bluuebunny/crossref_metadata_2025 huggingface dataset:
P-462. Disparities in HPV Vaccination among HIV Patients at a Rural Federally Funded HIV Clinic- A Retrospective Study
Authors: Sripathi Shanthi Reddy , Sivasubramanian Barath Prashanth , Jagannathan Madhumithaa , Javvaji Avinash , Shanmugam Dinesh Kumar , Swami Kannan Bharath Duraisamy , Joshi Shashvat , Jain Priyanshu , Babu Sonia , Smith Kathyrn , Dalal Rutul , Tirupathi Raghavendra
Published: January 2025

Background

Our study aimed to evaluate the demographic factors of HPV vaccination among racial minorities of HIV patients at a non-academic Ryan White clinic in rural Pennsylvania.

Methods

A retrospective cross sectional study (n=143) was conducted on a population composed of White (51.05%), White Hispanics WH (11.19%), Black (27.97%), Black Hispanics BH (1.4%), and Unknown (8.39%). Proportions and chi-square tests were used and multivariate regression analysis was done with p≤0.05 as significant.

Results

Our study found that 35% of the population was vaccinated, with 60.7% receiving three doses and 23.2% receiving two doses. Age was a key factor (p=0.000) for vaccination acceptance (VA), with those aged 25-45 years having a higher VA than the nonvaccinated (NonVA) (62% vs. 24.7%). VA was lower among those aged 46-65 years (30% vs. 61.3%) and those over 65 years (8% vs. 14%). Lack of awareness of the benefits and misconceptions about the side effects of vaccination are common among different age groups. Males were predominant in our study, with VA higher than NonVA (86% vs. 81.7%, p=0.5), though the difference was not significant. VA by race showed marginal significance (p=0.1), with Whites having the highest VA (40%), followed by Blacks (32%) and Hispanics (20%). Multivariate regression revealed that the 46-65 age group had 80% lower odds of VA compared to the 25-45 group (aOR 0.2, p=0.000), while >65 years had 78% lower odds (aOR 0.22, p=0.021). This regression analysis was adjusted for race (White=Ref, Black p=0.7, Hispanic p=0.1). Upon further stratification of the Hispanic population, VA in the 25-45 years was 6.4% for Black Hispanics and 22.6% for White Hispanics (p=0.000).

Conclusion

Our study highlights that age and ethnicity are significant predictors of vaccination acceptance, with younger individuals and Whites demonstrating a higher likelihood of vaccination acceptance. Among the racial minorities, vaccination acceptance was lowest in Hispanics. These findings underscore the importance of demographic and cultural factors affecting vaccination rates. Targeted interventions to increase awareness and future studies are needed to determine the factors associated with vaccine hesitancy and work toward implementing new strategies to improve it.

Disclosures

All Authors: No reported disclosures
P-464. Implementation of Non-Mydriatic Fundus Imaging for HIV-Associated Meningitis Patients in Uganda
Authors: Yueh Spencer , Mugabi Timothy , Leon Kristoffer E , Tran Tu M , Meya David , Skipper Caleb
Published: January 2025

Background

Persons with HIV-associated meningitis are at increased risk of visual impairment. It is often unclear whether this is due to the underlying meningitis pathophysiology or whether a second etiology may be present, due to the difficulty in accessing expert exams in resource-limited settings. Our long-term goal is to determine retinal disease prevalence, particularly treatable infections (e.g. CMV retinitis), in those with HIV-associated meningitis. Here we present pilot feasibility data of non-mydriatic fundus imaging in a sick inpatient population in Uganda.Figure 1.Full FOV image of a healthy retina.Non-mydriatic photo of the left eye of a 31-year-old male admitted for cryptococcal meningitis.

