bluuebunny/crossref_metadata_2025 huggingface dataset:
P-532. Pediatric Perspectives of PrEP
Authors: Rosencrance Alex , Rosebush Julia , Mannheim Jonathan
Published: January 2025

Background

Thousands of teens are diagnosed annually with HIV-1 in the U.S. despite the 2018 approval of PrEP for adolescents by the FDA, highlighting the need for research on pediatric PrEP prescribing practices. Research in this area is scant and chiefly focuses on patient barriers to accessing PrEP. Our study explores barriers to prescribing for pediatric providers.Table 1:Characteristics of Provider Respondents

Methods

We performed an online survey of medical providers from pediatrics, family medicine (FM) and internal medicine/pediatrics. A 5-point Likert scale (0-4) assessed comfort in providing adolescent sexual health care, including discussions around sexual activity, gender identity, sexual orientation, STIs, and PrEP. Potential barriers to PrEP prescription were explored. Unweighted proportions of responses were compared by provider characteristics, and logistic regression described the association between provider characteristics and the likelihood of having prescribed PrEP. Correlation matrix analysis identified strong relationships between item measure responses, identifying provider characteristics which associated with one another.Table 2:Comparing Comfort and Familiarity in Different Aspects of Sexual Health Care Between Pediatrics and Family Medicine

Results

158 providers responded. Comparison of pediatric and FM providers found large differences in comfort with sexual health care. FM providers were more familiar with PrEP overall (3.42 to 1.53, 76.4% difference) and prescribing PrEP (3.37 to 0.70, 131.2%). FM providers were also more comfortable discussing sexual orientation (3.45 to 3.01, 13.62%), gender identity (3.32 to 2.72, 19.87%) and providing treatment for STIs (3.72 to 3.19, 15.34%). Logistic regression found that FM providers were 32 times more likely to prescribe PrEP than pediatric providers. Correlation analysis revealed that parental knowledge of a provider-patient conversation about sex decreased provider comfort in discussing sexual orientation and gender identity.Table 3:Multivariable Associations Between Provider Characteristics and Likelihood of Having Prescribed PrEP

Conclusion

Pediatric providers were less comfortable than FM providers in matters related to sexual health, sexual identity, and gender identity, including PrEP. FM providers, who routinely see adults, were significantly more likely to prescribe PrEP than pediatric providers. Parental knowledge of patient-provider discussions of sex may decrease provider comfort with discussions about sexual orientation and gender identity.Table 4:Correlation Stratified by Parental Knowledge of Patient-Provider Conversation About Sex

Disclosures

All Authors: No reported disclosures
P-544. Whole Food Plant-Based Diet for HIV-Associated Reduction in Cardiovascular Risk: A Pilot Randomized Clinical Trial (PLANT-HART)
Authors: Martinez-Loya Carolina , Favela Ortiz Ruth Selene , Vargas-Castañeda Alejandra , Seijas-Vasquez Mariana , Perez-Castilla Jesus
Published: January 2025

Background

Globally, 39 million people are affected by HIV, most of whom are on antiretroviral therapy (ART), which increases cardiovascular risks. Guidelines lack specific dietary recommendations for this population, though plant-based diets may reduce these risks. This pilot study (NCT05796882), to our knowledge, is the first to explore the effects of a plant-based diet on cardiovascular risk in HIV-positive individuals.Table 1.Differences in variables for both groups combined and their statistical significance. Paired sample analysis.

Methods

This randomized controlled pilot clinical trial, conducted in Mexico, involved HIV-positive adults on stable ART, aged 30-60, with a body mass index > 25 and ≥ 1 cardiovascular risk factor. Exclusion criteria included: acquired immunodeficiency syndrome, major cardiovascular events, substance abuse, and ART non-adherence. Of 150 invited, 21 consented and 10 completed the 8-week intervention. Outcomes were analyzed using non-parametric tests (Wilcoxon Sign-rank and Mann-Whitney U). The ethics committee approved; all participants provided informed consent.

Results

Ten male participants (mean age 40.3 ± 8.2) were divided into a plant-based diet (PBD, n=4) and a nutritional standard care (NSC, n=6) group. After 8 weeks, reductions in cardiovascular risk were observed; the NSC group experienced a -0.9% in Framingham Hard Coronary Risk (p=0.2) and the PBD group a -0.1% (p=0.1). Blood pressure decreased significantly in both groups: systolic blood pressure decreased by 15.2 mmHg (p=0.01) and diastolic blood pressure by -7.3 mmHg (p=0.02) (Table 1). The PBD group also showed reductions in weight (-700g, p=0.7), body fat percentage (-0.9%, p=1.0), tricipital fold (-3mm, p=0.06), total cholesterol (-32.0 mg/dL, p=0.1) and LDL cholesterol (-39.7 mg/dL, p=0.2), though not statistically significant.

Conclusion

This pilot study suggests that a plant-based diet may reduce cardiovascular risks in HIV-positive individuals. Both groups were significant for reducing systolic and diastolic blood pressure. The plant-based diet can potentially be beneficial for weight and cholesterol management. Despite a small sample size and adherence challenges, regular follow-ups and dietary self-reports enhanced compliance, underscoring the need for larger, comprehensive studies to confirm these findings.

Disclosures

All Authors: No reported disclosures
P-546. Eligibility and Factors Associated with Long-Acting Injectable Cabotegravir – Rilpivirine Initiation in a South Side Chicago HIV Clinic
Authors: Liegeon Geoffroy , Kaperak Christopher , Friedman Eleanor , Djuricich Paul S , Dawdani Alicia , Plotkin Sophie , Schmitt Jessica , Hazra Aniruddha , Christopoulos Katerina , Schneider John , McNulty Moira
Published: January 2025

Background

We evaluated eligibility for long-acting injectable (LAI) cabotegravir (CAB) and rilpivirine (RPV) treatment among PWH in a Ryan White-funded HIV clinic and assessed factors associated with initiation to identify potential disparities in uptake.

