bluuebunny/crossref_metadata_2025 huggingface dataset:
1418. The Effect of Dry Hydrogen Peroxide on Environmental Contamination with Candida auris in an Adult Burn Unit
Authors: Sutton Jared Alan , Dotson Nychie , Nagy Jaquelyn , Moody Julia , Sands Kenneth E
Published: November 2023

Background

Candida auris (C. auris) is an emerging multi-drug resistant pathogen that is a health threat for hospitalized patients. C. auris may survive on surfaces where standard disinfectants may not achieve adequate disinfection. Continuous dry hydrogen peroxide (DHP) reduces microbial bioburden on surfaces and may reduce the risk of C. auris transmission in the clinical care setting. This study reviews the efficacy of DHP exposure, coupled with routine environmental cleaning, on reducing microbial burden of C. auris on surfaces.

Methods

DHP-emitting systems were installed on burn intensive care and burn stepdown units. After install, for each patient newly identified with C. auris, baseline surface sampling of the patient room and other unit areas was performed beginning on the first day of positive culture, defined as Day 0. The DHP systems were activated and surface sampling collected to include days 1, 7, and 14. Select surfaces were sampled using polyurethane foam neutralizing buffer swabs. Individual swabs were grouped into three composites: Inner Patient Halo, Outer Patient Halo, and Mobile Shared Equipment (Table 1). Bioburden was assessed through cultures of the swabs and the identification and enumeration of resulting colony forming units (CFU). A multivariate regression model was used to evaluate the potential relationship between duration of DHP exposure and the logarithmically transformed counts of C. auris yielded by the samples.Table 1:Sampling site locations included in each composite category

Results

Three patients were identified, resulting in collection of 36 composite swabs. C. auris CFU were obtained from all composite swabs, with observed decrease in count over time (Figure 1). In a regression model including included covariates for time, room and patient proximity, there was a statistically significant relationship between C. auris bioburden and exposure to DHP (Table 2, F(5,30)=6.999, p< 0.001, adjusted R2=0.461), with duration of DHP exposure adding significantly to the relationship, p=0.Figure 1:Candida auris colony forming units enumerated from environmental surfaces.Table 2:Multivariate Regression Analysis of DHP’s Impact on Candida auris Bioburden

Conclusion

Continuous DHP, coupled with routine environmental cleaning, augments disinfection and is effective in reducing surface microbial bioburden in rooms of patients with C. auris colonization/infection. To fully understand the synergism between routine environmental cleaning and DHP, further research is needed.

Disclosures

All Authors: No reported disclosures
1429. Temperature and Humidity Variations in the Operating Room: A Risk Assessment
Authors: Usiak Shauna , Yan Judy , Reyes Michell , Martin Ann , Bubb Tania N
Published: November 2023

Background

The American Society of Heating, Refrigeration, and Air-Conditioning Engineers (ASHRAE) recommends that hospital operating rooms (OR) are controlled for temperature and humidity with established ranges but does allow for exceedances for surgeons and surgical procedures. There is currently no clear consensus or established thresholds for out-of-range temperature and humidity ranges in relation to risk for surgical site infections (SSI). A study was performed at Memorial Sloan Kettering Cancer Center (MSKCC) to further examine if temperature and humidity deviations pose a patient safety risk.

Methods

The study included 5600 surgical procedures that were performed at MSKCC between September 2021 and January 2022 where temperature and humidity logs were available. Procedures were broken into groups based on in- (n=4419) and out-of-range (n=1187) temperatures and in- (n=5225) and out-of-range (n=381) humidity. SSIs following the procedure were identified using targeted positive microbiology cultures and within NHSN (National Healthcare Safety Network) surveillance periods. Chi-square and Fisher’s exact statistical tests were used to determine if there was a significant difference between groups where p < 0.05.

Breakdown of eligible procedures and follow up

Table represents the total number of eligible procedures with environmental parameters and SSI follow up period.

Results

There was no significant impact on SSI for out-of-range humidity (p=0.15). There was a significantly higher SSI rate observed for out-of-range temperatures (p=0.04) more specifically low out- of-range temperatures (p=0.02). A sub-analysis was performed for low temperatures based on procedures by duration. Significance of the finding was lost when surgery duration was 4 hours or greater.

Conclusion

If there was a true correlation between SSI and low ambient temperature, we would have expected to see a strengthening of SSI risk with longer procedures. This study suggests that temperature and humidity deviations out of the recommended guidelines in the operating room do not pose additional risks for surgical site infections and limited exceedances can be permitted without risking patient safety.

Disclosures

All Authors: No reported disclosures
1436. Effect of Personal Protective Equipment Conservation Due to COVID-19 on Multidrug Resistant Organisms in a Hospital Group
Authors: Fox Josephine , Leone Carole , Gasama Heather , Grimes- Jenkins Lydia J , Satish Munigala , Wood Helen , Whalen Kenneth , Marschall Jonas , Warren David K
Published: November 2023

Background

Early in the COVID-19 pandemic many healthcare facilities experienced shortages of personal protective equipment (PPE), which required them to conserve and prioritize PPE. We wanted to determine the effect a gown conservation strategy had on nosocomial methicillin-resistant Staphylococcus aureus (MRSA), Clostridioides difficile (C.diff.) and infections with vancomycin-resistant enterococci (VRE).

