bluuebunny/crossref_metadata_2025 huggingface dataset:
1455. Cluster of Methicillin-Susceptible Staphylococcus aureus (MSSA) Infections at an Outpatient Surgery Center
Authors: Bailey Allison , Kennedy Idamae , Ansorg Henning , Doohan Noemi C , Robles-Davis Shellie , Stoltey Juliet , Epson Erin , Siegel Jane D
Published: November 2023

Background

In February 2023, a local health department (LHD) notified the California Department of Public Health (CDPH) Healthcare-Associated Infections (HAI) Program of 3 patients hospitalized for methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia and/or abscess following sacroiliac (SI) joint injections for pain at an outpatient surgery center. Two recovered after treatment and one expired 9 days after the injection. CDPH-HAI and the LHD conducted an investigation.

Methods

LHD and CDPH infection preventionist staff went on site to evaluate infection control (IC) practices. Whole genome sequencing (WGS) was performed on all available MSSA isolates at the CDPH Microbial Diseases Laboratory.

Results

Initial investigation revealed single-dose vials of one product had been used for multiple patients; this practice was discontinued. WGS found the 3 patient isolates were identical (0 single nucleotide polymorphism (SNP) difference). The same healthcare personnel (HCP) team had performed the procedures for all 3 infected patients. A site visit identified gaps in IC and injection safety practices. One HCP who provided care to all 3 patients had visible skin lesions on their hands, wore bracelets, and was unaware of a facility policy to report if they were unable to perform adequate hand hygiene. MSSA screening cultures were collected from 3 involved HCP and were positive in only the HCP with skin lesions. WGS showed that the HCP MSSA isolates were highly related to the patient isolates (0-2 SNP difference). We advised the facility to develop an IC program tailored to the procedures performed, including adverse event surveillance, adherence monitoring of hand hygiene and environmental services practices, and attention to injection safety. The MSSA colonized HCP was referred for treatment of their skin condition and decolonization and was restricted from patient care until their skin condition improved.

Phylogenetic tree for MSSA

Conclusion

A combination of injection safety and hand hygiene lapses led to MSSA transmission from an HCP to 3 patients. This cluster underscored the importance of IC programs in outpatient clinics and the risk of transmission of infectious agents from HCP to patients with gaps in IC practices. It also highlighted the contribution of WGS in investigating HAI outbreaks.

Disclosures

All Authors: No reported disclosures
1456. Outbreak of Elizabethkingia anophelis on a Pulmonary Medicine Unit
Authors: Weber Rachel , Barajas Grace , Reiner Sandra , Malczynski Michael , Qi Chao , Zembower Teresa
Published: November 2023

Background

Elizabethkingia species are multidrug-resistant emerging pathogens that have caused outbreaks in healthcare settings and are associated with high mortality rates (20-40%) among infected patients. We experienced an increased number of E. anophelis isolates on our high-risk pulmonary medicine unit (PMU) in October 2022. An outbreak investigation was performed.

Methods

The outbreak investigation consisted of review of clinical and microbiological data, evaluation for potential laboratory contamination, water and medical equipment sampling, staff interviews, and pulsed-field gel electrophoresis (PFGE) to characterize clinical and environmental isolates.

Results

Between October and December 2022, E. anophelis was identified from respiratory cultures of five colonized patients on our high-risk PMU. None developed clinical infection. By PFGE, three isolates were identical, one was possibly related and one was distinct and not considered part of the outbreak. Laboratory contamination was ruled out when rounds identified no sources and repeat tracheal aspirate cultures processed manually grew E. anophelis. Between 10/23/22-10/31/22, all four patients had tracheostomy collars and received respiratory care on overlapping days on PMU. 144 environmental samples were obtained on PMU and three other units where patients had received care: 75 water fixture, 45 water, 15 respiratory equipment, and 9 other medical equipment. 3/144 (2%) environmental samples were positive, all from water fixture samples from PMU. These were distinct from each other and patient isolates. Rounds and interviews identified supplies stored in splash zones, excessive splashing of sinks, and potential misuse of tap water (i.e. rinsing nebulizers). Additionally, PMU had medical equipment needs which resulted in increased sharing of equipment between patients.

Conclusion

Although a definitive source for this outbreak was not found, the investigation concluded that transmissions likely occurred due to tap water misuse coupled with suboptimal infection prevention practices during respiratory procedures. Rapid identification and investigation of this outbreak, including swift awareness, education, and participation of frontline staff, likely contributed to the timely end of this outbreak.

Disclosures

All Authors: No reported disclosures
1457. Carbapenem-resistant Acinetobacter baumannii in an Intensive Care Unit during the COVID-19 pandemic: An Outbreak Investigation Utilizing Whole Genome Sequencing
Authors: Williams Samantha , Thompson Kolawole Rochelle T , Navalkele Bhagyashri , Grubb Melinda , Fletcher Sheila , Ware Daphne , Robinson Ashley
Published: November 2023

Background

Infections due to carbapenem-resistant Acinetobacter baumannii (CRAB) are associated with increased mortality, length of hospital stay, and cost. Due to the high patient volume during the Delta wave of the COVID-19 pandemic, one of the parking garages at our institution was converted into overflow ICU space that lacked institutional Infection Prevention (IP) oversight. Shortly afterwards, we experienced an outbreak of CRAB. Here we describe our outbreak investigation utilizing whole genome sequencing.