Methods

We designed a prospective cohort pilot study of adult Ugandans with HIV-associated meningitis to determine the feasibility of portable digital fundoscopic photography in detecting retinal pathology. We trained medical officers to use the Phelcom Eyer Fundus Camera, which obtains high quality non-mydriatic images of the fundus. We categorized image quality into three groups: full field-of-view (FOV), partial FOV and interpretable, or uninterpretable photographs with minimal FOV. We determined: 1) the proportion of eyes in which an adequate image is obtained and 2) the prevalence of any retinal pathology in this population.Figure 2.Partial FOV image of CMV retinitis.Non-mydriatic photo of the left eye of a 36-year-old female admitted for cryptococcal meningitis. The fundus has a "cheese and ketchup" appearance, a classic finding in CMV retinitis. (Full case description will be included with the poster)

Results

From 2/15/23 to 5/2/24, we captured retinal images of 245 patients and 475 eyes (15 patients had only one eye imaged), who were hospitalized for HIV-associated meningitis. We obtained a full FOV image (Figure 1) in 62% (296/475) of photographed eyes, while 31% (148/475) of eyes had a partial FOV, and 7% (31/475) of eyes had uninterpretable photographs. Of the 245 patients screened, 75 (31%) showed any retinal pathology. Figure 2 demonstrates a case where non-mydriatic fundus imaging was used to capture and diagnose a reversible case of CMV retinitis.

Conclusion

We demonstrated that the portable Phelcom Eyer camera can successfully generate fundus images to identify retinal pathologies in our patient population. Our team captured interpretable images in 93% of eyes despite the confusion or neurological deficits often present in this sick population. These results demonstrate the necessity of screening for retinal pathology in this population, and that mobile non-mydriatic fundoscopic imaging is a promising solution in resource-limited settings.

Disclosures

All Authors: No reported disclosures
P-485. Enhancing Adolescent Human Immunodeficiency Virus (HIV) Screening : A Quality Improvement Approach with Point-of-Care Testing
Authors: Abutouk Mona , Pina Gabrielle , Davidge Rachel
Published: January 2025

Background

Pediatricians play a key role in preventing Human Immunodeficiency Virus (HIV) by offering routine HIV testing. While there has been great progress in treatment for patients with HIV/AIDS, many adolescents still believe they are not at risk for HIV and have never been tested. Recent studies have shown that almost half of adolescents who have HIV are undiagnosed. A key barrier to screening adolescents for HIV during clinic well child visits includes patient follow through with HIV screening lab work. Traditionally, this requires a visit to the lab, serum draw, followed by waiting hours to days for a result. We sought to eliminate this barrier by implementing a point of care (POC) HIV oral swab during adolescent well child visits with anticipation of increasing overall HIV screening rates.

Plan Do-Study-Act Cycle

Multiple PDSA cycles were implemented throughout the project to ensure continued improvement and integration of HIV screening during clinic visits. This was the an example of the main overarching PDSA cycle driving quality improvement.

Methods

Adolescents ages 15-18 presenting for well-child check who had not yet tested for HIV were eligible.

Interventions included creating educational curriculum for physicians regarding HIV screening guidelines, generating mulit-lingual resources for families about the importance of HIV screening, and utilizing a multidisciplinary team to implement testing into clinic workflow.

The primary outcome measure was the monthly percentage of adolescents ages 15-18 who were screened for HIV via the POC swab during their WCC.

Multiple “Plan-Do-Study-Act cycles” were implemented to reinforce change.

Proportion of Adolescents tested for HIV

Red arrow indicated when POC HIV swabs became available for use in clinic

Results

We found a statistically significant difference between the proportion of patients screened for HIV before and after the availability of POC HIV swab with p< 0.001.

Prior to implementation, the year-to-date percentage of those screened among eligible patients from January 2023 to July 2023 was 29% (80/276). Within eight months of implementation of the HIV POC swab from August 2023 to March 2024 the percentage of adolescents screened increased to 47 % (155/331).

Conclusion

Improving HIV screening among adolescents is feasible and effective through the use of point of care rapid antibody testing. This type of testing is painless, can be quickly performed during clinic visits, and improves patient confidentiality as results are available at time of visit instead of traditionally waiting for the results by phone or email. Medicaid covers POC testing for HIV so this form of testing could be used in many clinics.