Methods

Prior to the pandemic, isolation gowns were required for patients colonized or infected with multidrug-resistant organisms (MDROs) at BJC Healthcare, a 15-site hospital group with >3,000 acute care beds. In April 2020, we initiated a modified contact precautions (CP) strategy for acute care patients colonized with MDROs (identified via surveillance cultures or based on past MDRO infection). Healthcare workers were instructed to wear gloves and follow standard precautions when seeing patients on modified CP. Patients with active MDRO infection and C.diff. were excluded from modified CP. Rates of NHSN laboratory identified (LabID) MRSA bacteremia and C.diff., and nosocomial VRE from blood/urine cultures, were compared before and after the modified CP. The study period was divided into baseline CP (1/01/2019- 8/30/2019) and modified CP (1/01/2021-8/30/2021) periods.

Results

There was no difference in LabID MRSA bacteremia or LabID C.diff. rates in the baseline CP versus the modified CP period (MRSA: 0.069 baseline vs 0.062 modified CP per 1000 pt days, p=0.64, and C.diff.: 3.96 baseline vs 3.66 modified CP per 10,000 pt days, p=0.45), respectively. There was no difference in the nosocomial VRE bacteremia & bacteriuria combined rate (0.097 baseline vs 0.116 per 1000 pt days modified CP, p=0.37). There was no difference in the subsets of nosocomial VRE bacteremia (0.038 baseline vs 0.047 modified CP, p=0.51) or VRE bacteriuria (0.059 baseline vs 0.069 per 1000 pt days modified CP, p=0.54).

Conclusion

We limited gown use to cases of MRSA, VRE and C. difficile infection in a conservation effort, and no longer required it for MRSA or VRE colonization; this change was not associated with increases of MRSA or C.difficile LabID rates nor with nosocomial VRE cases. Our findings highlight the importance of monitoring and evaluating PPE conservation strategies to document their safety.

Disclosures

All Authors: No reported disclosures
1437. Successful Control of Candida auris Outbreak in a Tertiary Hospital Intensive Care Unit in Greece
Authors: Nikopoulou Anna , Skalisti Paschalia , Tselenkidou Sophia , Veleni Anastasia , Papoti Sofia , Karampatakis Theodoros , Katsifa Helen , Iasonidou Christina , Christaki Eirini , Sotiropoulos Damianos
Published: November 2023

Background

Candida auris is an emerging pathogen, which can spread efficiently and cause outbreaks in healthcare settings.The purpose of this study is to highlight the importance of strict infection control measures to prevent in-hospital C. auris transmission.

Methods

Single-center retrospective observational study in hospitalized patients at the 2nd Department of Intensive Care Medicine (ICU) of G. Papanikolaou General Hospital from 02-11-2022 until 28-02-2023. Patient outcomes and epidemiologic indices were recorded. In total 79 surveillance cultures in 18 patients (male: 75%, median age: 51 years) were performed, while 187 surface samples were collected.

Results

After C. auris isolation from the index patient, colonization screening was performed in all ICU patients. C. auris was detected in a neighboring patient, 24 hours later, and in another patient from a central venous catheter tip culture 2 months later. An environmental culture from a pulse oximeter, was also positive. Immediately, an epidemiologic investigation was conducted, and an intensive infection control program was implemented in the ICU. Measures included strict adherence to standard and contact precautions and hand hygiene, isolation of positive cases, dedicated staff to care for patients with C. auris, disposable or specialized equipment for patient care, and cleaning and disinfection of frequently touched surfaces and equipment. In addition, surveillance cultures were performed twice weekly for each patient and once weekly for the environment. Also, to control the transmission to other departments, patient transfer was limited. At the same time, ICU personnel was educated on the significance and implementation of infection control bundles. The above measures resulted in the control of transmission of Candida auris in our hospital.

Conclusion

Strengthening appropriate infection control interventions and increasing compliance to their implementation, combined with continued surveillance and healthcare worker engagement by education, can prevent the transmission of pathogens such as Candida auris in healthcare settings.

Disclosures

All Authors: No reported disclosures
2001. IDWeek Oral Abstract Coaching Pilot Program
Authors: Blyth Dana , Cutrell James B , Bonura Erin , Luther Vera , Melia Michael T
Published: November 2023

Background

Oral abstract presentations (OAP) at national meetings are high visibility opportunities. However, there has not been a formal process for coaching presenters and providing feedback at IDWeek. We led a pilot project pairing ID-trained medical educators with OA presenters for feedback prior to and at IDWeek.

Methods

A link in IDWeek 2022 OAP acceptances invited presenters to participate in the OAP coaching pilot program (CPP). The link requested demographics, availability of local mentors to provide feedback, and areas of desired feedback for the OAP. Coaches were primarily solicited from the IDSA Med Ed Community of Practice Workgroups to give feedback pre-IDWeek, attend the IDWeek OAP, and provide feedback after. An anonymous survey was sent to presenters and coaches 8 days post-IDWeek.

Results

38 presenters (median of 1 (IQR 0, 4) prior national OAP) requested to participate, despite 71% already having feedback available (table 1). Due to coaching pool limitations, presenters with no prior national OAPs and/or without local feedback were prioritized for the CPP. 22 (85%) and 18 (69%) of the 26 coaches and presenters responded to the post-IDWeek survey, respectively (table 2). Presenters and coaches largely overlapped regarding the types of feedback requested and delivered before and at IDWeek (table 3). Presenter qualitative comments highlighted the value provided in improving OAP visual display, delivery, clarity for those unfamiliar with the work, and the presenter’s confidence. Coaches described appreciation for the opportunity to practice providing feedback and feelings of pride and fulfillment in the improvements noted following the feedback. Both presenters and coaches commented on the benefit of meeting new colleagues and building networks. 94% of presenters and 91% of coaches reported professional/personal benefit from the CPP.Table 1:Characteristics of presenters requesting and selected to participate in the IDWeek Oral Abstract Coaching Pilot ProgramTable 2:Demographics of presenters and coaches in the IDWeek Oral Abstract Coaching Pilot ProgramTable 3:Results of IDWeek Oral Abstract Coaching Pilot Program evaluation survey

Conclusion

This OAP CPP was highly successful, with > 90% of presenters and coaches reporting professional/personal benefit and interest in participating again. In the future, a coach’s guide will be incorporated to increase feedback effectiveness across the desired OAP topics and to augment expansion of the pool of potential coaches. We hope coaching targeting these early career presenters can enhance engagement and recruitment into ID.