Methods

After five cases of CRAB were noted in a ten-day period, enhanced IP measures were implemented, and an outbreak investigation was initiated (Figure 1). A hospital-onset (HO) CRAB case was defined as CRAB isolated from any specimen collected on or after hospital day three from August to September 2021 in patients without prior CRAB infection. A line list of HO CRAB cases was created. CRAB isolates underwent WGS and analysis (PA) (Figure 2). Location mapping was then performed on cases involved in the outbreak to assess potential transmission pathways.

Results

Nine cases of HO CRAB were initially identified. Eight of these underwent WGS and analysis (Figure 3). Based on WGS, six of the eight isolates were determined to be genetically related and were strains from global cluster 2 with intrinsic (OXA-51 family) and acquired (OXA-23) carbapenemases. Further investigation revealed the two unrelated isolates (C and H) had prior community-onset (CO) CRAB colonization, and they were excluded from the outbreak. One additional HO case was identified later during the outbreak and did not undergo WGS. A total of eight cases were labeled as HO CRAB. Location mapping of HO cases was performed. Multiple overlapping locations were noted among HO cases, with five of the eight cases notably having been located in the makeshift garage ICU during their stay (Figure 4). Patient demographics, clinical data, and outcomes are described in Table 1.

Based on results of WGS and analysis, isolates C and H are not related to other isolates. C has >1100 single nucleotide polymorphisms (SNPs) and H has >265 SNPs with other isolates. The remaining 6 isolates are closely related to each other with <20 SNPs.

Conclusion

Our study demonstrated the use of location mapping and utility of WGS to identify outlier cases and the strains involved in the CRAB outbreak. Our findings also highlight the need for IP involvement at the time of addition of new patient care areas to provide guidance on practices to help prevent outbreaks.

Disclosures

Ashley Robinson, PhD, Pfizer: Grant/Research Support
1459. Association of Antibiotic Prophylaxis Duration and Length of Stay in Patients Undergoing Coronary Artery Bypass Graft Procedure
Authors: Alnaimi Shaikha , Obaidi Warda , Habra Masa , Shoman Bassam , Carr Cornelia , Alhail Moza
Published: November 2023

Background

Antibiotic prophylaxis in surgery is a standard measure to reduce the risk of microbial contamination following an incision. For most surgeries, a single dose of antibiotics is generally required. However, in patients undergoing coronary artery bypass graft (CABG) procedure, antibiotics have been administered for ≥ 24 hours as data on the optimal duration is not sufficient. We aimed to correlate the duration of antibiotic prophylaxis in patients undergoing CABG with length of hospital stay (LOS).

Methods

We conducted a retrospective cohort study comparing LOS of patients undergoing CABG who received antibiotic prophylaxis for ≥ 24 hours (extended course group) and those who received it for < 24 hours (short course group). Inclusion criteria were adults who had undergone CABG between 01/09/2015 –01/03/2019 in a cardiology and cardiothoracic surgery hospital. Exclusion criteria were immunocompromised patients, in-hospital mortality and patients with a pre-existing infection. The primary outcome was LOS and we also explored other variables that may predict LOS. Effects were adjusted for confounders using a multivariate linear regression model.

Results

A total of 855 patients were identified. After exclusion, 840 were included in the analysis of which 425 (50.6%) received antibiotics for ≥ 24 hours and 415 (49.4%) received them for < 24 hours. The median LOS was 12.2 [IQR 11.0] days in the extended course group and 8.4 [IQR 8.8] days in the short course group, with a difference of 3.8 days (95% CI: 1.8-5.7), p-value < 0.001. However, after adjusting for potential confounders the difference was no longer significant, 1.7 days (95% CI: -0.23-3.7), p-value 0.083. Independent predictors of length of stay were, male gender, presence of chronic kidney disease, American Society of Anesthesiologists class, priority of the surgery and history of infection in the last 90 days.

Conclusion

There is no statistically significant difference in LOS between short and extended antibiotic prophylaxis course in patients undergoing CABG procedure. Future work should explore the cost-effectiveness of short versus extended course antibiotic prophylaxis.

Disclosures

All Authors: No reported disclosures
2003. Igniting the Spark: An Exploratory Qualitative Study of Medical Student Preclinical Infectious Diseases Learning
Authors: Scruggs-Wodkowski Elizabeth , Abdoler Emily
Published: November 2023

Background

Major educational goals of Infectious Diseases (ID) are to recruit more trainees into ID and promote good antimicrobial decision-making. National survey research (Bonura et al, 2016) revealed that ID curricula that deemphasize memorization are associated with greater odds of trainees entering the field of ID. As ID electives are not required during medical school, preclinical ID courses could represent the last dedicated opportunity for students to gain exposure to the field and acquire key clinical skills for antimicrobial selection. Yet little is known about how students experience preclinical ID courses. We aimed to explore how students experience and engage with these courses to better understand how best to augment their learning and interest in ID.

Methods

We conducted individual interviews with a purposeful sample of medical students who took the preclinical ID course during three curricular years (2019-2021). Our semi-structured interviews explored students' challenges in learning ID, as well as the motivations, learning principles, and strategies guiding that learning. We generated a codebook through an iterative, inductive process using Dedoose to code interviews and facilitate analysis. We confirmed and refined major themes over 19 interviews.