Methods

We conducted a retrospective cohort analysis among PWH who attended the University of Chicago HIV clinic from January 1, 2021 to May 31, 2023. PWH were considered eligible for LAI-CAB/RPV if they had HIV-1 RNA < 50 copies/mL for ≥3 months, no active hepatitis B virus infection, no resistance to rilpivirine or cabotegravir on historical genotypes, and/or no history of treatment failure on integrase inhibitors or non-nucleoside reverse transcriptase inhibitors. We used a logistic regression model to identify socio-demographic and clinical factors associated with treatment initiation among eligible PWH.

Results

Of the 655 PWH, 413 (63%) were eligible for LAI-CAB/RPV. Median age was 45 years, median time from HIV diagnosis was 9 years, 33% were women, 84% Black, 70% had permanent housing, 52% were employed, 56% had Medicaid insurance, 9% had active substance use, 26% had an active mental illness, 69% were taking other daily oral medications, 13% were receiving another ongoing injectable treatment, 48% had no historical genotype available, and 6% had a CD4 count < 200/mm3. Of the 413 eligible PWH, 64 (15%) initiated LAI-CAB/RPV. PWH who initiated LAI-CAB/RPV were significantly younger (34 vs. 48 years, P< 0.001), diagnosed with HIV more recently (6 vs. 11 years, P=0.002), had a higher employment rate (67% vs 50%, P=0.03), and tended to have no mental health issues (19% vs. 28%, P=0.14). They were also less likely to take other daily pills (48% vs 73%, P< 0.001) but more likely to be receiving another injectable treatment (17% vs 12%, P=0.002). In multivariate analysis, younger age (P< 0.001) and not taking other daily pills (P=0.048) were associated with LAI CAB/RPV initiation.

Conclusion

Younger age and not taking other daily pills were associated with LAI-CAB/RPV initiation. More work is needed to understand the reach of LAI-CAB/RPV for those eligible and interested in receiving it.

Disclosures

Eleanor Friedman, PhD, Gilead health sciences: Grant/Research Support Aniruddha Hazra, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|ViiV Healthcare: Advisor/Consultant Katerina Christopoulos, MD, MPH, Janssen: Honoraria Moira McNulty, MD, Gilead Sciences, Inc.: Advisor/Consultant
P-549. Early Results from a Community-Based HIV Rapid Start Initiative, Memphis TN
Authors: Closs David
Published: January 2025

Background

In 2023, Memphis ranked second in the US for the highest rates of new HIV infections. Friends for All (FFA) is a community-based organization located in Memphis whose aim is to prevent the spread of HIV and improve health outcomes of those living with HIV through a holistic and client-centered approach. To improve health outcomes for people diagnosed with HIV and prevent further transmission, FFA launched a rapid test and treat HIV initiative with the primary aim of increasing viral suppression and retention in care.

Methods

We offered free HIV testing at our sexual health clinic and pop-up community testing sites. Individuals that tested positive for HIV and had no prior HIV diagnosis were offered rapid start HIV treatment, defined as treatment initiation within 72 hours. Staff administered an assessment of barriers to linkage and scheduled the appointment.

Results

Between July 2023 and March 2024, FFA tested 2131 clients for HIV. Of the 125 who tested positive, 14 met rapid start criteria. We successfully initiated treatment inside the 72-hour window for 12 (83%) of the 14 eligible. Ninety days post rapid start, 10 (83%) achieved viral suppression and 10 (83%) attended at least 3 medical appointments. The two clients who did not initiate rapid start treatment were identified at pop-up events outside of normal clinic hours, and it was not possible to schedule an appointment within 72 hours. Both of these clients did, however, initiate treatment within 7 days of diagnosis.

Conclusion

While linkage to rapid start ART has been successful in the clinical setting, barriers remain at the patient and organizational level that prevent similar outcomes in the outreach setting. Patients reported barriers to appointment attendance, including food insecurity and transportation. At the organizational level, limited access to ART outside of clinic hours and prescriber requirements for in-person care prevent successful linkage from outreach settings. We are investigating the use of a mobile unit to initiate rapid start treatment in outreach settings and telehealth options for ongoing HIV care. To address patient level barriers, FFA will continue to provide transportation and food services to those living with HIV.

Disclosures

David Closs, MPH, Gilead Sciences: Grant/Research Support
P-556. Efficacy and Safety of Bictegravir/Emtricitabine/TenofovirAlafenamide in Females Living With HIV: 96 Weeks Real Life Analysis
Authors: De Vito Andrea , Ceccarelli Manuela , Colpani Agnese , Venanzi Rullo Emmanuele , Spampinato Serena , Sofia Sonia Agata , Pantò Grazia , Albanese Antonio , Frasca maria Chiara , Paternò Raddusa Michele Salvatore , Campanella Antonio Edoardo , Santoro Laura , Russotto Ylenia , todaro laura , Coco Mariagiovanna , Micali Cristina , Pulvirenti Sarah , calì claudia , Di Rosolini Maria Antonietta , moi Giulia , conti giuseppe , Marino Andrea , Pellicanò Giovanni Francesco , Iacobello Carmelo , Montineri Arturo , Santi Cacopardo Bruno , angioni goffredo , Madeddu Giordano , Nunnari Giuseppe
Published: January 2025

Background

Females with HIV (FWH) are underrepresented in HIV trials. Pooled data from 5 trials at 48 weeks demonstrated the virological efficacy and safety of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF). We evaluated the safety and efficacy of B/F/TAF in a cohort of 99 FWH, in a real-life setting, at 48 and 96 weeks from the switch.