Disclosures

James B. Cutrell, MD, IDSA: stipend as Deputy Editor for Open Forum Infectious Diseases
1446. Multidrug-Resistant Acinetobacter baumannii complex Cluster Outbreak Investigation
Authors: Chandramohan Divya , Ford Delvina , Beck Erica , Carroll Theresa , O’Neil Sean , Cadena Jose
Published: November 2023

Background

Healthcare-associated infections (HAI) have tremendously increased since the coronavirus-19 pandemic. With this increase, various attempts should be made to keep multidrug-resistant organisms in check. In 2021, the Veterans Affairs in San Antonio identified a patient with a multidrug-resistant Acinetobacter baumannii complex (MDR-A). This study was undertaken to determine the temporal and spatial relationship of similarly identified MDR-A from other patients at our facility to help prevent spread. We highlight the role whole-genome sequencing plays in a nosocomial outbreak investigation.

Methods

Since the identification of the first MDR-A, we performed interventions to include closure of the unit for new admissions, terminal cleaning, and collection of nasopharyngeal, peri-rectal, urine and wound swabs for surveillance. 15 positive samples were sent from our facility to Multidrug- Resistant Organism Repository and Surveillance Network (MRSN) for genotyping.

Results

Genotyping results confirmed that there were only one to four Single Nucleotide Polymorphism (SNP) variations between three of the patient isolates indicating that these were genetically related with likely nosocomial transmission. All isolates carried an OXA-23 carbapenemase and a 16S rRNA methyltransferase which conferred resistance to all clinically relevant aminoglycosides. Overall, twelve isolates were identified from our facility with < =4 SNP variations interlinking them with prior isolates sent to MRSN. MRSN identified 2-45 SNP variations between 87 isolates from seven different hospitals in South Texas (Figure 1). Environmental sampling in our hospital revealed an Acinetobacter baumannii isolated from shower trolleys. Since the organism isolated was identical, spread was presumed secondary to the contaminated shower trolley.

MDR-A cluster indicating interrelation between various isolates from seven different facilities in South Texas.

This figure depicts four common isolates pictured in the center, which resulted in SNP variations and spread across seven facilities in South Texas. The SNP variations between isolates are noted here. Several inter-facility spread of MDR-A took place as can be seen here. Abbreviations: SNP, Single Nucleotide Polymorphisms; MDR-A, Multidrug Resistant Acinetobacter baumannii complex

Conclusion

Spread of MDR-A from our index case was linked to transmission from shower trolleys. These were disinfected, and focused disinfection of all high-touch surfaces was undertaken in addition. Further spread was successfully prevented and no other cases with MDR-A identified thereafter. This case highlights the critical steps in outbreak investigation and highlights the importance of whole-genome sequencing in this process.

Disclosures

All Authors: No reported disclosures
1464. β-lactam versus Non-β-lactam Alternatives for Colorectal Surgical Prophylaxis: Does Recommended Dosing and Timing Matter?
Authors: Collins Curtis D , Hartsfield Eric , Cleary Robert K , Brockhaus Kara K
Published: November 2023

Background

Previous studies have shown reduced surgical site infections (SSIs) with β-lactam prophylaxis compared with non-β-lactam alternatives; however, variations in timing and dosing have been reported. Few studies have investigated the impact of preoperative antibiotic timing or dosing on reported SSI differences between regimens.

Methods

A multi-center, retrospective cohort study was performed utilizing available data from elective colorectal surgeries in Michigan. Adult patients receiving surgical prophylaxis between July 2012 and June 2021 were included. Exclusions included emergent or urgent surgeries and missing follow-up and antibiotic information. The primary objective was to evaluate the incidence of SSIs between patients receiving surgical prophylaxis with β-lactam antibiotics with those who received non-β-lactam alternatives. A multivariable logistic regression model tested the association of SSIs and covariates including antibiotic dosing and timing.

Results

A total of 28,899 procedures were included. Of these, 25,875 received β-lactam prophylaxis and 3,024 received non-β-lactam alternatives. Patients in the β-lactam cohort received higher recommended dosing (83.7% vs. 54.2%; p < 0.001), timing (93.6% vs. 83.9%; p < 0.001), combined recommended dose and timing (78.7% vs. 38.1%; p < 0.001), and had a lower unadjusted incidence of SSIs (6.7% vs 8.9%, p < 0.001). Multivariable logistic regression showed β-lactam prophylaxis was associated with a reduction in SSIs (adjusted odds ratio (aOR) 0.79; 95% CI 0.64 to 0.98; p =0.033) (Table 1). Recommended dosing (aOR 1.09; 95% CI 0.91 to 1.32; p = 0.359) and timing (aOR 1.07; 95% CI 0.83 to 1.39; p = 0.601) were not associated with any change in SSIs. Older age clean/contaminated procedures, and colectomies were associated with a decreased SSI risk. Higher body mass index, corticosteroid use, contaminated and dirty procedures, ASA scores 3-5, and open procedures were associated with an increased risk.