Results

Students face unique challenges learning ID but are motivated to succeed by both intrinsic and extrinsic factors (Table 1). We identified six core learning principles (Establishing Relevance, Organized Study, Relating Ideas, Multi-Modal Learning, Socially Constructed Learning, and Active Engagement with Material) that support student learning, deployed through four main strategies (Peer Advice, Writing it Out, Talking it Out, and Use of External Resources) (Table 2; Figure 1).Table 1.Challenges and Motivations in Learning Infectious Diseases (ID)Table 2.Infectious Diseases (ID) Learning Principles and StrategiesFigure 1.Infectious Diseases (ID) Learning Principles with Supportive Strategies

Conclusion

Our results build on prior research indicating that students learning ID benefit from incorporation of educational principles and strategies that move beyond rote memorization to encourage active engagement and self-reflection. We found that students preference deep, strategic learning methods propelled by intrinsic motivation, despite external pressures. Our findings have implications for optimizing ID education and ultimately increasing interest in the field.

Disclosures

All Authors: No reported disclosures
1467. Effects Of Oral Antibiotic Prophylaxis For Surgical Site Infections In Colorectal Surgery: Insights From Real World Data
Authors: Hata Hiroaki , Nakanishi Hiroki , Nishikawa Gen , Matsusue Ryo
Published: November 2023

Background

Surgical site infection (SSI) after colorectal surgery is a significant burden on healthcare costs and patient quality of life. Preventive strategies are very important to working on this problem. In a multicenter randomized controlled trial (RCT) published in Annals of Surgery(2016;263:1085-1091), we reported the efficacy of oral antimicrobial prophylaxis in preventing SSI before colorectal surgery. Since the end of the RCT in 2012, we have applied this prophylaxis in our clinical practice and have experienced a large number of cases. Here, we report the incidence of SSIs when this prophylactic measure is applied in real-world clinical practice.

Methods

We retrospectively evaluated the incidence of SSI in 1192 patients who underwent elective laparoscopic colorectal resection for colorectal tumors between January 2013 and June 2022. We excluded 24 patients who were unable to receive oral prophylaxis. Antimicrobial prophylaxis consisted of oral kanamycin (1 g) and metronidazole (750 mg) twice on the day before surgery and intravenous cefmetazole (1 g) just before and every 3 hours during surgery. The diagnosis of SSI follows the CDC/NHSN definition.

Results

Our study included 647 males and 545 females, with a mean age of 69.3 years (IQR 63-77) and BMI of 22.6 kg/m2 (IQR 20.2-24.7). The incidence of SSI in all surgical cases was 61/1192 (5.1%; 95% CI 4.0-6.5). The incidence of SSIs in colon surgery was 16/769 (2.1%; 95% CI 1.3-3.4), and in rectal surgery, 45/400 (11.3%; 95% CI 8.5-14.7). The incidence of Clostridioides difficile colitis, which is regarded as a side effect of oral antimicrobial agents, was low at 6/1192 cases (0.5%; 05%CI 0.2-1.1).

In our previous RCT, the incidence of SSI was 21/289 (7.26%) in patients treated with oral antibiotics. In a subanalysis of this trial published in the International Journal of Colorectal Disease(2016;31:1775-1784), the incidence of SSI was 9/188 (4.8%) in colon surgery and 13/103 (13%) in rectal surgery. The incidence of SSIs in the present data was similar to or lower than the incidence of SSIs in well-conditioned patients selected in the RCT.

Conclusion

Our results suggest that preoperative oral antibiotic prophylaxis in colorectal surgery is an effective method to reduce SSIs in a wide variety of patients in real-world clinical practice.

Disclosures

All Authors: No reported disclosures
1480. Detection of Multiple HIV Strains in an HIV-positive Transplant Recipient from an Acutely HIV Infected Donor.
Authors: Alavian Naseem , Travieso Tatianna , Blasi Maria , Wolfe Cameron R
Published: November 2023

Background

The HIV Organ Policy Equity (HOPE) Act allows persons living with human immunodeficiency virus (HIV) infection to accept HIV-positive donor organs. Risk of superinfection or viral recombination resulting from the transmission of a genetically distinct donor HIV-1 strain may be a concern. It is unknown if transplantation from acutely infected donors pose additional risk. Analysis of viral quasispecies from donor and recipient samples provides an opportunity to evaluate the transplanted kidney as a viral reservoir and explore the potential for viral superinfection or recombination in the recipient.

Methods

A 63-year-old HIV-positive recipient with focal segmental glomerulosclerosis and suppressed viral load (< 20 copies/mL) on antiretroviral therapy (ART) with dolutegravir and lamivudine, received a kidney from an acutely infected deceased HIV-positive donor (Table 1). Single genome amplification of the HIV-1 env gene was performed with viral RNA extracted from recipient urine and plasma and viral DNA from donor kidney cells, recipient PBMC and renal cells. We constructed phylogenetic trees assessed recombination probabilities.

Results

A new, genetically distinct env sequence was amplified from the recipient’s urine 30 hours post-transplant suggesting transfer of donor virus to recipient. Donor virus became undetectable on subsequent visits while recipient was maintained on ART. Notably, a third virus was detected 1.5 months post-transplant in urine-derived renal tubular epithelial cells and 5 months post-transplant in urine which was genetically distinct from previously detected donor and recipient strains (Figure 1). This third strain did not have genetic features suggestive of recombination. Our findings suggest potential superinfection in the donor or recipient.

Figure 1. Phylogenetic Analysis of HIV Quasispecies Isolated from an HIV-Positive Kidney Transplant Recipient, Showing Three Distinct Viral Lineages*

Conclusion

We documented presence of three unrelated HIV strains within a transplanted recipient and within different viral reservoirs. Donor and recipient recombination did not occur. In acutely infected donors, when the transfer of virus within the kidney occurs, ongoing virologic suppression can be achieved if appropriate ART is maintained. Additional long-term monitoring of viral populations in the recipient is important to fully assess any clinical and virologic implications of this finding.

