bluuebunny/crossref_metadata_2025 huggingface dataset:
P-365. Outbreak of Carbapenemase-Producing Organisms in the Cardiovascular ICU Linked to "Hoppers"
Authors: Fersovich Jordana H , Buchanan-Chell Maureen , Smith Stephanie W
Published: January 2025

Background

Between June and October 2023, a Canadian cardiac centre recognized a growing number of carbapenemase producing organisms (CPO) in patients in the cardiovascular intensive care unit (CVICU). The organisms were mainly KPC-producing Enterobacterales. Following declaration of an outbreak in the CVICU at the Mazankowski Heart Institute, we investigated the sources of CPO across the unit and in patient rooms to determine environmental reservoirs and mechanisms of patient transmission.

Methods

We employed prevalence screening to identify cases, environmental sampling to identify source, and comparison of patient strains utilizing whole genome sequencing (WGS) during the investigation.

Results

Between June and October 2023, five patients were identified as being colonized or infected with CPO-KPC. WGS of patient samples confirmed clonality with less than 10 SNV differences in the plasmid . Environmental sampling revealed drains in the hand-hygiene sinks and medical sinks used for disposal of liquid clinical waste (“hoppers”) harboured CPO. Using GlowGermTM, we found that the faucets of the hoppers resulted in a ∼30cm splash zone causing contamination of medical supplies and health care workers. GlowGermTM did not reveal splash from drains of hand hygiene sinks. Because the hoppers were the only temperature controlled water source on the unit, the majority of faucet use was to collect warm water for bathing patients. As a solution, the unit was equipped with single-use packages of chlorhexidine wipes in warmers for patient bathing. To prevent accidental use of the hoppers, the faucet handles were removed. Since implementing these changes, prevalence screening has not identified any further cases of CPO carriage or infection over 5 months.

Conclusion

A CPO-KPC outbreak in CVICU was linked to splashback from faucets of hoppers primarily used to collect warm water for sponge-bathing. The outbreak was ended by cessation of faucet use and transition to chlorhexidine wipes for patient bathing.

Disclosures

All Authors: No reported disclosures
P-367. Containment of an Outbreak of Carbapenem-Resistant Acinetobacter baumanii in a Burn Intensive Care Unit
Authors: Kannangara Saman , Grossman Richard F , Sharp Cheryl , lejano-Shao Marice , Lee Pureum , Jiang Isabel , Gotico Erwin R
Published: January 2025

Background

Acinetobacter baumanii is a cause of serious infections in hospital settings. Carbapenem-resistant Acinetobacter baumanii (CRAB) is especially difficult to treat. Patients in a burn unit are particularly vulnerable to colonization and infection with few reports describing CRAB outbreaks in a burn intensive care unit and measures required for containment. This study highlights the infection control measures successful in controlling an outbreak.

Methods

After detection of a patient with CRAB in an urban burn unit in January 2023, all patients in the burn unit were screened for carbapenem resistant organisms. Six patients with CRAB were identified between January 2023 and May 2023. Whole genomic sequencing was used for confirmation of clonal relatedness. All patients with a positive CRAB culture of sterile or non-sterile sites are included in this retrospective study.

Results

Six patients ages 29-53 tested positive for CRAB between January 2023 and May 2023. Case 1 was admitted from a long term acute care facility, with sputum culture positive for CRAB. One had CRAB from a blood culture, and four in wound cultures. Longer length of stay, 80 days vs 13 days was seen with CRAB positive patients because of partial skin graft failure, slower to heal wounds, and barriers to placement. After judicious use of antibiotics, following infection control practices were implemented:

1. Screening for carbapenem resistant organisms (CPOs) on admission, weekly, and on discharge.

2. Fluorescent markers added to adenosine triphosphate (ATP) testing of environmental surfaces and equipment.

3. Double terminal cleaning of rooms with CRAB.

4. A cleaning process for every piece of equipment.

5. Hand hygiene education and proper use of personal protective equipment.

With the above measures, no cases of CRAB were seen after May 2023.

Conclusion

The CRAB outbreak was associated with patients with burn wounds, antibiotic use, similarities in age and demographics, slower wound healing, partial skin graft loss, and longer length of stay. The control measures listed were successful in controlling the outbreak.

Disclosures

All Authors: No reported disclosures
P-387. Exploring the Association Between Penicillin Allergy Labels (PAL), β-Lactam Utilization and Surgical Site Infections
Authors: Boger Michael S , Davidson Lisa , Neelakanta Anupama , Jaffa Rupal K , Passaretti Catherine
Published: January 2025

Background

Several studies have reported higher surgical site infection (SSI) risk in patients with a penicillin allergy label (PAL). We explore the association between PAL, receipt of β Lactam Antibiotics and SSI in patients undergoing hip and knee arthroplasty.Figure 1: SSI per 100 Hip and Knee Arthroplasty Patients with and without a Penicillin Allergy Label (PAL) Stratified by Receipt of Preoperative β-Lactam Antibiotic

Methods

We performed a retrospective cohort study of hip (HPRO) and knee arthroplasty (KPRO) patients who underwent procedures in a large health system between August 1, 2022 and December 31, 2023 after implementation of a penicillin allergy risk assessment tool in the electronic health record. We compared demographic, clinical, procedural and SSI outcome data in patients with and without a PAL. Univariate and multivariable logistic regression were performed to assess for factors associated with risk of SSI.Table 1:Demographic and Clinical Characteristics of Hip and Knee Arthroplasty Patients with and without a Penicillin Allergy Label