Conclusion

The use of β-lactams for surgical prophylaxis in elective colorectal surgery procedures was associated with decreased SSIs. Significant differences in compliance with recommended prophylaxis dosing and timing between cohorts was not associated with changes in SSIs.

Disclosures

Robert K. Cleary, MD, FASCRS, FACS, Intuitive Surgical Inc: Honoraria
1472. Development of an Interactive Provider Dashboard for Enhanced Recovery After Surgery to Monitor Compliance with Perioperative Surgical Site Infection Measures
Authors: Patel Pratish C , Raymond Britany L , Cherry Brandi , Jayaram Jennifer , McEvoy Matthew D
Published: November 2023

Background

Enhanced Recovery After Surgery (ERAS) protocols are patient-centered, evidence-based pathways aimed at improving patient outcomes through multidisciplinary interventions in the perioperative period. Among other outcomes, these bundled protocols have been associated with improvement in postoperative immune function, decrease in perioperative inflammatory markers, and a reduction in surgical site infections and hospital readmission.

Methods

ERAS for colorectal surgery was launched at Vanderbilt University Medical Center in 2014. A working group of surgeons, anesthesiologists, infection preventionists, pharmacists, nurses, data analysts, and other staff reviewed the literature to provide evidence and guideline-based recommendations regarding various elements of perioperative care. Following a successful trial period, ERAS principles were sequentially introduced to multiple other surgical services.

Results

To track compliance to protocols and outcome variables associated with ERAS components, we required a method that would allow us to analyze data in real time, as well as customize the reports to align with specific goals of different surgical services. An adaptable data visualization dashboard was developed in Tableau® to meet this need. ERAS components were listed by phase of care and defined by the data source and specific data element. Surgical services could customize their dashboard by selecting data elements to review for informational use only or to include within a scoring system to track performance. An aggregate ERAS protocol view displayed mutual components of at least three service lines to suggest areas for improvement, as well as those of the highest compliance. Monthly and annual compliance trends assist in assessing each metric over time.

ERAS Metric Definitions and Scoring Grid

Aggregate ERAS Protocol Opportunities and Wins Summary

Monthly Compliance by Phase of Care and ERAS Component

Conclusion

The ERAS component dashboard allowed service line leaders and perioperative administrators to view various key performance indicators such as appropriate perioperative antimicrobial prophylaxis, avoidance of intraoperative hyperglycemia, and preoperative skin disinfection. The data from this dashboard seeks to standardize perioperative care, improve patient recovery, and reduce hospital readmission.

Disclosures

Pratish C. Patel, PharmD, BCIDP, AAHIVP, VBI Vaccines: Stocks/Bonds
1475. A Retrospective Study Analyzing Recurrent LVAD Driveline Infections
Authors: Tin Kathy , Malik Muhammad K , Santarossa Maressa , Yu Mingxi , Liebo Max , Clark Nina M , Reid Gail
Published: November 2023

Background

Left ventricular assist devices (LVADs) are an advanced form of heart failure therapy for patients who failed conventional medical therapy. LVAD patients are at increased risk for developing infections due to the presence of foreign hardware. Infection of the LVAD driveline (DL), the connection between the electrical cable and air vent to an external site, is the most common type of LVAD infection. Due to limited data available, this study sought to investigate outcomes of recurrent LVAD driveline infections (DLI).

Methods

This was a retrospective chart review study at Loyola University Medical Center of patients with LVAD driveline infections over 14 years. The primary outcome was days to recurrent DLI. Recurrent DLI was defined as any antibiotic alteration due to infection by a new organism, relapse with the same organism, and/or clinical signs or symptoms of worsening infection. Secondary endpoints included recurrent infection after surgical management, abscess development, and post-heart transplant (HT) infection.

Results

35 of 49 patients (71.4%) developed a recurrent DLI with a mean of 173 days (range 14-820 days) to recurrent infection. The most common organisms were methicillin sensitive Staphylococcus aureus, Pseudomonas aeruginosa, coagulase negative Staphylococcus, and Corynebacterium species. 4 patients with recurrent DLI developed local abscesses. 7 patients with recurrent DLI (20.0%) underwent DL debridement and/or revision, and 4 of these patients (57.1%) developed recurrent DLI afterward. 1 of the remaining 3 patients underwent HT 198 days after the DL procedure. 10 of the 35 patients with recurrent DLI underwent HT and 4 developed infections within 90 days of transplant; 2 were due to the same organism that caused the DLI. One of these had a retained portion of the DL and the other had a retained ICD lead. There were also 2 sternal wound infections of unknown cause.

Conclusion

Most patients with DLI developed recurrent infection. Additionally, DL debridement/revision was not successful in curing infection in most patients. In some cases, recurrent DLI may have been due to antibiotic non-adherence. Other than patients with retained device components, those who underwent a heart transplant did not have infections 90 days post-transplant caused by the DLI organism.

Disclosures

Kathy Tin, D.O., Merck: Stocks/Bonds|Novavax: Stocks/Bonds|Pfizer: Stocks/Bonds
1484. Hepatitis C Virus Infection and Cure by Priority Population Among New York City Ryan White HIV/AIDS Program Part A Clients
Authors: Cheek Jelani , Avoundjian Tigran , McPherson Tristan D , Irvine Mary
Published: November 2023

Background

Hepatitis C virus (HCV) infection is a common comorbidity among people with HIV (PWH). HCV-related liver disease is the second leading cause of death among PWH. To identify opportunities to improve service integration and health equity, we examined HCV infection and cure among priority populations identified for New York City (NYC) Ryan White HIV/AIDS Program Part A (RWPA) service delivery.