Disclosures

All Authors: No reported disclosures
1481. Clinical profile of cerebral small vessel disease in people with HIV hospitalized for ischemic stroke
Authors: Ayoade Folusakin , Hernandez Salma
Published: November 2023

Background

The risk of ischemic stroke (IS) is twice as likely in people with HIV (PWH) than in the normal population. Cerebral small vessel disease (CSVD), a well-recognized risk factor for IS is poorly studied in PWH and represents a missed opportunity for targeted surveillance and risk mitigation for IS in this population.

Methods

We retrospectively analyzed brain imaging (Computerized tomography and magnetic resonance imaging) findings of PWH obtained up to 8 years prior to the time of current admission for IS at our health institution. IS admission was between January 1, 2008 and December 31, 2018. We extracted information that suggests CSVD either in the imaging description or report summary. The terminologies include "ischemic leukomalacia", "white matter hyperintensities", "age related white matter changes", "lacunar infarcts" and "microbleeds". We analyzed demographic and clinical information including co-morbidities, HIV data, stroke severity data, hospital course and outcome. Several parameters of interest were analyzed in those with CSVD on brain imaging versus those without.

Results

Out of the 70 HIV positive patients analyzed who presented with IS during the time period, 54 or 77% had CSVD on a previous brain scan within the prior 8 years preceding the current stroke. Other demographic and clinical information are illustrated in Table 1.

Only 66% of the cohort had a Glasgow coma scale (GCS) of 15 at admission. The NIH stroke scale of 5 or greater was 50%. Individuals without CSVD were younger (Mean 52.8 ± 9.5) compared to those with CSVD (Mean 60.1 ± 9.3), p=0.01. CSVD was correlated to age and CD4 counts with Pearson correlation of 0.319, p=0.007 (age) and 0.364, p=0.012 (CD4) respectively. There was no difference in stroke severity scores, ICU and hospital length of stay, and outcome in both groups.Table 1:Demographic and Clinical information of CSVD in PWH (N=70). Legend: ART: Antiretroviral therapy VL: Viral load GCS: Glasgow Coma scale ICU: Intensive care unit LOS: Length of stay Min: Minimum value Max: Maximum value

Conclusion

In this descriptive analysis of PWH presenting for hospital admission due to ischemic stroke, 77% had CSVD on a previous brain scan. Mortality was 20% with over 60% surviving with disabilities. CSVD in PWH is correlated to age and CD4 count. Further studies are needed to understand the interaction between CSVD and other host specific mitigating factors including demographics, co-morbidities, HIV factors and microbiome and their roles in contributing to excess stroke risk in PWH.

Disclosures

All Authors: No reported disclosures
1483. Real-time Creation of HCV Treatment Cascades in Clinics to Improve HCV Treatment Rates Among Patients with HIV/HCV Co-infection
Authors: Wegener Maximilian D , Brooks Ralph P , Nichols Lisa G , Villanueva Merceditas
Published: November 2023

Background

U.S. National Viral Hepatitis strategy advocates Health Departments (HDs) use surveillance-based viral clearance cascades to track progress of HCV care. Cascades are also useful at the clinic level, but creation can be challenging. We developed and piloted a novel Data to Care (D2C) case conferencing tool which merges jurisdictional HD and clinic data, and automatically generates HCV treatment cascades for clinic clients with HIV/HCV co-infection, identifying gaps to be improved.

Methods

Six diverse state/county health departments (HDs) used the excel-based tool with 14 Ryan White-funded clinics to create real-time HCV treatment cascades for clients who received HIV related medical services (1/1/2018–8/31/2021) with a HCV diagnosis (through 11/30/2021). Cascade steps included: HCV PCR testing, treatment eligibility, treatment initiation, and cure (SVR). Barriers to treatment were captured to aid in developing personalized engagement plans. Virtual case conferencing occurred quarterly with HD champions and clinic staff for 1 year. Three models, dependent on HD resources and statutory limitations, were used to identify co-infection: A) HD generated a co-infection list from centralized HIV/HCV surveillance data, B) clinic created a list of persons with HIV that HD matched to HCV surveillance or C) clinic generated a co-infection list from medical records.

Results

For list creation: 1 HD used model A, 2 used model B, 1 used model C, and 2 used a combination of B and C. Among 1249 overall clients with co-infection, 282 (23%) were Black; 842 (67%) were born male. Baseline cascades as of 11/30/2021 showed 102 (8%) needed PCR, 685 (55%) were eligible for HCV treatment and 357 (52% of eligible) achieved SVR. SVR rates varied by clinic. Substance use was a primary barrier to treatment, although most clients experienced multiple barriers.

Conclusion

Our tool uses both surveillance and clinical care data to generate a real-time clinic-specific HCV treatment cascade for clients with HIV/HCV co-infection. It is more granular than using surveillance data alone, enabling clinics in collaboration with jurisdictional HDs to overcome personal barriers to care. Used longitudinally, quarterly case conference cascades allow for insight into progress.

Disclosures

Ralph P. Brooks, MS, Merck: Stocks/Bonds
1485. Landscape of peripheral blood mononuclear cell single-cell transcriptomes in HIV-infected patients with cryptococcal meningitis
Authors: Chen Yaokai , Li Yao , Zhao Ting
Published: November 2023

Background

Cryptococcal meningitis (CM) is a lethal opportunistic infection in patients with human immunodeficiency virus (HIV); however, the immunopathogenic mechanisms underlying HIV-associated cryptococcal meningitis (HIV-CM) remain largely unknown.