Methods

We conducted a multicentric cohort study that included all experienced FWH starting B/F/TAF treatment in the Shine&Shic cohort across six Infectious Disease Centers in Italy. We collected demographic, epidemiological, clinical, and laboratory data at the time of the switch and at 48 and 96 weeks. Informed consent was obtained from all participants.

Data were reported as numbers (%), or using median and interquartile range (IQR), as appropriate. We assessed differences between baseline, 48 weeks, and 96 weeks using the Mann-Whitney test. A p-value of less than 0.05 was considered significant.

Results

We included 99 females with HIV (FWH) in the study, with a median age of 51.9 years (IQR 43.1-57.8) and a duration of HIV infection of 15.1 years (IQR 5.1-24.7). During follow-up, we observed an increase in the percentage of FWH with an undetectable viral load (Figure 1).

We noted a significant increase in CD4 cells/mL and in CD4/CD8 ratio at 48 and 96 weeks and no differences in CD8 cell counts (Table 2).

Of importance, we observed a significant reductions in total cholesterol and low-density lipoprotein (LDL) at both 48 and 96 weeks. No significant changes were observed in transaminase levels, glucose levels, high-density lipoprotein (HDL), or triglycerides (Table 2). Regarding safety, there was a significant increase in creatinine at 48 and 96 weeks.

We registered 9 interruptions of B/F/TAF: 3 due to loss to follow-up, 1 death, 1 switch to long-acting treatment, 1 due to adverse events, and in 3 cases, due to patient’s choice.

Conclusion

The number of FWH on B/F/TAF under virological suppression increased at 48 and 96 weeks. Furthermore, CD4 T-cell and CD4/CD8 ratio also augmented, underlining an amelioration of the immunological and inflammatory profile. Of note, LDL cholesterol levels significantly decreased overtime. B/F/TAF is virologically and immunologically effective in FWH, in a real-life setting, at 96 weeks from the switch.

Disclosures

All Authors: No reported disclosures
P-564. Long Term Follow Up of Rapid or Same-day Start of Antiretroviral Therapy (ART) in Patients Living With HIV (PWH) in the Midwestern US
Authors: Duggan Joan , Sahloff Eric G
Published: January 2025

Background

Current DHHS guidelines recommend starting ART in PWH immediately or as soon as possible after HIV diagnosis to improve ART uptake, linkages to care and virologic suppression (VS). But there is little data measuring the longitudinal impact of rapidly starting ART. We previously showed that rapidly starting ART significantly decreased time to VS. This study compares the longitudinal effects of rapid ART start versus delayed ART initiation on retention in care and VS in a previously defined cohort of PWH.

Methods

IRB-approved follow up study of a single-center, retrospective cohort. The original cohort included all newly diagnosed, antiretroviral-naïve adult patients seen in the Ryan White Clinic (RWC) at a single site for their initial visit between 1/1/15-12/31/15 (delayed ART) and 1/1/17-12/31/17 (rapid ART): Table 1 and Table 2. In the original cohort, primary outcome of time from HIV diagnosis to VS [VL < 200 copies/ml (cp/ml)] was compared between groups. For the current study, the primary outcomes of VS (VL < 50 cp/ml) and retention in care (documented visit at study site or documented transition of care) were measured in the original cohort participants from 1/1/23-12/31/23. Reasons for lack of retention in care were death and loss to follow up.

Results

In the original cohort, 72 patients were screened and 60 met inclusion criteria; (24 delayed ART, 36 rapid ART). The long-term outcomes for VS and retention in care are shown in Table 3. 11/24 (delayed) and 23/36 (rapid) remained engaged in care at the study institution (p=.193). 9/11 (82%) and 22/23 (96%) maintained VS (p=.239), in the delayed ART and rapid ART, respectively. Participants were more likely to be retained in care (at study site or with documented transition in care) in the rapid ART group (11/22 delayed ART vs. 31/35 rapid ART, p=.002) If not retained in care at the study site, delayed ART participants were more likely to be lost to follow up versus having a documented transition in care or death [11/13 delayed ART vs 4/13 rapid ART, (p=.015)].

Conclusion

A previous study showed a shortened time to VS with rapid start of ART. Long-term retention in care may be significantly improved with rapid start of ART and requires further study. Rapid start may also demonstrate a trend towards increased VS.

Disclosures

All Authors: No reported disclosures
P-578. Just “Short of a Cure”: Unique Considerations in Uptake and Use of Long-Acting Injectable Cabotegravir/Rilpivirine Among Long-Term Survivors with HIV
Authors: Pareek Priyasha , Collins Lauren F , Dance Kaylin , Smith Mollie , Dawdani Alicia , Erguera Xavier A , Walker Ryan , Grochowski Janet , Mayorga-Munoz Francis , Hickey Matt , Johnson Mallory , Sauceda John , Gutierrez Jose I , Balter Laurence , McNulty Moira , Koester Kimberly , Christopoulos Katerina , Colasanti Jonathan
Published: January 2025

Background

Understanding perspectives of subgroups of people with HIV (PWH) who have accessed long-acting cabotegravir/rilpivirine (CAB/RPV-LA) is crucial for optimizing implementation; especially among long-term survivors (LTS) who have lived through the trauma of the early epidemic to the innovation of today.

Methods

We analyzed semi-structured interviews collected from 08/2022-05/2023 via a parent study at four Ryan White clinics in Atlanta, Chicago, and San Francisco among early adopters of CAB/RPV-LA (received ≥3 injections or discontinued). Our analysis explored factors impacting CAB/RPV-LA uptake and use in LTS (living with HIV since 2000 or earlier) using a socioecological model of HIV care engagement.