Results

Of 9,802 patients who underwent 11,019 HPRO and KPRO procedures, 1851 (19%) reported a penicillin allergy and 102 (1.0%) had one or more SSI. PAL was more common in patients who were older, white, female, lived in areas with socioeconomic status Social Vulnerability Index (SVI) < 75th percentile and who had a higher American Society of Anesthesiologists (ASA) risk score. PAL patients were less likely to receive nasal iodine in the preoperative area. (Table 1) 77% of PAL patients received a preoperative β-lactam for prophylaxis with no reported adverse events. Patients with a PAL were 1.6 times more likely to have a SSI than those without a PAL. The trend toward higher risk of SSI in patients with PAL persisted regardless of whether the patient received preoperative β-lactam antibiotics (Figure 1). In the univariate analysis, day of surgery nasal iodine in the preoperative area and undergoing an outpatient procedure were protective whereas having a HPRO, revision, longer procedure, and higher ASA score were associated with higher odds of SSI. After adjustment for patient age, procedure type, revision, procedure duration, ASA score, outpatient procedure, receipt of a preoperative β-lactam antibiotic and receipt of nasal iodine in the preoperative area, PAL remained associated with 1.6 times higher odds of SSI (p=0.05).Table 2:Comparative Analysis of Unadjusted and Adjusted Odds Ratios for Hip and Knee Arthroplasty Surgical Site Infection

Conclusion

The increased risk of SSI in patients with PAL may not be fully explained by the lack of preoperative β-lactam antibiotic. More study is needed to assess further.

Disclosures

All Authors: No reported disclosures
P-410. Gastrointestinal multi-drug resistant bacterial tango in Singapore General Hospital
Authors: Venkatachalam Indumathi , Aung May Kyawt , Foo Mabel Z Q , Yang Yong , Lai Deborah C M , Ying Sim Jean Xiang , Ling Moi Lin
Published: January 2025

Background

The gastrointestinal tract (GIT) is an ideal reservoir of antibiotic resistance genes where, under antibiotic pressure, multidrug resistant organisms (MDROs) express and disseminate resistance genes via horizontal gene transfer. Control of GIT-MDROs such as vancomycin resistant Enterococci (VRE) and carbapenemase producing Enterobacterales (CPE) within healthcare-settings remains challenging.

VRE Epidemiology

Methods

In Singapore General Hospital (SGH), a 2000-bed tertiary healthcare institution, vertical infection prevention programs have been implemented for VRE and CPE control. Selected high risk patients undergo rectal swabs or stool sampling for VRE and CPE genes. Positive samples taken less than three days after admission are considered community onset (CO),others are hospital onset (HO). Data between January 2022 and March 2024 were reviewed.

CPE Epidemiology

Results

Burden of VRE total (surveillance and clinical) increased from a baseline of 40 cases per month (10 per 10,000 patient-days) to 200 per month (45 per 10,000 patient-days) after December 2022 when VRE surveillance was expanded (Figure 1a). CO-VRE total remained elevated but HO-VRE total reduced to a baseline of 20 per 10,000 patient-days after August 2023 (Figure 1b). Clinical VRE incidence was stable at 5 per 10,000 patient-days (Figure 1c). Median days to clinical VRE was 14 (1-250 days), 425 of 671 (63%) VRE clinical isolates were from urine. VRE acquisition was 30-35%.

Burden of CPE total (surveillance and clinical) has been stable at 120 cases per month with 57% being Klebsiella pneumoniae carbapenemase (KPC) type CPE (Figure 2a). Incident KPC total has been 90 per month (18 per 10,000 patient-days) (Figure 2b). CO-KPC total incidence increased from 4 per 10,000 patient-days in 2022 to 8 per 10,000 patient-days in 2023/2024 whilst HO KPC total remained stable (Figure 2c). Clinical KPC incidence was stable at 2 per 10,000 patient-days (Figure 2d). Median days to positive clinical KPC was 11 (1-204 days). 162 of 300 (54%) KPC clinical isolates were from urine. KPC acquisition was 30-40%.

Conclusion

Trend of the total burden of VRE and KPC, corresponds to active surveillance strategy butI clinical incidence has been stable over the 27-months. VRE and KPC acquisition remains high at 30-40%.

Disclosures

Moi Lin Ling, FRCPA, Solventum: Honoraria|Solventum: Educational grant for APSIC projects
P-411. Activity of Omadacycline Against 35,000 Bacterial Clinical Isolates and Resistant Organism Subsets from Patients in the United States (2019–2023)
Authors: Huband Michael D , Fedler Kelley A , Wright Kelly , Mendes Rodrigo E , Castanheira Mariana
Published: January 2025

Background

Omadacycline (OMC) is a tetracycline class (aminomethylcycline) antibacterial with potent activity against bacterial isolates expressing common mechanisms of resistance to tetracyclines, penicillins, fluoroquinolones, macrolides, β-lactams, and vancomycin. This study determined the in vitro activity and susceptibility of OMC against 35,000 bacterial isolates collected during the 2019-2023 OMC post-marketing surveillance program.

Methods

Bacterial isolates were recovered from patients (multiple infection types) in medical centers in the USA from 2019–2023. Species identification was confirmed by MALDI-TOF MS. MIC testing was conducted according to CLSI M07 (2023) and M100 (2024) guidelines. OMC MIC results were interpreted using FDA breakpoint criteria.