Disclosures

All Authors: No reported disclosures
P-490. Differentiation of Latent Versus Active HIV Infection at the Single Cell Level Using RT-ddPCR
Authors: Pernet Olivier , Wu Qinlan , anthony Patricia , McCaney Gwyndolyn , Kovacs Andrea
Published: January 2025

Background

With successful treatment of HIV, viral loads can drop to levels undetectable by regular qPCR diagnostic methods. However, the virus remains latent in cellular reservoirs . These reservoir cells are rare, and their quantification is a critical parameter to assess future HIV treatments. Digital PCR (dPCR) technology bypasses the limitation inherent to regular qPCR, and can quantify to some extent cells with latent HIV infection within a cell population.

Methods

Here we describe a protocol relying on dPCR that allows differentiation between active and latent infection at the single cell level. We used a digital droplet setting (ddPCR) that allows for reverse transcription (RT) within the droplet. The assay is multiplexed to detect both HIV proviral DNA as well as spliced mRNA indicative of HIV active replication. Briefly, single cell are isolated into droplet containing RT-ddPCR reaction, including the Bio-Rad Supermix One-Step RT ddPCR Advanced Kit and primers/probe sets targeting HIV genome gag in the FAMlow channel and the spliced 2kb class mRNA in the FAMhigh channel. After the RT-PCR reaction, the droplet fluorescence intensity was measured using a Bio-Rad Q200 droplet reader.

Results

We successfully evaluated HIV activation in cells lines with (8E5) or without HIV (CEM-T4) infection, as well as volunteer Peripheral Blood Mononuclear Cells (PBMC). We first determine the fluorescence bandwith for each target using DNA/RNA purified from cell lysate, identifying the HIV genomic DNA signal (FAMlow) between 2500 and 3500 MFI and the active replication signal (FAMhigh) between 4000 and 5000 MFI. We then repeated the RT-ddPCR reaction, this time using cells isolated in an excess of droplets (2000 cells for 15,000 droplet per reaction).

Conclusion

This

Single Cell RT-ddPCR protocol allows for identification and quantification of HIV infected cells and assess their individual level of activation/latency. In the future, the multiplexing approach could be used to not only assess HIV activation, but also to identify cellular transcripts specific to latency or active replication.

Disclosures

All Authors: No reported disclosures
P-493. Decreasing Depressive Symptoms among Adults Living with HIV - United States Medical Monitoring Project (MMP), 2015-2022
Authors: O’Connor Siobhan M , Weiser John , Yuan Xin , Kuo Yishiow , Beer Linda
Published: January 2025

Background

People with HIV (PWH) have higher rates of depression than people without HIV. We assessed trends in prevalence of depression among PWH in the United States (U.S.).

Methods

We analyzed the weighted prevalence and estimated annual percentage change (EAPC), with associated 95% confidence intervals (CI), of DSM-IV criteria-defined major or other depression (depression) based on self-reported answers to Patient Health Questionnaire-8 questions from a nationally representative sample of U.S. adults with diagnosed HIV. Data were collected in 7 annual cycles (2015-2021) from June 01 of the indicated year to May 31 of the following year.

Results

From the 2015 through 2021 data collection cycles, prevalence of depression symptoms decreased an average of 8% annually (EAPC = -8.0%, CI -8.1%, -7.9%). Prevalence declined across most sociodemographic groups examined. Particularly large declines were seen among PWH self-identifying as heterosexual men (EAPC = -12.4%, CI -12.6%, -12.2%) or Black/African American persons (EAPC = -11.7%, CI -11.9%, -11.6%), particularly Black/African American cisgender women (EAPC = -13.8%, CI -14.0%, -13.6%; Fig 1a-1b). In contrast, prevalence of depression increased an average of 3% (EAPC = 3.0%, CI 2.2%, 3.8%) among transgender women (measured 2016-2021 due to small 2015 sample size) and changed minimally among people who injected drugs (PWID; EAPC = 0.4, 95% CI 0.1%, 0.8%; Fig 1a-1c). Further, in 2021 high prevalence of depression persisted among adult PWH who self-identified as transgender women (27.9%), PWID (39.5%) or aged 18-24 years (24.4%); experienced food insecurity (33.1%), homelessness (29.7%) or unemployment (22.8%); or self-reported disability (27.9%).