Methods

Using a merge of NYC HIV and HCV surveillance data with RWPA program data, we identified RWPA clients receiving services from 01/2019–12/2022. We categorized clients into priority populations: Black or Latina cisgender women; Black or Latino men who have sex with men (MSM); transgender, intersex, gender non-conforming, or non-binary (TIGNCNB) people; people who inject drugs (PWID); and people aging (age >50) with HIV (PAWH). We measured active HCV infections (any positive RNA test during analysis period), and HCV cure­ (negative RNA result on the most recent HCV test >12 weeks after most recent positive RNA result obtained during the analysis period). Using logistic regression, we compared HCV prevalence and HCV cure by population, adjusting for potential confounders.

Results

Among 15,702 RWPA clients, 15% (n=2,278) had active HCV infection, with 70% (n=1,596) achieving cure. 53% of clients were PAWH, 36% were Black/Latino MSM, 26% were Black/Latina cisgender women, 5% were TIGNCNB people, and 2% were PWID. PWID had the highest proportion of HCV infection (38%), and PAWH had the highest cure proportion (73%) (Table 1). After adjusting for potential confounders, PWID and PAWH had higher odds of HCV infection compared to other clients [adjusted odds ratio (aOR): 4.37, 95% CI: 3.41, 5.59 for PWID; aOR: 4.05, 95% CI: 3.61, 4.54 for PAWH]. Black/Latino MSM and Black/Latina cisgender women had lower odds of infection (aOR: 0.79, 95% CI: 0.71, 0.88 and aOR: 0.60, 95% CI: 0.53, 0.68, respectively) compared to other clients. Among clients with HCV, PWID had lower odds of cure compared to non-PWID (aOR: 0.58, 95% CI: 0.39, 0.85; Table 2).

Table 1, Part 1

Table 1, Part 2

Conclusion

These findings – particularly the low odds of HCV cure among PWID, who had the highest odds of infection – highlight gaps that can inform resource allocation and targeted integration of HIV/HCV care.

Disclosures

All Authors: No reported disclosures
1489. CD4+ T Cell Count and Associated Mortality in PLWHIV and Cancer at an Oncologic Center in Mexico over a 10-year Period.
Authors: Olmedo-Reneaum Alejandro , VOLKOW-FERNÁNDEZ P A T R I C I A , MARTÍNEZ-RIVERA N A N C Y , MENDOZA-PALACIOS M A R ÍA J O S É , ISLAS-MUÑOZ B E D A
Published: November 2023

Background

PLWHIV and cancer have an increased risk of mortality. Previous studies show that a 100 cells/mm3 drop in CD4+ T cells following chemotherapy increases the risk of mortality by up to 30%. In Mexico almost 40% of patients have a late diagnosis. The aim of this study is to measure the mortality association between the CD4+ T cell count nadir in PLWHIV and cancer.

Methods

We conducted a retrospective study involving PLWHIV and cancer ≥18 yo treated at the cancer and AIDS clinic of the Instituto Nacional de Cancerología in México City from January 01, 2005, to December 31, 2015, that received chemotherapy, immunotherapy, radiotherapy and/or oncologic surgery. The baseline CD4+ T cell count, nadir during treatment, first CD4+ T cell count after treatment, one year and five years after the end of oncologic treatment were evaluated. A logistic regression (LR) model was performed considering CD4+ T cell count at baseline, nadir during oncologic treatment and the association with all-cause mortality. Institutional Review Board (IRB) of INCan approved the study (Ref/INCAN/CI/0049/2022).

Results

A total of 445 patients were included, median of nadir CD4+ T cell count was 122 cells/µL (IQR 48-232), 147 (32.89%) had baseline CD4+ T cell ≤100 cells/µL. Kaposi Sarcoma (46%) and non-Hodgkin lymphoma (27%) were the most frequent diagnosis. One-year mortality occurred in 72 patients (16%), from them, the cause of death was cancer in 54 (75%). Descriptive analysis by mean difference showed significant difference in CD4+ T cell count between patients who died vs. those who survived 117.7 vs 175.4 (p=0.01). In the LR model, a significant association was found between stage IV of cancer and higher mortality at 1 year (OR 2.39; CI 1.27- 4.52) and at 5 years (OR 2.21; CI 1.21-4.02). At five years, mortality was higher in patients with a second AIDS defining event (OR 2.17; CI 1.12-4.17). At one year after completed cancer treatment having a CD4+ T cell nadir >200 cells/ µL was associated with lower mortality (OR 0.29; CI 0.08 – 0.92).

Conclusion

This study found that having other AIDS defining events and advanced neoplastic disease was associated with higher mortality; while having a nadir ≥200 cd4+ cells/ml showed lower mortality after one year of treatment.

Disclosures

All Authors: No reported disclosures
1492. Gender-Specific Targets for Primary Prevention in People Living with HIV : Applying Life's Simple 7 to a Gender-Stratified Population of ART-Naive People Living with HIV in Tanzania
Authors: Khan Safah , Manyangu Gloria J , Peck Robert N
Published: November 2023

Background

Cardiovascular disease (CVD) represents a major cause of premature mortality in people living with HIV (PLWH). However, morbidity is not equal between males and females. There is a need to better understand how gender influences cardiovascular health (CVH) in PLWH in order to identify targets for intervention. Therefore, we applied the Life's Simple Seven (LS7) scale to a gender-stratified cohort of ART-Naive PLWH and HIV-uninfected controls in adults.