Results

Gram-positive isolates demonstrated at least 98% susceptibility to OMC. Species and phenotypes of interest including methicillin-resistant Staphylococcus aureus (MRSA; n=3,255), S. lugdunensis (n=148), vancomycin resistant E. faecalis (n=30), S. anginosus group (n=153), erythromycin-resistant S. pyogenes (n=133) and penicillin-resistant S. pneumoniae (n=193; oral breakpoint) demonstrated high susceptibility to omadacycline with 96.1%, 99.3%, 100%, 98.0%, 98.5%, and 100% susceptible, respectively. Overall Gram-negative susceptibility to OMC ranged from 92.4% to 99.9%. Gram-negative phenotypes of interest including beta lactamase positive H. influenzae/H. parainfluenzae (n=367), ceftazidime non-susceptible E. cloacae (n=355), and carbapenem resistant K. pneumoniae (n=50) demonstrated susceptibility to omadacycline of 100%, 85.8%, and 86.0% respectively. For the subset of strains that were tetracycline-resistant, S. aureus (n=422), E. faecalis (n=842), S. anginosus group (n=59), S. pyogenes (n=162), and S. pneumoniae (n=343), omadacycline susceptibility was 92.9%, 100%, 94.9%, 98.1%, 99.7% respectively.

Conclusion

OMC demonstrated potent and consistent in vitro activity with susceptibilities of >90.0% against medically important FDA-indicated pathogens (including resistant phenotypes) during the 5-year post-marketing surveillance period (2019-2023) from medical centers in the United States.

Disclosures

Michael D. Huband, BS, Paratek Pharmaceuticals: Advisor/Consultant|Paratek Pharmaceuticals: Grant/Research Support Kelley A. Fedler, BS, Paratek Pharmaceuticals: Grant/Research Support Kelly Wright, PharmD, BCPS, Paratek Pharmaceuticals: Employee Rodrigo E. Mendes, PhD, JMI: RM is an employee of JMI. JMI was contracted by and received financial support from GSK to conduct gepotidac|Paratek Pharmaceuticals: Advisor/Consultant|Paratek Pharmaceuticals: Grant/Research Support
P-422. Incidence, Risk Factors, Etiology, and Clinical Outcomes of Pneumonia in Adults with Cancer at a Tertiary Care Centre: a One Year Prospective Cohort Study
Authors: Malik Simran , Bhattacharya Sanjay , Das Bhattacharya Sangeeta
Published: January 2025

Background

Pneumonia is an important cause of morbidity, mortality, hospital admission, and healthcare-associated costs in cancer patients. We investigated the incidence, risk factors, etiology, and clinical outcomes of pneumonia in adults with cancer admitted to the ICU in Tata Medical Center Kolkata from October 2022 to September 2023.Figure 1:Monthly Trend in Case Identification

Methods

We conducted a prospective cohort study involving two groups with malignancy admitted to the ICU: one with pneumonia and one without. Pneumonia was identified by clinical and radiological features.

Incidence was calculated as the proportion of patients in the ICU who developed pneumonia in one year. Community-acquired (CAP), healthcare-associated (HAP), and ventilator-associated pneumonia (VAP) were defined by NHSN and HAI Surveillance in India guidelines. Relative risks were calculated and logistic regression performed to assess risk factors for pneumonia and mortality; and clinical outcomes were compared using Z-tests on STATA-17.Figure 2:Kaplan-Meier Plot for the survival analysis for patients with or without pneumonia

Results

355 individuals with pneumonia and 356 without were enrolled among 2279 in-patients. The incidence of pneumonia was 15.6% (95% CI: 14.1-17.1%). 51.8% were CAP and 48.2% were HAP. 17.9% of HAP (7.3% of all pneumonia) was VAP.

Hematological malignancies (RR=2.08), diabetes (1.31), COPD (1.78), renal dysfunction (1.73), neutropenia (1.83), smoking (1.28), chemotherapy (2.01), radiotherapy (1.56), immunotherapy (1.61), and bone marrow transplantation (2.05) increased risk for pneumonia.

258 (72.7%) cases had a positive microbiology. Of these, 123 were polymicrobial (47.7%), termed “coinfections/ superadded infections” (table 1).

All-cause 90-day mortality (39.2%), mean length of hospital stay (18.6 days), ICU stay (10.9 days), and mechanical ventilation (2 days) were higher in patients with pneumonia than those without (p< 0.05, figure 2). CAP (RR=1.42), hematological malignancies (1.59), renal dysfunction (1.51), neutropenia (1.74), chemotherapy (1.60), immunotherapy (1.55), days of ICU stay (logit OR=1.04), days of mechanical ventilation (logit OR=1.03), and co-infections/ superadded infections (logit OR=1.82) increased risk of death in pneumonia.Table 1:Etiology of pneumonia with positive microbiology segregated by type of pneumonia.

The denominator corresponds to the number of cases in each category that had positive microbiology.

Conclusion

Pneumonia in cancer patients admitted to the ICU is associated with worse clinical outcomes.Table 2:Clinical Outcome in patients with or without pneumonia

Disclosures

All Authors: No reported disclosures
P-425. A Scoping Review of Data Systems for HPV Vaccination and HPV-Related Outcomes in China
Authors: Wang Wei , Wang Ruixuan , Chen Ya-Ting
Published: January 2025

Background

Human papillomavirus (HPV) is a major cause of cervical cancer, the sixth most common cancer among women in China. In 2023, China launched a new government plan to facilitate the elimination of cervical, requiring reliable data systems for monitoring and evaluating progress. This study aimed to identify, understand, and summarize data systems that record HPV vaccination, cervical cancer screening, HPV infection, HPV-related cervical and non-cervical diseases, as well as sexual and life behaviors in China.