Methods

Here, using the single-cell nucleus sequencing approach, we compared peripheral blood mononuclear cell (PBMC) transcriptomic alterations among ART-naïve HIV-CM patients (N=8), ART-naïve HIV-infected individuals (N=8), and healthy controls (HC, N=8). Additionally, alteration of the single-cell transcriptomes of HIV-CM patients before and after four-week antifungal treatment was also analyzed, to estimate the influence of treatment.

Results

In total, we obtained 318,718 PBMCs and identified 20 cell subclusters based on gene expression. In our PBMC sample, we observed the significantly decreased percentage of CD4+ T-cells and NK cells, as well as an increased percentage of CD14 monocytes in HIV-CM patients, relative to HC. Only the percentage of CD4+ T-cells was significantly altered in HIV-CM patients, compared to HIV-infected individuals. Moreover, after four-week of antifungal treatment, the percentage of these three cell types were significantly altered. After treatment, the proportion of CD4+ T-cells in HIV-CM patients was observed to be lower compared to HC, but was comparable to HIV-infected individuals. The relative fractions of NK and CD14 monocytes were also reversed, to revert to normal levels. The functions of the HIV-CM-specific differentially expressed genes (DEGs) among the three cell types are related to cytoplasmic translation, signal recognition particle (SRP)-dependent co-translational protein targeting, viral processes, and others. After antifungal treatment, the rate of reversal of the DEGs ranged from 11.7% to 22.9%. The reversed genes are mainly associated with neutrophil degranulation and immune system processes.

Conclusion

Together, the preceding findings suggest that the degree of change to the transcriptomes of PBMCs may be utilized as a potential marker for HIV-CM patients and for functional assessment of antifungal treatment. Furthermore, the disturbed molecular pathways may aid in understanding fundamental immunopathogenic pathways inherent to HIV-CM patients.

Disclosures

All Authors: No reported disclosures
1488. The Performance of a Multidimensional Frailty Index in Comparison to the Frailty Phenotype to Assess Frailty in an Urban HIV clinic.
Authors: Eke Uzoamaka A , Mohanty Kareshma , Schmalzle Sarah , Viviano Nicole , Hoffman Jennifer , Neha Pandit , Palmeiro Robyn , Lee Judith , Stafford Kristen A , Gruber-Baldini Ann
Published: November 2023

Background

Frailty is increasingly recognized in people living with HIV (PLWH), but optimal diagnostics are yet to be determined. Frailty indices (FI) represent accumulation of health deficits over time and have been shown to correlate better with mortality and adverse effects of aging than the phenotypic description of frailty or chronological age. This study compares a new FI to the Fried frailty phenotype (FP) to diagnose frailty and determine factors associated with frailty.

Methods

The Strengthening Therapeutic Resources in Older Adults Aging with HIV (STRONG) study incorporated standardized geriatric assessments in an adult HIV clinic in PLWH ≥50 years. FP scores of 0, 1-2, and ≥3 out of 5 criteria represented robust, pre-frail and frail, respectively. A 40-variable FI construct comprising demographic, clinical, and laboratory values was derived to calculate the FI as a fraction of the deficits present in each patient to the total variables that comprised the index. FI scores of ≤0.15, >0.15-0.4 and >0.4 were categorized as robust, pre-frail and frail respectively. FI and FP were compared with respect to frailty prevalence. Multivariate logistic regression models adjusted for age and sex were used to examine the association between FI frailty and each of the following factors: multimorbidity, falls, poor cognition history, polypharmacy (≥5 medications) and HIV duration.

Results

The 165 participants were mostly black (94%) and male (56%), with median age 59 years (IQR 55-63). 78% were virally suppressed (HIV viral load ≤40) with median CD4 count 606 cells/μl (IQR 393-873). 70% had multimorbidity (≥2 comorbidities), 38% falls, 25% poor cognition history, 24% polypharmacy and 32% < high school education. Using FP, 65% were prefrail, 2% frail, and 33% robust. Using FI, 67% were prefrail, 26% frail and 7% robust (range 0.08-0.57; mean 0.34 ±0.11). For FP categorized as robust, prefrail and frail, the mean FI was 0.31±0.1, 0.35±0.11 and 0.38±0.08 respectively (P=0.06). Poor cognition (OR 3.91, p=0.001), falls (OR 4.49, p < 0.001) and multimorbidity (OR 5.09, p=0.004) were associated with FI frailty, after adjusting for age and sex.

Conclusion

The majority of our PLWH are pre-frail or frail. The FI identified more patients as frail and had significant clinical associations compared to FP.

Disclosures

All Authors: No reported disclosures
1497. Cryptococcal Antigen Screening and Pre-emptive Fluconazole Therapy in HIV-infected Patients: A Multicenter, Retrospective Study in China
Authors: Lu Yanqiu , Chen Yaokai
Published: November 2023

Background

The implementation and effectivention of CrAg screening programs and pre-emptive treatment remains unclear in China.

Methods

We performed a multicenter, retrospective study at eight hospitals from 1st Jan 2019 to 31st Dec 2020, to evaluate whether CrAg screening programs and preemptive treatment are beneficial for saving lives in China.