Conclusion

Overall, prevalence of depression among PWH declined an average of 8% per year during 2015-2022. However, this positive outcome was not observed among certain National HIV/AIDS Strategy priority groups; depression increased in transgender women and did not change among PWID. Understanding reasons for the decline could inform interventions to further reduce depression among PWH and address unique needs of transgender women and PWID who are most affected by persisting high levels of depression.

Disclosures

All Authors: No reported disclosures
P-505. Integrating PrEP Services into a Gynecology Clinic in Alabama: A Qualitative Analysis of Key Determinants
Authors: Goymer Hannah , Pratt Madeline , Burgan Kaylee W , Phillips Desiree , Matthews Lynn T , Kempf Mirjam-Colette , Johnson Bernadette , Mugavero Michael J , Williams Audra , Elopre Latesha
Published: January 2025

Background

In the Southeastern United States, Black women are disproportionately diagnosed with HIV compared to White women. Client-centered approaches are needed to increase uptake of HIV prevention tools, including pre-exposure prophylaxis (PrEP). Gynecology (GYN) clinics are uniquely positioned to provide PrEP for women and Black women prefer receiving PrEP from GYN providers, but PrEP delivery in GYN settings has been limited. Thus, we evaluated barriers and facilitators to PrEP provision in GYN clinics.

Methods

From 08/2022-04/2023, we conducted dyadic focus groups and in-depth interviews with providers (i.e., physicians, nurses, and medical assistants) and clients accessing care at a university-affiliated GYN clinic in Alabama where clients face high STI burden. Interview guides grounded in the Information-Motivation-Behavioral Skills Model explored barriers to PrEP service delivery. Inductive qualitative analysis identified emergent themes from transcripts.

Results

10 providers and 21 clients (100% Black, 100% female, median age 32 (range 19-44), 90.5% insured (67% with Medicaid)) were interviewed. Emergent themes included: (1) Sexual health – including STI/HIV prevention – as part of routine women’s healthcare. Providers preferred a risk-based approach to sexual healthcare while clients preferred a sex-positive approach. (2) Incorporation of PrEP services into women’s healthcare. Both clients and providers supported that PrEP is important for women’s health. Providers felt PrEP discussions should be limited to specific visits whereas clients desired regular discussions of PrEP. (3) Multi-level barriers for PrEP service delivery in GYN clinics. Barriers included limited client and provider PrEP knowledge, inadequate clinic resources, financial costs, and STI/HIV stigma.

Conclusion

Incorporating PrEP services into GYN clinics could increase PrEP uptake amongst Black women. Effective multi-level interventions should focus on increasing client and provider PrEP knowledge, integrating sexual health history assessment into routine care, mitigating STI/HIV stigma, and addressing structural barriers.

Disclosures

Latesha Elopre, MD, Merck: Grant/Research Support
P-507. Implementation of Guideline-Based HIV Prevention at an Academic Primary Care Clinic
Authors: Daudelin Isaac , Kim Eileen , Palani Arthi , Goyal Ritik , Wang Heather M , Swaminathan Shobha , Walsh Jared , Finkel Diana
Published: January 2025

Background

Primary care providers often lack familiarity with pre-exposure prophylaxis (PrEP) for HIV and miss screening for high-risk behavior. From 2017-2019 the Academic Internal Medicine Clinic (AIMC) at University Hospital in Newark, NJ averaged 2 PrEP prescriptions/year. Multiple resident lectures to improve screening and treatment saw minimal improvement to 4 PrEP prescriptions/year from 2020 to 2021, all of which were refills. This QA/QI project uses Epic smart tools to speed integration of guideline directed HIV prevention at AIMC.