Results

Among 20 LTS, median age was 56 (Q1-Q3 54-60) years and median time living with HIV was 27 (Q1-Q3 25-34) years. Thirteen (65%) identified as racial/ethnic minorities and seven (35%) as cis or trans women. We identified three primary themes: 1) The majority of LTS eagerly awaited CAB/RPV-LA and seemed unconflicted in their choice to switch from oral antiretroviral therapy (ART). Their confidence stemmed from experience using new iterations of oral ART over decades, with some citing CAB/RPV-LA as being a step closer to a cure. 2) Choosing to start CAB/RPV-LA was sometimes facilitated by input from longstanding, trusted relationships with healthcare providers or other PWH. 3) Reflections on the emotional gravity of witnessing loved ones die from AIDS-related illnesses early in the epidemic, and the mental imprisonment of around-the-clock pill taking required for their own survival, influenced use of CAB/RPV-LA. In fact, many reported transforming HIV-related psychological trauma and tragedy into education, support, and advocacy efforts: using CAB/RPV-LA was a unique mechanism to further benefit their community—indeed, it was an obligation to both PWH who have passed as well as PWH to come, who could learn from their experience. 

Conclusion

The perspectives of LTS who initiated CAB/RPV-LA during early implementation revealed uptake and use was shaped by the emotional, psychosocial, and physical impact of living with HIV for decades. These data serve as a framework to tailor service delivery of current and future long-acting ART options in this population.

Disclosures

Moira McNulty, MD, Gilead Sciences, Inc.: Advisor/Consultant Katerina Christopoulos, MD, MPH, Janssen: Honoraria
P-585. Improvement in Time to Viral Suppression Pre/Post an Anti-Retroviral Treatment and Access to Services Intervention (ARTAS) for Emergency Department Patients
Authors: Ludden Thomas , Parker Sam , Leonard Michael , Thomas Jeremy , Jefferson Dasia , McLean Jaylyn
Published: January 2025

Background

While the benefits of early entry into medical care are well-documented, more than one-third of people living with HIV and AIDS (PLWHA) who know their serostatus are not linked to medical care. Nearly 39 percent delay entry into care by 12 months, and 32 percent delay entry for more than 2 years. People do not link to medical care following an HIV-positive diagnosis for a variety of reasons. These may include but are not limited to personal barriers such as unemployment, lack of health insurance, fear, stigma, substance use, mental health issues, lack of transportation, homelessness, and/or not having the required forms of identification to receive services. Other system-level barriers include wait lists for services and/or medications and complex, confusing administrative processes. Rarely do people face only one barrier to accessing medical care. Anti-retroviral treatment and Access to Services Intervention (ARTAS) is an individual-level, multi-session, time-limited intervention designed to link individuals who have been recently diagnosed with HIV in the Emergency Department (ED) to medical care.

Methods

African American or Hispanic/Latino male patients who tested positive for HIV for the first time in the emergency department in an urban Southeastern location were included in the analysis. The number of days to viral suppression was calculated from the date of diagnosis to the undetectable viral load test. The average number of days was summarized and compared using the difference in means one year pre/post the implementation of ARTAS in the emergency department.

Results

ARTAS was implemented on March 1, 2022. Eight patients were diagnosed with HIV in the ED one year before this date, with an average of 264 days to viral suppression. 53 patients were diagnosed one year after that date, with the average number of days from diagnosis to viral suppression decreased to 113 with an average difference of 151 days ([95%] CI 54.6150 to 247.3850, P=0.03). From the time of the first visit with an HIV provider to viral suppression was 86 and 85 days, respectively.

Conclusion

An ARTAS implementation in the ED reduced the time from diagnosis to viral suppression by 57%.

Disclosures

All Authors: No reported disclosures
P-593. Does Dolutegravir increase hypercholesterolemia and/or hypertriglyceridemia?
Authors: Talibi Alaoui Zahid , Idalene Malika
Published: January 2025

Background

Antiretroviral therapy improved prognosis of people living with HIV (PLWA). WHO recommends Dolutegravir as the preferred treatment option for HIV in all populations considering its high genetic barrier and rare adverse effects compared to other treatments. In Morocco, the transition to Dolutegravir has begun in 2020 with the regimen: tenofovir desproxil fumarate/lamivudine/dolutegravir TDF/3TC/DTG (TLD). Some studies shown increased cholesterol and triglycerides levels on TLD regimens. The purpose of this study is to compare the effect of TLD on cholesterol and triglyceride levels compared to other antiretroviral therapy (ART) regimens.

Methods

We conducted an observational comparative study at the Infectious diseases department Mohammed VI university hospital Marrakesh, MOROCCO. We included all PLWA admitted between 1st January 2021 and 31 December 2022 put on any ART and having a lipidic dosage. We excluded all patients with previous hypercholesterolemia and/or hypertriglyceridemia. We compared the occurrence of hypercholesterolemia and/or hypertriglyceridemia in PLHIV on TLD with those on other ART. For the statistical analysis a pearson chi-square test was used with the R software.

Results

We included 173 PLWA; the median age was 33 years. 66.5% were male. The viral load was available in 152 people and was < 1000 copies/mL in 98%. The CD4 count was available in 161 persons and was >200 cells/mm3 in 69.6%. There were 120 persons on TLD arm (69.36%) and 53 on other ART arm (30.64%). On the TLD arm 15 people (12.5%) and 16 (13%) have developped an hypercholesterolemia and/or hypertriglyceridemia respectively versus 10 (18.86%) and 12 (22.64%) have developped an hypercholesterolemia and/or hypertriglyceridemia respectively on the others ART arm, but the difference was statistically non-significant (X2= 0.74; p=0.38) for hypercholesterolemia and (X2= 1.47; p=0.22) for hypertriglyceridemia.

Conclusion

This study shows that there is no strong evidence of any association between the TLD regimen and the hypercholesterolemia and/or hypertriglyceridemia. The TLD regimen is more safe on the lipidic metabolism compared with other ART. Further large studies are needed to prove this benefit.

