swati , Lai Jianhao , Basuli Falguni , Turner Mitchell , Peiravi Morteza , Sampson Kevon , Swenson Rolf , Maldarelli Frank , Nath Avindra , Lau Chuen-Yen , Hammoud Dima A
Published: January 2025

Background

Targeted molecular imaging of HIV-1 can potentially identify viral reservoirs and provide a better understanding of disease pathogenesis and management. Nanobody-based radiolabeled probes offer several advantages over full antibodies, including smaller size, deep tissue penetration, and high stability. In this study, three fluorine-18 labeled nanobodies targeting the well-conserved CD4-binding site on HIV-1 envelope protein (gp120) were evaluated in gp120-expressing flank tumor models.

Methods

Binding affinities to gp120 protein were determined by bio-layer interferometry. For in vivo PET imaging, an animal model with wild type (WT) and/or gp120-expressing HEK293T cells (gp120+) flank tumors was developed in nude mice. Radiolabeled nanobodies were prepared by an indirect labeling method using 6-fluoronicotinic acid-2,3,5,6-tetrafluorophenyl ester (6-[18F]FPy-TFP) prosthetic group. Dynamic PET/CT images up to 60 minutes and static images at 120 minutes were obtained. Tumors were evaluated ex vivo using immunofluorescent staining. Unpaired t test was used for statistical analysis.

Results

J3 nanobody showed higher binding affinity to gp120 compared to 3E3 and B9, with KD values of 1.1nM, 3.4nM, and 23.7nM, respectively. PET/CT imaging revealed selective binding (measured as SUVpeak) to gp120+ compared to WT tumors with J3 (0.64 ± 0.14 vs. 0.29 ± 0.08) and 3E3 (0.61 ± 0.27 vs. 0.22 ± 0.12) but not with B9 (0.21 ± 0.14 vs 0.25 ± 0.12). After 2 hours, J3 and 3E3 had minimal background signal, whereas B9 showed poor ligand clearance and off target binding (Fig. 1). [18F]J3 time activity curves (TACs) from dynamic and static scans showed selective binding to gp120+ tumors compared to WT tumors (Fig. 2). To validate our PET findings, ex vivo gp120 tumor expression was confirmed by immunofluorescence staining. J3 nanobody showed specific immunoreactivity that colocalized with VRC01, an anti-gp120 full antibody (Fig. 3).

Conclusion

We evaluated the binding characteristics of three 18F-labeled nanobodies to gp120+ cells. Overall, J3 nanobody had higher specificity and binding to its target compared to 3E3 and B9, demonstrating a higher potential for non-invasive identification of HIV-infected cells in infected models.

Disclosures

All Authors: No reported disclosures
P-503. Health Care Providers' Experiences with and Perceived Barriers to Implementation of Long-Acting Injectable Preexposure Prophylaxis
Authors: Beideck Elena , Gould Ryan , Krakower Douglas
Published: January 2025

Background

Many patients eligible for preexposure prophylaxis (PrEP) for HIV are not yet prescribed it. Long-acting injectable cabotegravir (CAB-LA) may be a tool to increase PrEP coverage, though its uptake has been limited.

Methods

We conducted an online national survey to evaluate providers’ experiences with prescribing and perceived barriers to implementing CAB-LA. The anonymous survey was administered from 07/2023 to 11/2023 to a convenience sample of providers affiliated with the AIDS Education and Training Centers. We used Fisher’s exact tests to assess for factors associated with availability and use of CAB-LA.

Results

There were 89 total respondents from diverse professions (40% physicians, 60% non-physicians) from multiple regions (61% in the Northeast). Nearly half (46%) reported that at least 10% of their panel was uninsured and most (85%) reported that at least 40% of their panel had public insurance. Among providers, 57% reported their primary clinic site offered CAB-LA. Only 29% had patients on CAB-LA, and 10% had patients who tried CAB-LA and switched to oral PrEP. The most common perceived systems-level barriers to use of CAB-LA were concerns about insurance coverage (84%) and logistic constraints (78%). The most common perceived patient-related barriers were lack of patient requests (71%), concern for missed injections (68%), and cost (64%). The most common perceived reasons for patients to switch off of CAB-LA were burden of appointments (78%), injection site pain (67%) or other side effects (44%), and cost (33%). A majority (67%) reported that lack of training was at least a minor barrier to the prescribing of CAB-LA by providers at their practice site. Rates of CAB-LA availability and providers having prescribed CAB-LA did not vary by provider credentials, region, panel insurance mix, or rates of uninsured patients in providers’ panels (p-values all >0.05).

Conclusion

This study highlights the modest rate of availability and the low rate of prescribing of CAB-LA. This suggests the need for improved strategies to implement CAB-LA, specifically surrounding cost, clinic logistics, patient awareness, and provider education. The rate of providers who have had patients switch off of CAB-LA suggests that patients may benefit from support to ease the burden of appointments and cost.

Disclosures

Douglas Krakower, MD, FluidForm Bio: Stocks/Bonds (Private Company)|Gilead: Grant/Research Support|Matchbox Health: Stocks/Bonds (Private Company)|Medscape: Funding to develop educational content|Merck: Grant/Research Support