Methods

Intervention: A PrEP screening smartlist was created in Epic and implemented in the common healthcare maintenance (HCM) smartphrase used by residents at AIMC. A positive screen directs the user to another smartphrase which guides the user to start or continue PrEP safely.

Assessment: 2021 CDC HIV PrEP Guidelines were used. Charts from 100 patients randomly selected from 5320 patients visiting AIMC in 2023 were reviewed for documentation of PrEP screening. Epic was queried and charts were reviewed to find all patients prescribed PrEP by AIMC residents in 2023.

Results

Of patients seen by residents at AIMC in 2023, 23% were screened for PrEP compared to 0% in previous years. 11 unique patients were prescribed PrEP, 5 of which were new prescriptions.

22% of patients seen in 2023 were new to the clinic. Of these, 52% used the common HCM smartphrase, 38% used a personal HCM smartphrase, and 10% used outdated versions of the common HCM smartphrase.

When the common HCM smartphrase was used, 72% of users screened for PrEP, 8% deferred screening to a future visit, and 20% removed the screening tool.

Conclusion

This study shows that an intuitive smart tool can create immediate change in a resident training program. Outdated versions of HCM copied forward from old visits were the largest barrier to this initiative, however this should spontaneously improve each year with 22% of patients in the year new to the clinic. Future directions include: tool use training, email reminders to use the smartphrase or to update personal templates annually to include updated guidelines, resident champions, and/or resident surveys.

Disclosures

Shobha Swaminathan, MD, Viiv Healthcare: Advisor/Consultant
P-510. Describing the Cohort of Women Veterans Prescribed HIV PrEP at the Veterans Health Administration
Authors: Broderick Kaitlyn , Keddem Shimrit , Beste Lauren , Sorrentino Anneliese , Dixon Tammara , Agha Aneeza , Caceres Omaris
Published: January 2025

Background

Pre-Exposure Prophylaxis for HIV (PrEP) is a highly effective option available to women in the Veteran’s Health Administration (VHA). However, PrEP uptake among VHA patients has remained modest, particularly among women. To better understand PrEP uptake for women Veterans, we used VHA administrative data to describe the cohort of women Veterans prescribed PrEP and their prescribers at the VHA.

Methods

We conducted a cross-sectional study of women enrolled in VHA care between January 1, 2012 and June 30, 2022 who were prescribed HIV PrEP for at least 30 days.

Results

PrEP initiation increased gradually over the study years, with most patients receiving initial prescriptions after January 1, 2020. Among the cohort of 417 women, 48% lived in the South, and most were aged 18-39 years. In terms of racial demographics, 53% identified as white and 40% as Black, while ethnically Hispanic women constituted 12% of the group. Eleven percent were homeless. Nearly half of the cohort were noted to have military sexual trauma. There was a high prevalence of mental health disorders, with 85% experiencing depressive disorder. Regarding prescriber profiles, 22% were advanced practice providers, 20% were clinical pharmacists, and 58% were physicians, 87% of whom specialized in infectious diseases.

Conclusion

These findings indicate an increase in prescriptions over time and significant geographic disparities among a vulnerable population of women Veterans. Although most patients lived in the South, this region has a lower rate of PrEP prescription to HIV incidence than in other regions. Most prescribers were infectious disease physicians, in contrast to estimates amongst general and commercially insured populations. Many patients in the study were prescribed PrEP via clinical pharmacists, and although data is lacking to compare to the general population, this suggests that Clinical Pharmacist Practitioners, who possess a scope of practice within the VHA which includes medication prescriptive authority and serving as a direct care provider, are an important tool to enhance PrEP uptake among women Veterans. More research is needed to identify barriers and strategies to overcome them for PrEP service implementation among women Veterans.