Disclosures

All Authors: No reported disclosures
P-619. Effectiveness of the 10-valent Pneumococcal Conjugate Vaccine (PCV10) on Hospital Admission due to Pneumonia among Nepalese Children
Authors: Hayashi Yumiko , Shrestha Dhruba , Raya Ganendra , Shrestha Raj , Morimoto Konosuke , Parry Christopher , Ariyoshi Koya , Dhoubhadel Bhim G
Published: January 2025

Background

Streptococcus pneumoniae is the most common bacteria that causes pneumonia in children. The 10-valent pneumococcal vaccine (PCV10) has been introduced in the national immunization program (2+1 schedule: 6 and 10 weeks, and 9 months) in Nepal since 2015. The impact of PCV10 on hospital admission due to pneumonia is not well known in Nepal.

Methods

A cross-sectional study was carried out in Siddhi Memorial Hospital (SMH), Bhaktapur, Nepal, including hospital data from 2014 to 2022. SMH is the only pediatric general hospital in Bhaktapur district. The impact of PCV10 was assessed as a prevalence ratio analyzed with a log-binomial regression model. The prevalence ratio was calculated with the prevalence of hospital-admitted children due to chest x-ray confirmed pneumonia before and after the introduction of PCV10. The adjusted prevalence ratio (aPR) was measured in each year of the post-PCV10 period (2016 to 2022) by comparing the pre-PCV10 period (2014 and 2015) and adjusted by age, sex, and month of admission.

Results

A total of 10,897 children were admitted to the hospital during the study period (2014-2022). The prevalence of pneumonia was 20.4% (429/2,105) in the pre-PCV10 period and 10.5% (923/8,792) in the post-PCV10 period. The overall aPR declined; it was 0.50 (95%CI: 0.42-0.59) in 2019, just before the COVID-19 pandemic, and 0.32 (95%CI: 0.26-0.40) in 2022. Among children of 2 months to 2 years of age, we observed a 51.7% reduction in hospital admission due to pneumonia (aPR: 0.48, 95%CI: 0.37-0.61) in 2019 and a 72.6% reduction (aPR: 0.27, 95%CI: 0.19-0.40) in 2022.

Conclusion

We observed a significant decrease in hospital admissions due to pneumonia among children after the introduction of PCV10 in the national immunization program in Nepal. However, the surveillance of cases of pneumonia should be continued as the non-vaccine pneumococcal serotypes may emerge and hospital admissions due to pneumonia may go up in the future.

Disclosures

Konosuke Morimoto, MD, PhD, Pfizer: Grant/Research Support Koya Ariyoshi, MD, PhD, Pfizer: Grant/Research Support
P-625. Missed opportunities for vaccination among healthcare-seeking children–Kyrgyzstan, 2023
Authors: Dadanova Gulzada , Kubatova Aisuluu , Horth Roberta , Nabirova Dilyara , Ishenapisova Gulbara , Otorbaeva Dinara
Published: January 2025

Background

High vaccination coverage is critical to prevent disease transmission. In Bishkek, Kyrgyzstan (population: 1.15 million), coverage for many childhood vaccines had dropped to < 90% in 2022. Opportunities for vaccination were being missed at child healthcare visits. Understanding the burden and reasons for these missed opportunities was needed to increase coverage.Figure 1.Missed opportunities for vaccination by vaccine type among healthcare-seeking children in Kyrgzystan, 2023

Methods

We conducted a cross-sectional study in Bishkek in 2023 using the Missed Opportunities for Vaccination (MOV) World Health Organization protocol. We selected 33 primary care clinics and interviewed 20 caregivers of < 30 months olds in each. We abstracted vaccine history from medical records. MOV was calculated as the number of children not receiving a vaccine among those eligible for vaccination (defined as missing a dose at the start of the visit and no vaccine contraindications). The p-values from Poisson regression Wald tests are shown.Table 1.Characteristics associated with missed opportunities for vaccination among healthcare-seeking children in Kyrgzystan, 2023

Results

Of 660 caregivers interviewed, 69% (448/650) met the inclusion criteria. MOV prevalence was 86% (386/448). In children aged 0-11 months, 81% (195/240) had MOV and in children 12–30-month-olds 92% (191/208) had MOV. Vaccine-specific MOV was lowest for hepatitis B vaccines (8%; 52/648) and highest for diphtheria- pertussis-tetanus vaccines (50%; 52/103) (Figure 1). Among eligible children (n=448), 62% had >4 annual clinic visits, 6% had never been immunized, and 84% were missing vaccine cards (Table 1). Healthcare providers did not check immunization status in 53% of children or ask to see vaccine cards in 79%. Among children who came specifically for vaccination, 53% (71/133) had a MOV. MOV did not differ by sex, district, or number of annual clinic visits. MOV was higher among children with never-vaccinated caregivers vs vaccinated caregivers (98% vs 85%, p=0.03) and caregivers with self-reported negative vaccine attitudes vs positive (94% vs 83%, p=0.01).

Conclusion

Nearly nine out of ten children missing an opportunity to be immunized while seeking healthcare services. Additional training for healthcare workers, to check immunization status of all children at each visit can help reduce MOV. Strategies that address caregiver barriers to timely vaccinations can help increase immunization coverage.