Methods

A scoping review of literature from PubMed and the China National Knowledge Infrastructure databases was conducted, covering publications from 2012 to 2023. Two reviewers independently reviewed articles in two rounds, and all disagreements were resolved by a third reviewer.

Results

From 234 studies, 146 data sources were identified, covering topics including HPV vaccination (n=2), HPV-related cervical and non-cervical diseases (n=121), cervical cancer screening and HPV infection (n=11), HPV-related knowledge, attitude, and belief (n=1), and sexual and life behaviors (n=7). The main source for HPV vaccination data is the National Immunization Program Information Management System, while HPV-related cancer data primarily come from the National Central Cancer Registry of China. Cervical screening and HPV infection data are recorded in clinical or laboratory databases, including KingMed Diagnostics Laboratory and the national “Two Cancer” Screening database. HPV knowledge, attitude and sexual behaviors are mainly collected from surveys of individuals registered in epidemiology registries. Notably, several cities, including Yinzhou, Chengdu, Suzhou, and Lecheng, have recently established population-level data systems linking vaccination, screening to cervical/other HPV outcomes; however, a national system linking HPV vaccination and cervical screening with HPV-related disease outcomes, health beliefs, and risk behaviors is lacking.

Conclusion

There is a clear need for comprehensive and integrated data systems in China to effectively monitor and evaluate the impact and progress of public health intervention for cervical cancer elimination.

Disclosures

Wei Wang, PhD, Merck: Stocks/Bonds (Public Company) Ruixuan Wang, MPP, Merck: Co-Op Ya-Ting Chen, PhD, Merck & Co., Inc: Stocks/Bonds (Private Company)
P-443. Outcomes in Pneumocystis Pneumonia Hospitalizations in Patients with HIV: A County Hospital Study 2015-2022
Authors: Chow Erica , Fetters Kirk B , Ziegenbein James C , Hatlen Timothy
Published: January 2025

Background

Therapy related complications, morbidity and mortality are still problematic in treating pneumocystis jirovecii pneumonia (PJP) in persons living with HIV (PWH) on antiretroviral therapy (ART). Our study aims to outline patient demographics and hospital outcomes among PWH in a safety-net hospital during the contemporary ART era.

Methods

We retrospectively reviewed and extracted data from inpatient encounters with HIV and PJP between 2015-2022 at a safety-net hospital in Los Angeles County, California

Results

We identified 55 PWH (58 admissions) with confirmed or presumed PJP. Only 6.9% had a known HIV diagnosis and linked to care the prior year. 37.9% had concurrent opportunistic infections (OIs), and 20.7% had prior OI history. Treatment with trimethoprim-sulfamethoxazole (TMP-SMX) was used in 84.5% of cases in whom 48% had treatment related adverse effects. 62.1% received steroids. At one-year post-hospitalization, 63.8% were linked to care and 27.6% were lost to follow up or out of network. Inpatient mortality was 5.2%, and 10.3% died at 1-year. Higher oxygen requirements predicted a higher 1-year mortality (OR 2.68, 95%CI = 1.28 – 5.64, p = < 0.01), as did necessity of TMP-SMX alternatives (OR 18.8, p = 0.003, 95% CI 2.72 – 129.73).

Conclusion

A total of 32.8% of patients failed TMP-SMX. These patients also had higher 12-month mortality rate, likely reflecting underlying host comorbidities and disease severity. Atovaquone is inferior to TMP-SMX and primaquine-clindamycin is non-inferior to TMP-SMX, however, only in mild-moderate disease. There is a paucity of data for alternative treatments for severe disease.

Concurrent OI were found in 37.9%, of whom 81.8% had no prior history of OI. Of the three inpatient mortalities, two had concurrent OIs, emphasizing the clinical importance of screening for other OI in patients who present with PJP.

In-hospital mortality was 5.2%, compared to 9 -17% in other studies; 1-year mortality was 10.3% compared to estimates of 37-53% during early ART period, suggesting a positive trend compared to both pre- and early ART outcomes. The one-year follow-up mortality of 10.3% and having only 63.8% successfully linked with in-network HIV care underscores an opportunity to improve linkage and retention strategies for PWH.

Disclosures

All Authors: No reported disclosures
P-445. Clinical Complications and Quality of Life in People Living with HIV (PLWH) and Other Comorbidities
Authors: Lui Grace , Cheung Catherine , Yuen Ka-Ki , Wong Vivian , Au-Yeung Chuk-To , Ho Hang-Yee , Li Timothy
Published: January 2025

Background

Comorbidities in PLWH tend to cluster, and may raise risk of multiple clinical complications. It is important to understand the burden of these complications and health-related quality of life (QOL) in PLWH with comorbidities.

Methods

This is an ongoing prospective longitudinal observational study in Hong Kong to determine the prevalence and incidence of clinical complications among PLWH with ≥1 documented comorbidities (hypertension, diabetes, obesity, liver disease, kidney disease and cardiovascular disease). The endpoints are the prevalence of each clinical complication and QOL. Clinical complications are (i) high cardiovascular risk (QRISK3 >10%), (ii) renal complication (glomerular filtrate rate < 60 mL/min/1.73m2, or urine albumin:creatinine >3 mg/mmol), (iii) liver steatosis and significant liver fibrosis (Controlled Attenuated Parameter >248 dB/m and liver stiffness >9.0 kPa, measured by transient elastography) and (iv) low bone mineral density (BMD) at lumbar spine and femoral neck (T score < -1.0 if ≥50 years or Z score < -2.0 otherwise, measured by dual energy X-ray absorptiometry). QOL was measured by EQ-5D-5L. Association between each comorbidity and the endpoints are determined by logistic or linear regression analyses, adjusted for age and gender.