Results

A total of 12768 PLWH were screened for serum CrAg. The prevalence of serum CrAg positivity was 5.3% (678/12768). Lumbar puncture (LP) records were completed and available in 580 patients. Among them, 36.4% (369/580) were diagnosed with CM, and 63.6% (211/580) were diagnosed with isolated cryptococcal antigenemia (ICA). 123 HIV/ICA patients have available clinical data. Of these patients, a median CD4+ T-cell counts were 41cells/µL (IQR, 19-83). Upon Cox proportional-hazards regression analysis, patients with no preemptive fluconazole treatment had a threefold higher risk of CM and/or death [19.0% (8/42) vs 8.6% (7/81), p=0.037] compared to the preemptive fluconazole treatment participants. However, there was no statistically significant difference for the development of CM and/or death in different dosage (therapy as per WHO recommendations vs oral fluconazole 400mg daily therapy) of fluconazole therapy (p=0.836). Also, we found no statistically significant difference in the proportion of CrAg negativity [60.0% (12/20) vs 54.5% (18/33), p=0.779] and the median time from positivity to negativity of serum CrAg [14 (IOR:9.25, 14) vs 14 (10.5, 15), p=1.000] within one year follow up. In our study, Patients who with virological suppression had a lower incidence of CM and/or death than patients who with virological non-suppression [5.6% (1/18) vs (17.2% (5/29), p=0.384], however, there was no statistically significant difference in Cox proportional-hazards regression analysis.

Conclusion

Rapid ART initiation, appropriate CrAg screening are essential for advanced PLWH. Lp is a necessary intervention in advanced HIV-infected patients for CrAg positive individual to prevent potential missed diagnosis and mistreatment of CM. Targeted improvements to pre-emptive antifungal therapy for cryptococcal antigenemia are required to further improve patient outcomes in CrAg-positive severely immunocompromised people with HIV/AIDS.

Disclosures

All Authors: No reported disclosures
1500. Chest Computed Tomography in Respiratory Asymptomatic HIV patients
Authors: Muñeton Gerardo A , Perdomo-Fonseca Juan Pablo , Guevara-Plata Laura Lucia , Murcia Mariana Espinosa , Saenz Angie Tatiana , Lopez Santiago , Rueda Melissa , Vergara Hernan
Published: November 2023

Background

New HIV infections in Colombia are diagnosed in AIDS stage in 39% of cases. Some pulmonary infections are not diagnosed on time because of the absence of clinical findings, worsening the prognosis of patients. In this study we evaluate the usefulness of chest computed tomography in asymptomatic patients with HIV diagnosed with a CD4 count off less than 200cell/uL.

Methods

This was an analytical cross-sectional study in 2 third-level hospitals. We included patients diagnosed with HIV without respiratory symptoms and a CD4 count of less than 200 cell/uL, who where study with a chest computed tomography. We determined the proportion of anormal chest tomography, the percentage of patients going on additional tests and treatments and the definitive diagnostics found. The association between clinical and epidemiological findings with pathological alterations found in the chest CT scan was also explored.

Results

34 individuals were included. Abnormal CT scans findings were found in 18 of 34 (53%) patients. Two (5.8%) were classified as micronodular, 8 (23.5%) as nodular, 3 (5.8%) as consolidation, 2 (5.8%) as masses, 3 (8.8%) as ground glass opacities and 1 (3%) as pleural effusion. All of the patients with abnormal chest CT scan required one or more additional diagnostic tests or procedures. 8 (24%) patients received new treatments after CT scan findings and results of the additional diagnostic tests. In 6 (18%) of the patients a definitive diagnosis was possible, 2 cases of tuberculosis, 1 case of non hodgkin lymphoma, 1 case of Kaposi sarcoma and 2 cases of disseminated histoplasmosis. An association between clinical manifestations and specific chest tomography results was not found.

Conclusion

All HIV respiratory asymptomatic patient with CD4 count less than 200 cells/uL should be considered for chest computerized tomography scan, taking into account that at least 50% will have abnormal findings, 30% will require new treatments and 20% will have a definitive diagnosis that could not be possible to find without the chest tomography.

Disclosures

GERARDO A. MUÑETON, Infectious diseases and Internal Medicine Specialist, PFIZER: Advisor/Consultant
1502. Disseminated Mycobacterium-avium complex in People with HIV in México City: a Single-center, 23 year (1999-2022) Retrospective Cohort Study.
Authors: Hernández Alejandro Ortiz , Guerrero-Torres Lorena , Benavides Rodrigo Ville , Ventura Rafael Valdes , Caro-Vega Yanink-Nereid , Crabtree-Ramírez Brenda-Eloisa
Published: November 2023

Background

Despite universal access to combined antiretroviral therapy (ART) in Mexico since 2005, people with HIV (PWH) still present with late-stage complications due to delayed diagnosis and/or entry into care. Among these complications, disseminated Mycobacterium-avium complex infection (DMAC) remains a concerning issue given its high mortality and diagnostic challenges. Therefore, we aimed to describe the clinical and microbiological characteristics and outcomes of PWH with DMAC in a tertiary care center in Mexico City over a period of 23 years.

Methods

In this retrospective study, we reviewed all records of PWH attending our hospital from 1999-2022. We included adult PWH with any positive extra-pulmonary MAC-culture. We developed a standardized case report form and recorded sociodemographic, clinical, and microbiological characteristics. We followed patients until microbiological cure or death.