Disclosures

All Authors: No reported disclosures
P-628. Real-world impact of pneumococcal conjugate vaccines on vaccine serotypes and cross-reacting non-vaccine serotypes
Authors: Apodaca Kevin , Grant Lindsay , Perdrizet Johnna , Daigle Derek , Mircus Gabriel
Published: January 2025

Background

Cross-reactivity of vaccine-induced antibodies with some non-vaccine serotypes has been demonstrated in clinical trials and serological studies, but there is limited longitudinal data on the impact of pneumococcal conjugate vaccines (PCVs) on cross-reactive serotypes after implementation in infant immunization programs. This study describes the impact of PCVs on pneumococcal disease cases due to potential cross-reactive serotypes.Table 1.Countries included in analysis

Methods

We identified 13 countries with serotyped invasive pneumococcal disease (IPD) surveillance data that had introduced PCV10 or PCV13 (Table 1). Analyses were restricted to IPD cases due to serotypes included in PCV10/13 (VTs: 6B, 9V, 18C, 19F, 23F, 7F; PCV13 only VTs: 6A, 19A) and to non-vaccine serotypes (NVTs: 6C, 7A, 7B, 7C, 9N, 18A, 18B, 18F, 23A, 23B) that could be immunologically related to VTs in children < 5 years. For each country, we compared case counts 1 year before and the latest year of data available (2018/19) after PCV introduction and calculated relative percent change.

Results

Decreases in VT IPD cases were observed across all countries after PCV introduction, while some NVT IPD cases had no change or increased. VT cases declined by 59-100%. Serotype 19A cases declined by 34-100% (0-26 cases in 2018/19) in PCV13 countries but increased by 63-1460% (13-78 cases in 2018/19) in PCV10 countries. NVT 6C cases had little to no change (0-6 cases in 2018/19) in PCV13 countries but increased by 100-1200% (1-12 cases in 2018/19) in PCV10 countries. In PCV13 countries, 7B, 7C, and 9N cases did not change (0-6 cases in 2018/19), while 23A and 23B increased moderately by 200-900% (2-16 cases in 2018/19). NVT 7B, 7C, 9N, 23A, and 23B had no data available for PCV10 countries, while NVT 7A, 18A, 18B, and 18F did not have sufficient cases in any PCV setting to include in the analysis.

Conclusion

The inclusion of VT 19A in PCV13 and not in PCV10 may explain the significant increase of NVT 19A cases in PCV10 countries. Conversely, the minimal change of NVT 6C cases in PCV13 countries but large increases in PCV10 countries suggest cross-protection of serotype 6C by PCV13, likely due to inclusion of serotype 6A. For other NVTs, cross-protection was not identified based on observing no change or increasing cases or could not be evaluated due to low case counts.

Disclosures

Kevin Apodaca, MPH, Pfizer, Inc: Employee of company|Pfizer, Inc: Stocks/Bonds (Private Company) Lindsay Grant, PhD, MPH, Pfizer, Inc: Employee of company|Pfizer, Inc: Stocks/Bonds (Private Company) Johnna Perdrizet, MPH, Pfizer, Inc: Employee of company|Pfizer, Inc: Stocks/Bonds (Private Company) Derek Daigle, PhD, Pfizer, Inc: Employee of company|Pfizer, Inc: Stocks/Bonds (Private Company) Gabriel Mircus, PhD, Pfizer, Inc: Employee of company|Pfizer, Inc: Stocks/Bonds (Private Company)
P-742. Characterization of the Inoculum Effect in Battlefield Trauma Patients with Methicillin-Susceptible Staphylococcus aureus Infections
Authors: Justen Despain , Mende Katrin , Stewart Laveta , Igo Matthew , Seibert-Parzyszek Ian , Carson M Leigh , Campbell Wesley , Wyatt Andrew , Tribble David R , Kiley John L
Published: January 2025

Background

The clinical relevance of the cefazolin inoculum effect (CIE) in methicillin-susceptible Staphylococcus aureus (MSSA) isolates has been debated, with some studies showing poor outcomes in CIE(+) MSSA patients treated with β-lactams and others finding no effect. As less is known about CIE in trauma patients, we examined characteristics of US wounded military personnel with MSSA infections with and without CIE.

Methods

Data and initial / serial (defined as isolation ≥ 7 days from prior isolate) MSSA isolates were collected from the Trauma Infectious Disease Outcomes Study (6/09-12/14). Isolates collected for surveillance were excluded. Antimicrobial susceptibility testing was performed via BD Phoenix Automated Microbiology System using CLSI criteria. Isolates were tested for CIE by broth microdilution utilizing standard (∼5x105 cfu/mL) and high (HI) inocula (∼5x107 cfu/mL). CIE(+) was defined as a MIC increase to ≥ 16 μg/mL with HI.

Results

Among 112 MSSA patients, 6 had CEI(+) and 106 CIE(-) isolates. The patients were primarily males (99%) who sustained critical injuries (mean injury severity score 36) via blasts (65%), requiring critical care (80%) and prolonged hospitalization (mean 45 days, Table 1). All patients received 1st generation cephalosporin or β-lactam with Staphylococcus coverage. There were no significant differences between the CIE(+) and CIE(-) patients. No CIE(+) patients had serial isolates, and no patients in either group died. A total of 179 MSSA isolates were assessed: 9 (5%) CIE(+) and 170 (95%) CIE(-). The majority of MSSA isolates were from respiratory (N=87, 49%), wound (N=72, 40%), and blood cultures (N=12, 7%). All isolates were uniformly susceptible to cefazolin, ampicillin-sulbactam, and ceftaroline, and had reduced susceptibility to doxycycline and tetracycline (Table 2). When compared to CIE(-) isolates, CIE(+) isolates had decreased susceptibility to clindamycin and erythromycin.

Conclusion

CIE was uncommon with battlefield MSSA infections. Evaluation of clinical outcomes was limited (i.e., small numbers), but serial CIE(+) isolation was not observed. Although CIE(+) isolates were more resistant to clindamycin and erythromycin, isolates remained susceptible to other first-line antimicrobials.