Disclosures

All Authors: No reported disclosures
P-513. Recruitment Challenges for Youth HIV Pre-exposure Prophylaxis (PrEP) Research
Authors: Abuogi Lisa , Limas Alexander , Moor Jennifer , De La Garza A J , Leonard Katherine , Pierce Kimberly , Gallegos Sam , Vyas Priya H , McFarland Elizabeth , Straub Diane M
Published: January 2025

Background

Recruitment for youth-focused PrEP studies among sexual and gender minority (SGM) youth is a challenge. We report on recruitment strategies and lessons learned from a youth TelePrEP study in Colorado.Table 1:Recruitment strategies used for youth PrEP study

Methods

Youth assigned male at birth, ages 18-24 years, eligible for PrEP using FTC/TAF, and at risk for HIV in Colorado were recruited to participate in a pilot feasibility trial of PrEP services provided via telehealth. Participants agreed to be seen via telehealth and to obtain initial lab testing at one of seven sites located throughout the state. PrEP medications were offered free for up to 12 months via in-person pick up or mail delivery. Youth were able to enroll and receive clinical care regardless of insurance type. HIV self-test kits were available via mail for follow up testing. Participants received $25 at time of enrollment. Recruitment methods were informed by two electronic youth surveys (N= 375 total), student young adult advisors, youth PrEP providers, and research team experience in youth HIV treatment and prevention studies.Figure 1:Recruitment Flow Chart

Results

A total of 319 individuals completed an online recruitment survey of which 44 (14%) were eligible and 21 (48%) of those enrolled between January 2023 and March 2024 out of a target of 100 study participants. (Figure 1) An estimated 107,500 individuals received at least one form of study recruitment. (Table 1) Direct recruitment occurred through adolescent clinics (including family planning/STI, transgender care, adolescent primary care, and youth HIV clinics) and pediatric primary care offices via primary care provider referral (N=4 enrolled). Community recruitment was done through SGM youth-serving organizations, community events, during community HIV education sessions (N=4 enrolled). On-line recruitment utilized social media (including targeted ads and sponsored influencers), dating apps, and survey outreach (N=6 enrolled). (Figure 2) Dating apps and social media were the most common recruitment strategies among eligible participants.Figure 2:Examples of Youth TelePrEP Recruitment Materials

Conclusion

Despite a multipronged approach to recruitment of SGM youth for a study on youth TelePrEP, recruitment was below targets. Additional innovation and evaluation of strategies are needed to not only increase recruitment to youth PrEP studies but also youth PrEP services.

Disclosures

Lisa Abuogi, MD, MS, Gilead Sciences: Grant/Research Support Alexander Limas, MSW, Gilead Sciences: Grant/Research Support AJ De La Garza, BSW, Gilead Sciences: Grant/Research Support Katherine Leonard, MSN, FNP-BC, Gilead Sciences: Grant/Research Support Sam Gallegos, BS, Gilead Sciences: Grant/Research Support
P-541. PD-1 expression impacts cardiovascular risk in naïve PLWH (people living with HIV), undergo suppressive ARV
Authors: Aksak-Wąs Bogusz J , Parczewski Miłosz , Skonieczna-Żydecka Karolina , Niedźwiedzka-Rystwej Paulina
Published: January 2025

Background

Human Immunodeficiency Virus (HIV) infection leads to progressive immune dysfunction, among others mediated through the PD-1/PD-L1 pathway. This study aims to assess the impact of ARV therapy on PD-1 expression and SCORE 2 changes in patients over a twelve-month observation period.

Immunofenotype trends in analysed population.

Methods

This observational study evaluated 58 PLWH undergoing standardized ARV therapy according to national guidelines, obtaining viral suppression. Initial and twelve-month follow-up assessments included measurements of SCORE 2, as well as PD-1 expression, and lymphocyte subsets (CD4+, CD8+, and CD4+/CD8+ ratio) using flow cytometry. Wilcoxon signed-rank tests analyzed within-subject changes in these parameters. Principal Component Analysis (PCA) was employed to reduce dimensionality and identify the major axes of variance in the data (delta for all measures) with ARV type as grouping variable. To determine whether the clusters observed in the PCA scatter plot reflect statistically significant differences among the treatment groups, an Analysis of Variance (ANOVA) was conducted on the scores of the first two principal components.