Methods

A cross-sectional analysis was conducted on a cohort of ART-naive PLWH and HIV-uninfected adults recruited from HIV clinics between June 2016 and August 2019 in Mwanza, Tanzania (HIV&HTN cohort). We applied modified Life's Simple Seven (LS7) definitions (Table 1) and compared the distribution of Ideal LS7 metrics between males and females of both study groups. Each LS7 metric was categorized as ideal (2 points), intermediate (1 point) and poor (0 point) and ordinal regressions were employed to investigate associations between gender and each individual LS7 metric. Regressions were adjusted for HIV status, age, income, education level.

Results

Our study included 997 participants, with 493 PLWH (68.7% female) and 504 HIV-uninfected (66.4% female). As displayed in Figure 1, the distribution of Ideal LS7 metrics differed between the males and females in both study groups. Males had a higher prevalence of ideal physical activity (aOR=4.12 [95%CI=3.11 to 5.44], p< 0.001) and ideal BMI (aOR=5.10 [3.47 to 7.49], p< 0.001) but lower prevalence of ideal smoking (aOR=0.037 [0.021 to 0.065], p< 0.001) and ideal blood pressure (aOR= 0.65 [0.50 to 0.85], p=0.002). The magnitude of these differences also varied by HIV status such that they were larger in PLWH than HIV-uninfected group for smoking (41.3% vs 26.4%), physical activity (41.6% vs 24.8%) and blood pressure (12.7% vs 9.2%) metrics. By contrast, these differences were less pronounced in PLWH vs HIV-uninfected group for the BMI metric (23.1% vs 29.7%).

Figure 1: Distribution of Ideal Life's Simple 7 metrics, stratified by gender for both PLWH and HIV-uninfected controls

Conclusion

Cardiovascular health profiles vary by gender and HIV status, with stark differences between male and female PLWH for most metrics. Gender-specific interventions targeting smoking cessation, blood pressure control in male PLWH and physical activity, weight loss in female PLWH are warranted to mitigate CVD risk.

Disclosures

All Authors: No reported disclosures
1498. Geographic differences in weight change on dolutegravir: a prospective cohort study
Authors: Chen Geoffrey , Migisha Richard , Muyindike Winnie R , Aung Taing N , Nanfuka Victoria , Komukama Nimusiima , Chandiwana Nomathemba , Shazi Gugulethu , Moosa Mahomed-Yunus S , Gupta Ravindra K , Pillay Deenan , Marconi Vincent , Hedt-Gauthier Bethany , Francois Venter W D , Siedner Mark J , McCluskey Suzanne M , Manne-Goehler Jennifer
Published: November 2023

Background

People with HIV (PWH) on integrase inhibitors may be at increased risk of excess weight gain, but it is unclear if this risk is consistent across settings. Our study objective was to compare weight change over 48 weeks among PWH in Uganda and South Africa.Figure 1.Mean weight change (kg) over 48 weeks among DISCO participants overall (A), among men (B), and among women (C).

Methods

The Population Effectiveness of Dolutegravir Implementation in Sub-Saharan Africa (DISCO) study is a prospective observational cohort of PWH in routine clinical care at public-sector HIV clinics in Uganda and South Africa. Inclusion criteria were as follows: PWH >18 years old, on NNRTI-based first-line ART for >6 months, and switched to tenofovir disoproxil fumarate, lamivudine, and dolutegravir) by clinic staff. We measured the primary outcomes of weight (in kilograms [kg]) and waist circumference (WC, in centimeters [cm]) at enrollment, 24 weeks, and 48 weeks after switch. The primary outcomes were (1) weight change (kg) and (2) change in WC (cm). We used a linear mixed-effect regression model, adjusted for age, sex, education, duration on ART, and the interaction of study site and visit, to estimate weight.

Results

428 individuals in Uganda and 387 in South Africa had data available. The mean weight change over 48 weeks was 0.6 kg [95% CI: 0.1-1.0] in Uganda compared to 2.9 kg [2.4-3.4] in South Africa (p< 0.001); men had significantly smaller mean weight changes than women did in both countries (Figure 1). After adjustment, PWH in South Africa gained significantly more weight than those in Uganda. In participants with available waist data (277 in Uganda and 402 in South Africa), the mean change in WC was significantly greater among those in South Africa (2.3 cm [1.4-3.2]) than those in Uganda (0.8 cm [0.0-1.5]) (p< 0.017).

Conclusion

PWH in South Africa experienced greater weight gain than in Uganda, suggesting substantial heterogeneity in this risk across settings. Strategies to address obesity risk in PWH should account for regionality.

Disclosures

W D Francois Venter, MD, FCP, PhD, Gilead Sciences: Grant/Research Support|South African Medical Research Council: Grant/Research Support|Unitaid: Grant/Research Support|USAID: Grant/Research Support|ViiV Healthcare: Grant/Research Support Mark J Siedner, MD, MPH, Viiv Healthcare: Grant/Research Support
1499. Tesamorelin Reduces Visceral Adipose Tissue and Liver Fat in INSTI-Treated Persons with HIV
Authors: McLaughlin Taryn , Grinspoon Steven K , Stanley Takara , Fourman Lindsay
Published: November 2023

Background

Significant attention surrounds the recent observation of weight gain in persons with HIV (PWH) initiating integrase inhibitors (INSTIs). Given the finding that visceral adipose tissue (VAT) is a critical component of this weight gain, the clinical implications of this weight gain are a growing concern, since VAT has been associated with downstream comorbidities including non-alcoholic fatty liver disease (NAFLD). Tesamorelin, a growth hormone releasing hormone analogue, has been shown to reduce VAT by over 15% in 6 months in PWH with lipohypertrophy. Therefore, we sought to investigate if tesamorelin could reduce VAT and liver fat in PWH on INSTI-containing regimens.