Results

We included data from the first 279 PLWH (baseline characteristics in Table). Overall, 40.5% had high cardiovascular risk, 35.1% had renal complication, 10.8% had significant liver fibrosis, and 31.5% had low BMD at femoral neck (Figure 1A), while 14.3% had difficulty in mobility, 38.4% had pain or discomfort, and 34.1% had anxiety or depression (Figure 1B). EQ VAS was 80 (25th, 75th percentile 67, 85).

PLWH with hypertension and diabetes had significantly higher cardiovascular risk and renal complication. Diabetes and obesity were significantly associated with liver fibrosis, but lower risk of low BMD (Figure 2).

PLWH with diabetes had significantly greater impairment in mobility, while obesity was associated with a trend of pain or discomfort and anxiety or depression (Figure 3). Kidney disease was associated with worse EQ VAS (unstandardized B -7.032, p=0.022).

Conclusion

PLWH with comorbidities are vulnerable for multiple clinical complications and worse QOL.

Disclosures

Grace Lui, MBChB, Gilead Sciences: Grant/Research Support|MSD: Grant/Research Support
P-454. An Analysis of an Evolving Malignancy Profile in an Urban, Predominantly African-American Population Living with HIV
Authors: Rallo Melissa K , Leahy Nicholas , Riedel David J
Published: January 2025

Background

It is well known that HIV increases the risk of certain malignancies, including AIDS-defining cancers (ADCs) such as Kaposi Sarcoma, non-Hodgkin Lymphoma, and invasive cervical cancer. While the incidence of effective antiretroviral treatment (ART) has allowed the incidence of ADCs to decline, HIV-infected individuals are still at a higher risk for non-AIDS-defining cancers (NADC). A 2014 study conducted at the University of Maryland Medical Center (UMMC) showed that while HIV-infected patients presented with late-stage cancer and significant mortality, ART had a significant mortality benefit. While this study was pivotal, it’s important to consider how this malignancy profile continues to change. The purpose of this study is to characterize the numbers and types of cancers, patient demographics, ARTs, and mortality among HIV-infected patients in an urban population in order to contrast with data from an older cohort of data.

Methods

A retrospective cohort study was used to review 301 HIV-infected patients diagnosed with invasive cancer from January 1st, 2015 to December 31st, 2022 who were managed at UMMC.

Results

There were 322 cases of invasive cancer in this population. Patients were predominantly African American (81%) and male (61%). The majority of cases involved patients who were compliant with an ART regimen when they presented initially for diagnosis (79%) with a subset of patients meeting the criteria for AIDS (CD4 < 200) at the time of cancer diagnosis (25%). The overall incidence of stage 3 or 4 cancer in the population was 45%, and 58% among HIV-infected patients who met the clinical criteria for AIDS. There were 139 deaths with a majority of the causes of death attributed to cancer progression or infection (68%).

Conclusion

An evolving ART regimen profile is continuing to mold the malignancy composition of patients living with HIV. When the current retrospective cohort was contrasted with the older cohort from 2000 to 2010, there were a few key changes – most notably a higher composition of females, a higher percentage of those with a documented ART regimen at the time of diagnosis, and a lower proportion of malignancies at diagnosis meeting Stage 3 or 4 criteria.

Disclosures

All Authors: No reported disclosures
P-458. Factors Associated with Completion of High-Resolution Anoscopy in a Cohort of Transgender Women – Findings from a Mixed-Methods Study
Authors: Harfouch Omar , Whitfield Darren , Mammaldi Tural , Mansfield Megan E , Eyasu Rahwa , Bijole Phyllis , Ebah Emade , Zoltick Meredith , Davis Ashley , Liu Tina , Jones Miriam , Silk Rachel , Sternberg David , Omari Habib , Kottilil Shyamasundaran , Masur Henry , Kattakuzhy Sarah , Rosenthal Elana S
Published: January 2025

Background

Guidelines recommend anal cancer screening in transgender women (TGW) – particularly those living with HIV (LWH) - using anal cytology followed by high-resolution anoscopy (HRA) in those with abnormal results. This study examines factors associated with completion of HRA in TGW with abnormal cytology.

Methods

We recruited 80 TGW using convenience sampling from 4/2021 – 9/2023. We collected survey data, serum samples, and anal swabs for cytology and HPV testing. TGW with abnormal cytology were scheduled for off-site HRA. Non-completion of HRA was defined as being scheduled for HRA but not completing it within 3 months of cytology result. We conducted semi-structured interviews with 8 TGW who completed HRA and 8 who didn’t complete HRA. We used chi-square tests and the weaved approach to compare factors associated with HRA completion from quantitative and qualitative data.

Results

Of 75 TGW with anal cytology collected, 48% had abnormal results and of those 39% completed HRA (Figure 1). Of 36 TGW with abnormal cytology 97% were black, 61% were unstably housed, 78% were LWH. In the last year, 48% engaged in transactional sex and 69% in receptive anal sex (Table 1). HRA completion was associated with being employed (p=0.01) and, among TGW LWH, an undetectable HIV viral load (p=0.01) (Table 1). Qualitative data identified patient-provider trust as a facilitator to HRA completion and experiences of stigma or discrimination related to gender identity as a barrier to HRA completion (Table 2). Mixed-methods analysis revealed that socio-economic challenges, including housing, and financial factors – notably health insurance - were a barrier to HRA completion (Table 3).