Figure 1

The scatter plot of the first two principal components

Results

There were statistically significant alterations in percentages of CD4+/CD8+ ratio, CD3+, CD4+ along with CD4+ PD-1 and PD-L1 found, all elevated at endpoint. CD19+ was significantly elevated after twelve-month period, as well. Data is displayed in Table 1. We found that the change in these parameters was not dependent on ARV type. SCORE 2 at endpoint correlated positively with CD4+PD1 change (r=0.372; p=0.011), but the parameter change was not dependent on ARV therapy (p >0.05). In PCA analysis, the first principal component captured 22.6% of the total variance, while the second accounted for 20.7%. The scatter plot (figure 1) of the first two principal components showed that the data points (deltas) are distributed and clustered by treatment groups however the differences are not significantly different (PC1: p=0.684; PC2: p=0.840).

Conclusion

Higher expression of PD-1 in CD4+ cells correlates positively with higher cardiovascular risk calculated with SCORE 2, reason for elevated PD1 and PD1-L in ARV treated individuals in comparison to baseline evaluations requires further analysis.

Disclosures

Bogusz J. Aksak-Wąs, MD. PhD. ID Specialist, Gilead Sciences: paid lectures|GSK: paid lectures Miłosz Parczewski, Prof. MD. Phd., Gilead Sciences: Advisor/Consultant|Janssen: Advisor/Consultant|MSD: Advisor/Consultant|ViiV: Advisor/Consultant Karolina Skonieczna-Żydecka, Prof., Sanprobi sp. z o.o. sp. k.: Advisor/Consultant|Sanprobi sp. z o.o. sp. k.: Grant/Research Support|Sanprobi sp. z o.o. sp. k.: Honoraria
P-560. Evaluating the Use of Long-Acting Lenacapravir among Treatment-Experienced Adults with HIV in a Large Community-Based Clinic Network
Authors: Altamirano Jessica A , Shukla Prerak , Barnett Steven K
Published: January 2025

Background

Lenacapravir (LEN) is the first-in-class long-acting capsid inhibitor approved by the FDA in December 2022 for the treatment of multi-drug resistant HIV in adults. It is administered by subcutaneous injection every six months in combination with other antiretrovirals (ARV). It is indicated for heavily treatment-experienced people with HIV (PWH). We assessed the use of long-acting LEN within the CAN Community Health Network.

Methods

A retrospective analysis of electronic medical records within the CAN Community Health Network of 23 clinics located throughout six US states. People with HIV who received one or more injections of LEN for treatment between December 2022 and April 2024 were included. Demographic characteristics, HIV viral load, CD4 count and composition of pre-LEN ARV regimens were studied.

Results

Twenty-four PWH were identified as receiving one or more injections of LEN between December 2022 and April 2024. The median age was 58 years; 79% were male, 67% White and 71% Non-Hispanic (Table 1). Mean number of injections received was 2. Pre-LEN HIV VL was >50 copies/mL in 8 PWH (33%) and pre-LEN HIV VL was < 50 copies/mL in 16 PWH (67%). Five PWH (21%) had a pre-LEN CD4 count < 200 and 19 PWH (79%) had a pre-LEN CD4 count >200. Post-LEN HIV VL decreased in all eight patients with HIV VL >50 copies/mL (Table 2).

Pre-LEN ARV regimens included a median of 4 active agents with 92% of them containing integrase inhibitors (INSTIs), 71% NRTIs and 58% protease inhibitors (PIs) (Table 3). Reasons for switching to a LEN-combination regimen in those with HIV VL < 50 included: simplification, side effects or intolerance to oral ARVs and non-adherence. Three (13%) patients stopped LEN due to injection site reactions (ISRs), 1 patient (4%) stopped due to side effects, 2 patients (8%) were lost to care and 1 patient (4%) was switched to an oral alternative due to travel.