Methods

To do this, we leveraged data from a previous placebo-controlled trial of 61 participants with HIV-associated NAFLD. Measurements of body composition and hepatic fat fraction (HFF) were taken at baseline and after 12 months of treatment. Post-hoc analyses were performed to evaluate changes in body composition amongst individuals receiving INSTIs.

Results

Amongst participants, 39 (64%) were on INSTI containing regimens, the most common of which was dolutegravir (41%). These individuals were largely similar at baseline to those on regimens without INSTIs. Interestingly, although anthropometric measurements at baseline did not differ between the two groups, at 12 months, there were marked changes in VAT amongst the INSTI group. After 12 months, there was a significant difference in VAT change between the placebo and tesamorelin treated groups (p=0.0034). The placebo group had an increase in VAT of 10.8% whereas the Tesamorelin treated group had an overall reduction in VAT of 8.3%. Furthermore, the tesamorelin treated group saw a 31% relative reduction in HFF compared to baseline (p=0.006) which was significantly higher than in the placebo treated group (T:-4.9%, P:-0.1% absolute change p=0.015).

Conclusion

These data reinforce the impact of INSTIs on VAT, body composition, and concomitant organs in PWH. It also demonstrates the potential for tesamorelin as a strategy to reduce VAT and HFF amongst individuals with INSTI-associated VAT accumulation.

Disclosures

Taryn McLaughlin, PhD, Theratechnologies, Inc: Employee Steven K. Grinspoon, MD, Theratechnologies: Grant/Research Support Takara Stanley, MD, Pfizer, Inc: Grant/Research Support Lindsay Fourman, MD, Amryt Pharmaceuticals: Advisor/Consultant|Amryt Pharmaceuticals: Grant/Research Support
1507. The Yield and Correlates of Mandated Annual Screening for Chlamydia Trachomatis and Neisseria Gonorrhea in People Living With HIV in a Large Federally-Funded Clinical Cohort
Authors: Suryadevara Madhu , Bishburg Eliahu , Hogan Dennis
Published: November 2023

Background

Gonorrhea (GC) and Chlamydia (CT) screening is part of the requirement for grantees of the Ryan White funding of HIV clinics. Tests are required to be done at least once yearly. Testing is required to all patients regardless of age or sexual activity.

Our aim was to assess the yield of GC/CT screening in patients living with HIV (PLWH) in an inner-city HIV clinic.

Methods

Retrospective Chart Review over a 10-year period (2013-2023). Data was collected for demographics, sexual history, HIV Viral Load (VL), CD4 count, syphilis serology, GC/CT urine probe results using nucleic acid amplification testing (Amplicor PCR and Aptima TMA), treatment when infection was diagnosed and outcome.

Results

1120 unique patients were identified, a total of 5050 GC/CT tests were analyzed. Median age of GC/CT (-) pts. was 53.6 yrs. with a range of 21-90 yrs. Positive GC/CT tests was found in 43 pts of whom 28/43 (65%) males, 42/43 (97.6%) were African American. These 43 patients had 56 tests with a positivity rate of 56/5050 (0.01%). Median age of GC/CT (+) pts. was 33.7 yrs. Age range of positive pts. was 21-65 yrs. GC (+) only tests in 13/56 (23%), CT (+) only tests in 43/56 (76.7%). Both GC (+) and CT (+) co-infection in 3/43 (6.9%). Positive syphilis serology concomitant with GC/ CT(+) in 5/43 (11.6%). In the GC/CT (+) group, median VL 43.5 copies/mL and median CD4 534.5 cells µL. 30/43 pts. had undetectable VL. All GC+/CT+ pts. were successfully treated with post treatment negative test documented in all but 1 non adherent patient. All patients were sexually active. 7/43 with prior Sexually Transmitted Disease (STD).

Conclusion

Yield of screening for GC/CT in our clinic was very low. Younger patients had higher positivity rates compared to the elderly. Routine screening for these infections should be targeted at younger patient who are sexually active and/or symptomatic.

Disclosures

All Authors: No reported disclosures
1508. The effects of the COVID-19 pandemic on depression severity and viral load non-suppression among people with HIV accessing care in an urban infectious disease clinic in Baltimore, MD
Authors: Verinumbe Tarfa , Lesko Catherine , Moore Richard , Fojo Anthony , Keruly Jeanne , Snow LaQuita N , Pytell Jarratt , Falade-Nwulia Oluwaseun
Published: November 2023

Background

The COVID-19 pandemic heightened concerns about people experiencing more depressive symptoms. Among people with HIV (PWH), who have higher rates of depression, these symptoms may lead to adverse HIV-related outcomes. This study sought to characterize the effects of the COVID-19 pandemic on depression severity and to investigate the association between depression trajectories and viral load (VL) non-suppression among PWH enrolled in HIV care.