Results

We included 37 PWH diagnosed with DMAC infection, of whom 34 (92%) were men. Overall, 4 (11%) were diagnosed with DMAC before 2005 and 33 (89%) after 2005. The median age was 34 years (IQR 27-36 years). Following HIV diagnosis, mean time to diagnosis of DMAC was 14.2 months (IQR 1.6-11.3 months). At DMAC diagnosis, 12 (32%) patients were on ART and 25 (68%) were ART naïve. Fever was the most common presenting symptom, affecting 32 patients (86%). Mean time to microbiological diagnosis was 34 days. The most common sites for culture isolation were blood (76%) and bone marrow (70%). Anemia occurred in 34 patients (92%), followed by leukopenia in 23 (62%) and pancytopenia in 9 (24%). All patients required hospitalization, with 32 (86%) receiving DMAC-specific treatment and 5 (14%) dying before treatment initiation. Thirty-four patients (92%) received a clarithromycin-based regimen, 15 (41%) of patients developed IRIS. Overall mortality during follow-up was 51%, with 79% deaths occurring within the first year after DMAC diagnosis.

Conclusion

Despite universal ART access, DMAC remains a high-mortality AIDS-defining illness in Mexico City. Efforts must be made to promote HIV testing, early diagnosis, and entry into care.

Disclosures

All Authors: No reported disclosures
1504. Weight Gain and Weight Loss Attempts among People with HIV(PWH) in Louisiana
Authors: Richey Lauren , Schroeder Jonathan , Mistretta Kyle , Lin Hui-Yi , Arnold Connie , Welsh David , Apolzan John
Published: November 2023

Background

Weight gain is common among PWH. The Louisiana Translational Collaborative on Health Behaviors [LATCH] is a multi-center workgroup created to study modifiable health behaviors in PWH in Louisiana with participating HIV clinics in three cities: New Orleans, Baton Rouge, and Shreveport. We set out to characterize the BMI, weight gain, and weight loss attempts within this population.

Methods

PWH aged ≥ 18 y were recruited from three HIV clinics during regular appointments from 2019 to 2023. Participants completed standardized surveys that assessed weight gain/loss and methods used. Participants were divided into two groups: BMI < 30 and BMI 30 and greater for analysis.

Results

106 PWH were enrolled as of Jan 2023. The average age was 51 y, most were African-American (81%), men (55%), and had a BMI >25 (74%). Fifty-eight (55%) participants had a BMI < 30, mean BMI and weight were 25 kg/m2 (range 17.9 to 29.8) and 75.6 kg, respectively. In the 48 people with obesity (45%), the mean was BMI and body weight was 38 kg/m2 (range 30 to 54) and 116 kg, respectively. Among the participants with a BMI < 30, 45% reported weight gain in the last 12 months, 7% reported trying to lose weight, but 31% lost weight, with a mean weight loss of 12.5 pounds. Exercise, medical illness, and diet were the most common contributing factors in the weight loss for this group. Among participants trying to lose weight, the average weight loss was 14 pounds. Among participants with a BMI of >30, 62% reported weight gain in the last 12 months, 27% reported trying to lose weight, but 40% lost weight, with an average of 23.7 pounds lost. Exercise and diet were the most common contributing factors in the weight loss for this group. Among participants trying to lose weight, the average weight loss was 26.7 pounds. No patients in either group reported weight loss surgery as a contributing factor in their weight loss.

Conclusion

In this study, most people with HIV in Louisiana had a BMI >25 and reported weight gain in the past year. In the group with obesity, over a quarter reported trying to lose weight and those who tried had success. People with HIV and overweight or with obesity show encouraging outcomes when attempting weight loss, which may be critical in addressing the weight gain associated with first line HIV regimens.

Disclosures

John Apolzan, PhD, WW(Weight Watchers) Inc: Grant/Research Support
1505. Clinical characterization of TB/HIV naive coinfection patients enrolled in a TB program in Cali - Colombia.
Authors: Muñoz-Lombo Jenny Patricia , Llanos-Torres Julio , Rebellon-Sanchez David E , Montes-Tello Sofía Alexandra , García-Goez José Fernando , Rosso Fernando
Published: November 2023

Background

Although antiretroviral therapy (ART) is beneficial for patients with TB/HIV coinfection, there are issues associated with concomitant therapy administration such as overlapping drug toxicity profiles, drug interactions, and the possibility of developing immune reconstitution inflammatory syndrome (IRIS). The clinical experience in managing patients with TB who develop de novo HIV is poorly described in Colombia and the prevalence of IRIS in our context is unknown. This study aims to describe the clinical characteristics of patients with TB who develop de novo HIV coinfection and determine the prevalence of IRIS following treatment initiation.

Methods

Retrospective, observational study. Patients in the TB program whit de novo HIV coinfection were included.

Results

A total of 39 patients were included. Most of the patients were male (64%) and of mixed race (58%) with an urban origin (92%). Smoking was documented in 24% of the patients and the Bacille Calmette-Guérin (BCG) TB vaccine was recorded in 48% of the patients. Pulmonary TB occurred in 74% of the patients, while miliary TB and lymph node involvement occurred in 26%. Meningeal TB and CNS TB were present in 15% of the patients, peritoneal TB in 18%, and pleural TB in 5.1%. More than 70% of the patients experienced weight loss and dyspnea (74% and 76%, respectively). Antiretroviral treatment was administered to 46% of the patients with EFV-AZT/3TC, to 21% with LPV/R+ABC/3TC, and to 14% with EFV+TDF/FTC. Individualized tuberculosis treatment was administered to 38.48% of the patients. Of the patients, 19% (5/27) developed IRIS, of which three developed TB-IRIS. The mortality rate was 2.6%, while the cure rate was 18%.