Conclusion

In a cohort of TGW, we found high rates of abnormal anal cytology and low rates of HRA completion, highlighting missed opportunities for anal cancer prevention. Interventions aimed at improving anal cancer screening and linkage to HRA for TGW must be intentional about eschewing stigma and creating environments affirming of gender identity, while addressing barriers to care due to prevalent socioeconomic challenges. Additionally, TGW LWH with a detectable HIV viral load may require further targeted interventions to improve both the HIV care continuum and the anal cancer screening cascade.

Disclosures

Shyamasundaran Kottilil, MD PhD, CDA Foundation: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Orsobio: Advisor/Consultant|Orsobio: Stocks/Bonds (Private Company)|Red Queen Therapeutics: Advisor/Consultant Elana S. Rosenthal, MD, Gilead Sciences: Grant/Research Support|Merck: Grant/Research Support
P-467. The clinical prognostic risk stratification system for HIV infected hepatocellular carcinoma
Authors: Chen Yifan , Zhao Han , Wang Yao , Liu Bo , Chen Zhimin , Tao Yu , Xun Yang , Yang Hua , Liu Rongqiu , Feng Lizhi , Liu Xinhua , Li Hengjing , Wang Sibo , Zhao Dong , He Haolan , You Hua
Published: January 2025

Background

Patients with human immunodeficiency virus (HIV) are more susceptible to liver cancer because of their compromised immune system. There is no specific prognostic model for HIV-infected hepatocellular carcinoma (HCC) patients.

Methods

Clinical data of 85 patients with HIV-infected HCC was divided into a 7:3 ratio for training and internal validation sets, while the data of 23 patients with HIV-infected HCC was served as the external validation set. Data of 275 HIV-negative HCC patients was considered as external HIV-negative validation set. Variables associated with overall survival (OS) in the training set were used to develop the HIV-infected HCC prognosis (HIHP) model. The model was tested in the internal and external validation sets. The predictive accuracy of the model was assessed with conventional HIV-negative HCC prognostic scoring systems.

Results

The HIHP model demonstrated a significant association with OS in the training set, with a median OS of 13 months for low risk, 7 months for medium risk, and 3 months for high risk (p < 0.001). The HIHP model showed a significant association with OS, and exhibited greater discriminative abilities compared to conventional HIV-negative HCC prognostic models both in the internal and external validation sets. In the external HIV-negative validation set, the HIHP model did not show better discrimination than conventional HIV-negative HCC scores.

Conclusion

The new model presented in the work provided a more accurate prognostic prediction of OS in HIV-infected HCC patients. However, the model is not applicable to patients with HIV-negative HCC.

Disclosures

All Authors: No reported disclosures
P-475. Anal Cancer Screening in HIV Positive MSM and TGW: A Multistage Quality Improvement Project
Authors: Kenison David , Zamor Rudline G , Shah Khushbu , Nath Sarath
Published: January 2025

Background

Men who have sex with men (MSM) and transgender women (TGW) living with HIV (PLHIV) have an estimated 37-fold increased risk of anal cancer compared to the general population. Currently there are no national guidelines on screening for anal cancer with cytological analysis creating discrepancies in anal cancer screening and increasing risk of progression to anal cancer. We reviewed the MSM and TGW PLHIV cohort in our institution to identify demographics, risk factors, and anal cancer screening rates, we also identified outcomes of patients with cytological testing.

Methods

We conducted a retrospective chart review of MSM PLHIV over the age of 18, who were seen in Stony Brook University HIV clinic from 02/01/21 to 02/01/24. Demographics, smoking history, HIV viral load, human papillomavirus (HPV) vaccination status, and sexually transmitted infection (STI) history was obtained from chart review and compared between patients with and without anal cancer screening with Chi square test.

Results

We identified a total of 160 MSM and 2 TGW. The majority of patients were unvaccinated for HPV (n=144; 88%). 84% had suppressed HIV viral load (n=137), 49% had a smoking history (n=80), and 35% had recent history of STI (n=57). Only 32% (n=53) patients had anal cancer screening done. We also found the patients who were less than 50 years, who had smoking history and recent STIs had a higher chance of being screened. Fifty-three patients were identified with prior cytological analysis, 15 (28.6%) with atypical squamous cells of unknown significance, 6 (11.3%) with low-grade, and 1 (1.9%) with high-grade squamous epithelial lesions.

Conclusion

We identified that anal cancer screening rates were low at our institution despite the prevalence of risk factors such as smoking, high prevalence of STIs and low HPV vaccination status. Nearly 50% of patients had abnormal cytological analysis, highlighting the importance of establishing and implementing anal cancer screening. We have implemented an institutional protocol from 03/01/24 to increase the screening rates for anal cancer for this high risk population.

Disclosures

All Authors: No reported disclosures
P-514. Enhancing the Pediatric Primary Care Provider’s Role in Adolescent HIV Prevention
Authors: Vicetti Miguel Claudia P , Thew Margaret , Ehrman Wendi , Mojica Lia
Published: January 2025

Background

Youth with a history of bacterial sexually transmitted infections (STIs) are at increased risk of HIV acquisition and should be counseled on HIV Pre-Exposure Prophylaxis (PrEP). PrEP counseling has been associated with high acceptability rates in primary care, but most pediatric providers do not discuss PrEP during clinic visits. We conducted a quality improvement project at primary care clinics affiliated with a tertiary not-for-profit children’s hospital serving the city of Milwaukee. The objective of this project is to increase rates of counseling on HIV testing and PrEP during primary care visits around an STI diagnosis, as part of a larger institutional initiative to increase PrEP utilization in at-risk youth.