Disclosures

All Authors: No reported disclosures
Destined for destruction: The role of methionine aminopeptidases and plant cysteine oxidases in N-degron formation
Authors: Fuentes-Terrón Andrea , Latter Rebecca , Madden Samuel , Manrique-Gil Isabel , Estrada Jessenia , Arteaga Noelia , Sánchez-Vicente Inmaculada , Lorenzo Oscar , Flashman Emily
Published: January 2025

The cysteine/arginine (Cys/Arg) branch of the N-degron pathway controls the stability of certain proteins with methionine (Met)-Cys N-termini, initiated by Met cleavage and Cys oxidation. In seeding plants, target proteins include the Group VII Ethylene Response Factors, which initiate adaptive responses to low oxygen (hypoxic) stress, as well as Vernalization 2 (VRN2) and Little Zipper 2 (ZPR2), which are involved in responses to endogenous developmental hypoxia. It is essential that these target proteins are only degraded by the N-degron pathway under the appropriate physiological conditions. Modification of their N-termini is under enzymatic control by Met Aminopeptidases (MetAPs) and Plant Cysteine Oxidases (PCOs); therefore, the substrate-binding requirements and catalytic effectiveness of these enzymes are important for defining which Met-Cys–initiating proteins are degraded. Physiological conditions can also impact the activity of these enzymes, and the well-characterized oxygen sensitivity of the PCOs ensures target proteins are stabilized in hypoxia. In this review we compile the functional and structural properties of MetAPs and PCOs, including their interactions with substrates. We also consider the evolution of MetAPs and PCOs through the plant kingdom to highlight their important role in controlling the initial steps of this branch of the N-degron pathway.
The Spirit and/of Political Science
Authors: Menchik Jeremy
Published: January 2025

The word “spirit” appears in discipline's leading journals more often than other expressions associated with religion like “Christianity,” “religion,” and “faith.” Yet, despite its ubiquity, it is unclear how or why the term is used in social science analysis. What do political scientists talk about when they talk about the spirit? Answering this question has important implications for conceptual clarity, for the study of religion in the discipline of political science, and for mapping the influence of religion on the discipline of political science. The article answers this question through a conceptual genealogy of the term “spirit” in the publications of classical, modern, and contemporary scholars, alongside a quantitative content analysis using a novel data set. For classical scholars, the concept of the spirit repurposed the Christian Holy Spirit to advance Enlightenment theories about human progress. For modern and contemporary scholars, the spirit was further scrubbed of Christian connotations and inscribed with liberal idealist commitments to freedom. When political scientists talk about spirit, they reveal a theoretical indebtedness to the Christian concept of a transcendent and intangible force that animates, directs, and guides humans. American political science's continued entanglement with liberal Protestantism has made the discipline's emphasis on liberal democracy appear natural and given rather than particularistic. Furthermore, explicating American political science's entanglement with liberal Protestantism helps to explain longstanding gaps in knowledge and systematic exclusions.
Research progress regarding endocannabinoid system involvement in pain modulation and electroacupuncture analgesia
Authors: Qin Renjie , Wu Yisong , Jin Nuo , Xu Xingzhi , Lan Yuye , Jing Xianghong , Li Man
Published: January 2025

Pain is a subjective and unpleasant sensation that significantly impacts the daily lives of individuals. Chronic pain represents one of the most challenging public health issues, and ensuring effective pain management is a fundamental right of individuals and a sacred duty of healthcare providers. Cannabis, one of the earliest recognized medicinal plants, contains cannabinoids, which are non-opioid substances that modulate nociceptive responses. Electroacupuncture (EA), characterized by its low-risk and well-tolerated nature, is pivotal in pain management. The endocannabinoid system consists of endocannabinoids, cannabinoid receptors, and enzymes involved in endocannabinoid synthesis, degradation, and transport. Recently, the role of the endocannabinoid system in pain development and EA analgesia has attracted considerable research attention. Studies have highlighted the role of the endocannabinoid system in various types of pain, including inflammatory pain, neuropathic pain, and cancer-related pain, as well as in EA analgesia. This study aims to review the mechanisms of endocannabinoid system involvement in pain modulation and EA analgesia to provide insights to inform clinical approaches to pain management.

Graphical abstract: http://links.lww.com/AHM/A150.
Correlation Between Handgrip Strength and Bone Density and Fragility Fracture Risk Among Older Adults: A Cross-Sectional Study
Authors: HUANG Shyh-Geng , LEE Ru-Ping , YAO Ting-Kuo , WANG Jen-Hung , WU Wen-Tien , YEH Kuang-Ting
Published: January 2025

Background

Population aging has led to a surge in elderly care needs worldwide. Bone aging, skeletal muscle degeneration, and osteoporosis pose critical health challenges for the elderly. The process of bone and skeletal muscle aging not only impacts the functional abilities but also increases fragility fracture risk. Although a negative correlation between handgrip strength and fragility fracture risk has been identified in elderly populations, there is a lack of related research in Taiwan.

Purpose

This cross-sectional study was designed to investigate the association between handgrip strength and two outcome variables, bone density and risk of fragility fracture, in Taiwanese individuals aged 65 years and older with low bone mass.

Methods

A total of 548 older adults, including 84 men and 464 women, were recruited between August 2019 and July 2021. Bone mineral density T-scores acquired using dual-energy X-ray absorptiometry scan, the total score for the Taiwan-specific Fracture Risk Assessment (FRAX) tool, and bilateral handgrip strength acquired using a digital hand dynamometer were recorded along with other factors such as comorbidities, dietary habits, and daily activities.

Results

In this study, the mean age was 70.9 (SD = 5.6) years, mean bone mass index was 24.1 (SD = 3.5) kg/m2, mean FRAX main fracture risk score was 19.5% (SD = 8.3), and mean FRAX hip fracture risk score was 7.7% (SD = 5.7). Lumbar and hip T-scores were both significantly correlated with both dominant and nondominant handgrip strength in older woman. Older age; both lower hip and spine T-scores; both lower dominant and nondominant handgrip strengths; having Type 2 diabetes, coronary artery disease, or chronic hepatic disease; and lacking a steady job were significantly associated with a higher risk of fragility fracture.