Conclusion

our study sheds light on the clinical characteristics of patients with TB who develop de novo HIV coinfection in Colombia. The high prevalence of smoking and low prevalence of BCG vaccination among these patients are notable findings. Additionally, our study highlights the importance of individualized treatment for TB and the need for careful management of patients receiving ART to minimize the risk of developing IRIS. Further research is warranted to explore the prevalence of IRIS in our context and to develop strategies to reduce its incidence.

Disclosures

All Authors: No reported disclosures
1506. Prevalence of Histoplasma Antigenuria among an outpatient Advanced HIV cohort in Kampala,Uganda
Authors: Sekar Preethiya , Nalintya Elizabeth , Kwizera Richard , Mukashyaka Claudine , Niyonzima Godfrey , Namakula Olive Loryndah , Nerima Patricia , Fieberg Ann , Dai Biyue , Bahr Nathan C , Ellis Jayne , Meya David , Boulware David R , Rajasingham Radha
Published: November 2023

Background

Histoplasmosis is a major cause of mortality in persons with advanced HIV disease (CD4< 200 cells/mcL) and areas of endemicity are evolving. Presenting symptoms of histoplasmosis may overlap with that of tuberculosis (TB). The true burden of histoplasmosis remains unknown in persons with advanced HIV disease, in part due to poor diagnostic capacity. We sought to evaluate the prevalence of Histoplasma antigenuria among outpatients with advanced HIV disease in Kampala, Uganda.

Methods

This prospective cohort study of outpatients with advanced HIV in Kampala, Uganda was nested within the ongoing ENCORE trial evaluating preemptive therapy and prophylaxis among outpatients with advanced HIV disease. Urine samples were obtained from participants at the time of enrollment and a Histoplasma galactomannan enzyme immunoassay (EIA) (Immy, Norman OK) was run on urine per manufacturer’s instructions. We obtained baseline characteristics and laboratory values, a statistical comparison by antigen status was not done due to a low number of positives. We calculated the prevalence of histoplasmosis in our cohort using EIA results. We obtained information on symptoms, TB diagnostics, and TB treatment for those with Histoplasma antigenuria.

Results

We tested 388 urine samples among participants with advanced HIV disease. Four samples were positive for Histoplasma antigen (1%). Baseline characteristics of participants are summarized in Table 1. Histoplasma antigen prevalence among participants with CD4< 100 cells/mcL was 2.5% (4/158). Of those that tested positive for histoplasmosis, the median CD4 count was 39 cells/mcL (interquartile range (IQR): 16–54), and median CRP was elevated at 29 (IQR 14-46). All four participants with Histoplasma antigenuria had a positive TB urine lipoarabinomannan (LAM, AlereLAM, Abbott, Palatine, IL, USA), though only two of four participants reported symptoms of cough, weight loss, and/or physical weakness. Three of four participants with positive Histoplasma antigen were started on anti-TB treatment. Patient symptoms resolved with no intervention.

Conclusion

Among outpatients with severe advanced HIV disease with CD4< 100 cells/mcL in Kampala, Uganda Histoplasma antigen prevalence was 2.5%.

Disclosures

All Authors: No reported disclosures
1513. Evaluating the Incremental Accuracy of HIV Self-Test Together with an App-Based Solution: A Secondary Data Analysis of Trial Data
Authors: Beecroft Ashlyn M , Duchaine Thomas , Engel Nora , Liang Chen , Esmail Aliasgar , Dheda Keertan , Pai Nitika
Published: November 2023

Background

According to the United Nations Programme on HIV/AIDS (UNAIDS), in 2019, two out of every seven new human immunodeficiency virus (HIV) infections, globally, were among young people aged 15 to 24 years old. HIV self-testing (HIVST) is a convenient strategy that helps increase knowledge of HIV serostatus in the young. In 2012, the Food and Drug Administration (FDA) approved the OraQuick In-Home HIV Test with a reported sensitivity of 92%. Digital supports such as applications (Apps) and websites, in conjunction with oral self-tests, have demonstrated a high feasibility, acceptability, and impact, yet data on accuracy with digital supports remain largely unexplored.

Methods

We performed a secondary data analysis of a quasi-randomized trial of oral HIVST with HIVSmart! conducted in South African township populations (2017-2019). We hypothesized that HIVSmart! guided interpretation increased test accuracy. We evaluated the diagnostic accuracy of the HIVSmart! guided interpretation of an oral self-test result against the reference standard (dual Elisa and HIV RNA). Stored picture of a self-test result was uploaded by the participants.

Results

Accuracy data from (n=1489) HIVST participants versus reference standard (2 rapid tests and HIV RNA) demonstrated:

Sensitivity: 95.52% (95% CI: 94.48%-96.56%)

Specificity: 99.93% (95% CI: 99.79%-100.00%)

Positive Predictive Value: 99.22% (95% CI: 98.78%-99.67%)

Negative Predictive Value: 99.57% (95% CI: 99.24%-99.90%)

Conclusion

With the App, we noticed an improved sensitivity to 95.5% (from 92% with self-tests without the use of the App), specificity high at 99%, together with high positive and negative predictive values. Findings demonstrate that Smart-App based digital interpretation removed subjectivity and increased accuracy of test result interpretation, together with recording and storage of data for monitoring purposes. Findings suggest that Smart-App based readers could be useful adjuncts to improve the accuracy estimations of self-tests, translating to increased trust and confidence in self-tests.

Disclosures

All Authors: No reported disclosures