Methods

Rates of HIV testing and PrEP counseling were monitored monthly during baseline (July 2022-June 2023) and post-intervention periods (July 2023-June 2024) using Plan-Do-Study-Act (PDSA) cycles tracked via a statistical process control chart.

We included well child and sexual health-related office visits in youth aged 12 and older that occurred within 3 months of a bacterial STI diagnosis (gonorrhea, chlamydia, or syphilis). Interventions consisted of a clinician educational session, a prompt in the electronic health record (EHR) for missing HIV tests and a communication to the primary care provider containing internal PrEP resources following a patient’s STI diagnosis.

Results

From July 2022 to December 2023, we identified 255 primary care visits around an STI diagnosis (90.59% chlamydia, 25.49% gonorrhea, 0.39% syphilis and 16.47% co-infections). Patient characteristics are summarized in Table 1. Interim analysis showed counseling rates on HIV testing increased from 50% to 63% (Figure 1) and PrEP counseling from 5% to 15% (Figure 2) through December 2023. Data will continue to be measured through June 2024.

Conclusion

For the first 6 months of our project, clinician education combined with an EHR prompt and provider communications containing PrEP resources have resulted in a modest increase in counseling rates on HIV testing and PrEP for at-risk youth during primary care visits. These initial interventions demonstrate a promising start towards enhancing HIV prevention discussions in pediatric primary care.

Disclosures

All Authors: No reported disclosures
P-516. Implementation and Uptake of Long-acting Injectable PrEP at Atlanta VA Healthcare System
Authors: Harris Nadine M , DeSilva Kathryn E , Kuriakose Roseylee , Sorlie Stacy , Reed Sarah , Oliver Nora T , Moanna Abeer , Webster Andrew S , Cartwright Emily J
Published: January 2025

Background

Long-acting injectable (LAI) pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV and has the potential to expand PrEP access. Atlanta VA Healthcare System (AVAHCS) has one of the largest PrEP programs within the Veteran’s Health Administration (VHA). In mid-2023, we started a LAI PrEP program and quickly became the largest provider of LAI PrEP within VHA. We aim to share our experience building this program as well as describe uptake amongst patients

Methods

In May of 2023, a dedicated advanced practice provider (APP) was hired to manage the LAI program, working closely with an Infectious Disease (ID) clinical pharmacist and ID nurse to refer patients for LAI PrEP based on VA criteria (Figure 1, Figure 2). Active LAI PrEP patients are added to a database tracker and reviewed at weekly interdisciplinary team rounds

Results

From May 2023 to April 2024, 77 patients were referred for LAI PrEP. There are 62 active LAI PrEP patients, with a mean age of 41 years (23-83 years). Most were men (n=49, 79%) and self-identified as black race (n=51, 82%). The most common indication for LAI PrEP use (n=46, 74%) was being at high risk of HIV acquisition, or having special patient factors that affect adherence to oral PrEP (Table 1). Of the 15 patients who were referred for LAI PrEP but discontinued use , reasons cited included: adverse reactions (n=4, 40%), inability to adhere to clinic scheduling (n=3, 30%), no longer desiring PrEP (n=2, 20%), and relocation to another state (n=1, 10%); 5 never initiated LAI PrEP. There were 7 patients (46%) who resumed oral PrEP after LAI discontinuation.

Conclusion

We have rapidly expanded access to LAI PrEP at the AVAHCS using a model that may be replicated at other VA facilities. Assessment of risk and patient preference often guides the decision about starting LAI PrEP in our cohort and should be an important consideration when creating guidance about eligibility for LAI PrEP.

Disclosures

All Authors: No reported disclosures
P-519. Long-acting Injectable PrEP Uptake and Persistence in a Sexual Health Clinic
Authors: Massanet Nicholas Francisco , George Jonathan , Jajoo Veena , Bevard Kerri , Forstell Sheila , Acosta Maritza , Bookins Marcia , Somboonwit Charurut , Sherbuk Jacqueline E
Published: January 2025

Background

HIV pre-exposure prophylaxis (PrEP), a powerful tool for HIV prevention, has traditionally been taken as a daily oral medication. Long-acting injectable (LAI) cabotegravir is superior to daily oral PrEP for HIV prevention and was approved for use as LAI-PrEP in 2021. We aimed to evaluate the uptake of LAI-PrEP and six-month LAI-PrEP persistence in a sexual health clinic.

Participant characteristics (N=36)

LAI: Long acting injectable

PrEP: Pre-exposure prophylaxis

Methods

In February 2023, an LAI-PrEP pilot was implemented in a county sexual health clinic serving a diverse patient population in a designated ending the HIV epidemic in the South. Through state funding, patients at risk of HIV through sexual transmission were eligible to receive initial doses of LAI-PrEP at no cost and same-day initiation was encouraged. We evaluated the first 12 months of implementation. The primary outcome was LAI-PrEP persistence at 6 months. Statistical analyses were performed (SPSS version 29) using chi-square test for categorical variables with a significance level of 0.05.

LAI-PrEP – long-acting injectable pre-exposure prophylaxis

Results

During the 12-month period, 55 people initiated LAI-PrEP, with 36 eligible for the six-month PrEP persistence evaluation. This population was 83% men, 31% Black, 58% Hispanic/Latino, and the median age was 32 (range 20-58) years. 75% received oral PrEP previously. LAI-PrEP six-month persistence rate was 72% (26 of 36). Among the 10 people with LAI-PrEP discontinuation, 1 transitioned to oral PrEP, 2 no longer had an indication for PrEP (change in serodifferent relationship status), and 7 were lost to follow-up. LAI-PrEP persistence differed by race (46% Black vs 88% white, p=0.007) and sexual orientation (37% heterosexual, 89% gay, 67% bisexual, p=0.019).