Conclusions/Implications for Practice

The results of this study provide important information regarding the correlation between handgrip strength and several variables, including bone mineral density T-score, FRAX score, comorbidities, and job status, among older adults. Notably, these correlations were found to be particularly strong in the female participants. This information may be used to facilitate the early identification of elderly individuals at a high risk of fragility fractures, enabling the timely development of preventive nursing strategies and the provision of targeted interventions.
The Relationship Between Perceived Staffing and Quality of Care: The Mediating Roles of Job Satisfaction and Work Engagement
Authors: WANG Limin , DONG Xu , SHANG Shaomei
Published: January 2025

Background

Although work engagement and job satisfaction are two important indicators associated with care quality, their mediating effects on the relationship between perceived staffing and quality of care have not been adequately clarified.

Purpose

This study was designed to determine the mechanism by which nurses' perceived staffing influences quality of care by clarifying the mediating roles of job satisfaction and work engagement.

Methods

A cross-sectional questionnaire survey was implemented among 2,142 clinical nurses from 211 inpatient wards in 13 hospitals. Work engagement, job satisfaction, perceived staffing, and rated quality of care were measured.

Results

Most (89.7%) of the respondents rated quality of care as good or better, and 56.1% perceived staffing in the wards as adequate. The two main findings of this study are as follows: (a) Perceived staffing influenced quality of care via one direct and three indirect pathways, with the indirect effect greater than the direct effect (βdirect = 0.09, βtotal indirect = 0.25), and (b) work engagement and job satisfaction were important mediators of the impact of staffing on quality of care.

Conclusion

Quality of care may be enhanced by improving the work engagement and satisfaction of nurses in their current job, suggesting an effective approach to alleviating the current nursing shortage.
Causal role of 731 immune cells in pancreatic cancer: a Mendelian Randomization study
Authors: Feng Zhengyuan , Cao Ruiqi , Wu Jiaoxing , Mo Jiantao , Wang Qiqi , Wu Shuai , Ma Qingyong , Wang Zheng , Zhou Cancan , Wu Zheng
Published: January 2025

Background:

Pancreatic cancer poses a significant worldwide health challenge. Immune cells are implicated in pancreatic cancer progression and therapy, yet the precise influence of distinct subsets of immune cells remains largely unexplored. The objective of this study is to pinpoint immunophenotypes linked to pancreatic cancer.

Methods:

Two-sample Mendelian randomization (MR) analysis was employed. Immune phenotypes were retrieved from GWAS, and pancreatic cancer data from the IEU project was split into training and validation sets. Causality was evaluated using the IVW, MR Egger, and weighted median methods. Evaluation included MR-Egger intercept test, funnel plot, leave-one-out analysis for horizontal pleiotropy, and Cochran's Q test for heterogeneity. Estimates from the two sets were combined using the fixed-effects meta-analysis methods.

Results:

6 immunophenotypes exhibiting inhibitory effects and 1 showing promoting role. Which is CD20 on IgD+ CD38- naive B cells (95% CI=0.765~0.948, P=0.003, OR = 0.852), CD24 on unsw mem B cells (95% CI=0.861~0.975, P=0.006, OR = 0.917), CD25 on B cells (95% CI=0.859~0.978, P=0.008, OR = 0.917), CD64 on monocyte (95% CI=0.802~0.921, P<0.001, OR = 0.859), CD25 on resting Treg cells (95% CI=0.784~0.957, P=0.005, OR = 0.866), CD39+ CD8br AC Treg cells (95% CI=0.816~0.971, P=0.008, OR = 0.890), HLA DR on B cell (95% CI=1.055~1.206, P<0.001, OR = 1.128) . None immunophenotype displayed potential reverse causality. The reliability of these results was confirmed by the fixed-effects meta-analysis methods.

Conclusion:

Our study has unveiled causal relationships between immunophenotypes and pancreatic cancer, which can offer guidance for future clinical and basic research endeavors.
Quality of Information in Carpal Tunnel Syndrome
Authors: Aguilar Javier Suárez , Florido Manuel Viñuela , Mayol Julio , Cristóbal Lara , Maldonado Andrés A.
Published: January 2025

Introduction

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment disease, and it is a subject of great interest and concern to medical professionals and the general public. Our study aims to analyze and compare the quality and accuracy of the information related to CTS provided by social media platforms (SMPs) and the new large language models (LLM).

Methods

On YouTube, the first 20 videos in English and the first 20 videos in Spanish when searching for “carpal tunnel syndrome” and “síndrome túnel carpo” were selected. On Instagram, the first 20 videos with the hashtag #carpaltunnelsyndrome and #tunelcarpiano were chosen (in total 80 videos). Duration, number of likes, number of views, number of followers, upload date, and author category (medical specialist, patient, etc) were evaluated. Three specific questions about CTS were asked to 2 new LLMs (ChatGPT and Google Bard). The quality of information was analyzed and compared by two independent board-certified plastic surgeons using the Journal of American Medical Association (JAMA) and DISCERN scales.

Results

LLMs showed a significant higher quality of information when compared with SMPs based on the DISCERN scores (P < 0.05). Average DISCERN scores for answers given by ChatGPT and Google Bard were 52.83 and 57.83, respectively (good quality). In YouTube and Instagram, the average score for the 80 videos based on the JAMA scale was 1.92 (low reliability) and 25.18 (very low quality) on the DISCERN scale. Videos created by medical professionals in SMPs were associated with a higher JAMA and DISCERN scores (P < 0.05). 53.8% of the videos were made by a nonmedical author.

Conclusions

The quality of information from LLMs was good and significantly better than in SMP. A low participation of board-certified surgeons in SMP was found. Board-certified surgeons should be more involved in LLM and SMPs to increase leadership, improve education, and spread knowledge of peripheral nerve surgery.