Methods

The study sample was PWH in the Johns Hopkins HIV Clinical Cohort who reported depression symptoms on the Patient Health Questionnaire 8 (PHQ-8) via a self-administered survey pre-pandemic (Mar. 1, 2018 - Feb. 28, 2020) and during the COVID-era (Sept. 1, 2020 - Feb. 28, 2022). Depression severity was categorized using standard PHQ-8 cutoffs ranging from normal (0-4) to severe (20-24). Depression severity categories pre-pandemic (last survey) and COVID-era (earliest survey) were compared, and trajectories were classified as: 1) remained depressed (PHQ-8 > 4 and no change in severity category) or worsened (change to a higher severity category) and 2) remained non-depressed (PHQ-8 ≤ 4 and no change in severity category) or improved (change to a lower severity category). The association between depression trajectories and VL non-suppression (HIV RNA > 200 copies/ml on the first measurement after a COVID-era survey) was assessed using logistic regression adjusting for age, gender, pre-pandemic VL, clinical diagnosis of mood and substance use disorders.

Results

Among 793 PWH in this study, 60% were male, 88% were Black and the mean age was 56 years. Approximately 24% of PWH remained depressed (9%) or worsened (15%), while 76% remained non-depressed (60%) or improved (16%). PWH who remained depressed or worsened were more likely to be virally unsuppressed (adjusted odds ratio:2.45, 95% confidence interval: 1.19 – 5.06) compared to those who remained non-depressed or improved.

Conclusion

In our cohort of PWH, a quarter either remained consistently depressed or experienced worsening depression in the COVID-era. Depression was significantly associated with VL non-suppression during the pandemic. Our findings suggest that strategies to monitor and address depression symptoms among PWH may contribute to reduced risk of VL non-suppression.

Disclosures

Oluwaseun Falade-Nwulia, MBBS ,MPH, Abbvie Inc: Grant/Research Support|Gilead Sciences: Advisor/Consultant
1517. Sexual Network Characteristics of MSM with Detectable Viremia Living with HIV in Lima, Peru
Authors: Harris Carlyn L , Segura Eddy , Gutierrez Jessica , Lake Jordan , Blair Cherie , Clark Jesse
Published: November 2023

Background

In Lima, Peru, the HIV epidemic is concentrated among men who have sex with men (MSM) and transgender women (TW). Few data exist on the sexual network characteristics of MSM with detectable HIV-1 viremia, yet these networks have important implications to control transmission. We report data on frequency of sero-discordant, condomless anal intercourse (CAI) among MSM in Lima with detectable viremia.

Methods

This cross-sectional secondary analysis includes MSM screened for a STI trial in Lima, Peru between June 2022 and January 2023. Participants completed questionnaires on demographics, sexual identity and role, and sexual network characteristics. Participants were screened for HIV infection and those who tested positive were included and HIV-1 RNA was measured. Descriptive and comparative statistics are reported for those with detectable and undetectable viremia.

Results

665 MSM with HIV were included. 153 (23%) had detectable ( >200 copies/mL) viremia. Among those with detectable viremia, the median (IQR) age was 29 (25, 35) years. 70% identified as homosexual and 57% identified their sexual role during intercourse as “moderno” or “versatil”. The median (IQR) number of sexual partners in the last 3 months was 15 (5,20). 55/153 (35.6%) of the detectable group were aware of their HIV diagnosis, 33/55 (60%) reported being on anti-retroviral therapy (ART) and 15/32 (47%) believed they were virally suppressed. Among all participants living with HIV, 499/662 (75%) were aware of their HIV status, 469/499 (94%) reported to be on ART and 436/469 (93%) were virally suppressed. 147/153 (96%) of men with detectable viremia reported sero-discordant CAI with at least one of their last three sexual partners, and 106/144 (74%) reported this with all three of their last partners. In the undetectable group, 302/489 (62%) reported sero-discordant CAI with all three of their last partners (p < 0.01).

Conclusion

In this sample of MSM living with HIV in Lima, Peru, almost all men with detectable HIV-1 viremia reported sero-discordant CAI, more often than those with undetectable viremia. The primary gap in the HIV care cascade was participant awareness of their HIV status, suggesting that broader HIV testing and improved access to resources for secondary HIV prevention are key objectives in Peru.

Disclosures

Jordan Lake, MD, Gilead Sciences: Grant/Research Support|Theratechnologies: Advisor/Consultant
1519. Prevalence and factors associated with HIV testing among sexually experienced high school students in the U.S.A.
Authors: Kangogo Geoffrey K
Published: November 2023

Background

HIV testing is a critical strategy for the prevention of HIV/AIDS yet testing among sexually experienced adolescents remains low. This study examined the prevalence of HIV testing and its influential factors among high school students in the USA.

Methods

We analyzed cross-sectional data from the 2019 National Youth Risk Behavior Survey. Analysis was limited to 3123 complete cases of sexually experienced high school students as measured by ever having sex. Chi-square and binary logistic regression analyses involved three models comprising predisposing, enabling and need factors were conducted to study lifetime HIV testing.

Results

The prevalence of lifetime HIV testing was 18.8% with females getting tested more than males. Female gender (OR:1.55; p< 0.001), being Black (OR:1.42; p=0.008), and sexual debut below 13 years (OR:1.67; p=0.013) were positively associated with lifetime HIV testing. Further, we observed that having multiple sexual partners (OR:3.09; p< 0.001) and mild physical activity (OR:1.28; p=0.025) were significantly associated with HIV testing. Lastly, we noted that Hispanics/Latinos (OR:0.67; p=0.025) and those using condoms (OR:0.77; p=0.015) were less likely to have reported ever having an HIV test.

Conclusion

Our study revealed that HIV testing among sexually experienced high school students remains low and sexual risk behaviors that impede testing among students need to be addressed to effectively scale up testing for this vulnerable population. The implication of this study to the relevant stakeholders responsible for creating a healthier nation is to strengthen the current efforts targeting sexually experienced high school students to encourage HIV tests and linkage to care.

Disclosures

All Authors: No reported disclosures