LAI-PrEP – long-acting injectable pre-exposure prophylaxis

Conclusion

In the first year of LAI-PrEP implementation, LAI-PrEP uptake was favorable in our clinic, especially among priority populations for HIV prevention. Loss to follow-up was the most common reason for discontinuation, but change in PrEP method or loss of PrEP indication accounted for 30% of discontinuations. Nevertheless, the differences in persistence rates suggest a need for targeted interventions to improve long-term adherence in minority and heterosexual groups. Addressing PrEP persistence in these populations is crucial for optimizing the impact of LAI-PrEP in communities with a high burden of new HIV infections.

Disclosures

All Authors: No reported disclosures
P-523. Impact of Tailored Education on Engagement in Sexual Health and HIV Prevention Services Among US Women
Authors: Sheth Anandi N , Vincent Shaina Y , Simone Laura , Napolitan Chris , Carter Jeffrey D , Rodriguez Melissa , Meza Jimenez Jenniffer A , Molloy Leah
Published: January 2025

Background

Women in the US are facing increasing barriers to sexual health services. This project aimed to enhance sexual health literacy and linkage to HIV prevention among US women.

Methods

From 6/2023-8/2023, six patient education sessions on sexual health and HIV prevention were held in women’s health clinics in California, Georgia, and Virginia. Surveys were given to participating patients and healthcare professionals (HCPs) before/after each session and one month later. Content was shared nationally through an online toolkit for HCPs and a public social media video.

Results

Among the 88 patients who attended a sexual health education session (mean age: 44 years; 60% Black, 83% previously tested for HIV), baseline awareness of pre-exposure prophylaxis (PrEP) (23%) and resources for HIV testing/prevention (63%) significantly increased to 71% (P < .001) and 84% (P = .002), respectively, after the sessions. More women felt confident in HIV prevention after the education than before (93% vs. 82%, P = .028). After education, all participating HCPs (n = 6) correctly identified that a woman’s HIV risk is nearly constant throughout life and that PrEP should be offered to anyone who asks for it, compared to 50% correctly answering each question at baseline (P = .181). When asked about patients’ barriers to HIV/STI testing, HCPs most frequently chose fear of judgment (50%), while patients reported cost concerns (27%) and test-related anxiety (26%). When asked what would make testing easier, learning about free or low-cost local testing centers was most frequently chosen by both patients (49%) and HCPs (67%). Discordances were observed regarding PrEP barriers. The top patient-reported barrier was insurance coverage/medication costs (48%), while HCPs perceived fear of side effects as the main barrier (67%). One month later, 73% (n = 19/26) of patients had gotten tested for HIV, and HCPs had discussed HIV screening/prevention with 94 women and helped 38 start PrEP. As of 1/2024, the online toolkit and social media video were accessed by 1,057 and 4,054 people, respectively.

Conclusion

This tailored educational initiative offered insights into women’s barriers to HIV screening and prevention, after which women’s participation in HIV testing and awareness of PrEP improved.

Disclosures

All Authors: No reported disclosures
P-551. The Effects of Antiretroviral Therapy on Immune Activation, Inflammation, Cellular Changes and Clinical Outcomes in Elite Controllers
Authors: Chan Elizabeth , Zhou Lei , Emu Brinda , Paintsil Elijah , Barakat Lydia A
Published: January 2025

Background

Elite controllers are people living with HIV (PLWH) who maintain their HIV viral load (VL) < 50 copies/mL without antiretroviral therapy (ART). Viremic controllers are persons who have HIV who are able to keep their VL < 2000 copies/mL without ART. Current published data does not clearly define the benefits of ART nor the adverse effects of ART in elite controllers. Evaluation of the effects of ART on immune activation, inflammatory markers, mitochondrial and cellular function in elite controllers can better inform utilization of ART in this group.

Methods

Four PLWH—3 elite controllers and 1 viremic controller— were enrolled from our HIV academic center clinic. Participants were women aged 45 to 60 years old who were diagnosed with HIV for 5 to 35 years. After shared decision making with their primary care provider, 2 of the 4 participants were started on ART, one on Triumeq and the other on Cabenuva. Participants were followed from 0 to 12 months. At each visit, routine standard of care labs, as well as inflammatory lab markers IL-6 and CRP were drawn. We assessed their mitochondrial function measuring mitochondrial membrane potential, mitochondrial DNA (mtDNA) deletions, apoptosis, and reactive oxygen species (ROS) production.

Results

Compared to baseline levels, inflammatory markers IL-6 and CRP both decreased at 12-months in participants started on ART (E2 and E3), whereas these markers increased in controls (E1 and E4) (Figure 1). All participants have increased apoptosis and ROS production at 12-months compared to baseline (Figure 2). At the 12-months visit, participants in the ART group (E2 and E3) showed elevated levels of mtDNA deletion, apoptosis, ROS production, and a reduction in mitochondrial membrane potential (Figure 2).

Conclusion

From our small cohort, the observed IL-6 and CRP decrease suggest decreased inflammation at one year after elite controllers start ART. However, decreased mitochondrial function was also noted in those on ART, which suggests possible early signs of ART toxicity. This preliminary data emphasizes the need for further studies to better understand the risk-benefit of initiating ART in elite controllers, including markers for cellular inflammatory markers.

Disclosures

Brinda Emu, MD, Genentech/Roche: Advisor/Consultant|Theratechologies: Advisor/Consultant