Conclusion

The majority of PWH who were switched to LEN-combination regimens were older males with HIV VL < 50 copies/mL. Reasons for switching included simplification, side effects to other ARVs and non-adherence. Of those with HIV VL > 50 copies/mL prior to switching to a LEN-combination regimen, all had a decrease in their HIV VL. The most common reason for discontinuation was ISRs. Sample size was small and a longer duration of follow-up is needed.

Disclosures

Jessica A. Altamirano, MD, FIDSA, Gilead Sciences: Speaker's Bureau
P-603. Potential Public Health Impact of Respiratory Syncytial Virus (RSV) Vaccines for Prevention of RSV Among Older Adults in the United States
Authors: Averin Ahuva , Sato Reiko , Chilson Erica , Atwood Mark , Quinn Erin
Published: January 2025

Background

Two United States (US) Food and Drug Administration-approved vaccines are recommended by the Advisory Committee for Immunization Practices for prevention of lower respiratory tract disease (LRTD) due to respiratory syncytial virus (RSV) among US adults aged ≥ 60 years and another vaccine for adults is under regulatory review. We evaluated the potential public health impact of vaccines for prevention of RSV-LRTI in older adults.

Methods

A cohort model was employed to depict clinical outcomes and economic costs of RSV-LRTD over two years with use of alternative vaccines (ie, Pfizer’s RSVpreF, GSK’s RSVpreF3, Moderna’s mRNA-1345 respectively, vs no intervention) among a cohort of 2.4M adults aged ≥ 60 years in a hypothetical US health plan with 10M beneficiaries. Clinical outcomes were projected (monthly) based on age, comorbidity profile (ie, with vs without chronic or immunocompromising medical conditions), RSV-LRTI disease rates (requiring hospitalization [H], emergency department [ED], or physician office/hospital outpatient care [PO/HO]), calendar month, case fatality rates (RSV-H only), and vaccination status (23.6% uptake in October of model year 1 only). Initial vaccine effectiveness (VE) and waning of VE was derived from published or presented Phase III clinical trial data. Economic costs were generated based on cases and corresponding unit costs.

Results

Without use of RSV vaccine, 14,687 hospitalizations, 11,201 ED encounters, 132,472 PO/HO visits, and 1,230 RSV-related deaths are projected to occur over two years. Pfizer’s RSVpreF would result in a 22,301-case reduction (RSV-H: 2,713; RSV-ED: 2,069; RSV-PO/HO: 17,519) and 227 fewer deaths; total medical care costs would be lower by $86.0M (RSV-H: $64.2M; RSV-ED: $7.4M; RSV-PO/HO: $14.4M) (Table). GSK’s RSVpreF3 would reduce cases by 16,183, deaths by 205, and medical care costs by $76.8M. Moderna’s mRNA-1345 would reduce cases by 9,357, deaths by 112, and medical care costs by $43.2M (based on single-season efficacy data).

Conclusion

RSV vaccines have the potential to substantially reduce the clinical and economic burden of RSV-LRTI in older adults. Of the three vaccines, Pfizer’s RSVpreF would provide the greatest benefit due to its high 2-year efficacy.

Disclosures

Ahuva Averin, MPP, Pfizer Inc: Advisor/Consultant Reiko Sato, PhD, Pfizer Inc: employee|Pfizer Inc: Stocks/Bonds (Private Company) Erica Chilson, PharmD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds (Public Company) Mark Atwood, MS, Pfizer Inc: Advisor/Consultant Erin Quinn, BS, Pfizer Inc: Advisor/Consultant
P-633. Implementation and Uptake of Nirsevimab within Nemours Children’s Health Delaware Healthcare System
Authors: Mann Sara , Mason Matt , Rellosa Neil , Ravin Karen
Published: January 2025

Background

Nirsevimab, the first FDA approved monoclonal antibody to protect against Respiratory Syncytial Virus (RSV), became available for the 2023-2024 RSV season. Distribution of nirsevimab was affected by cost and a supply shortage, limiting overall uptake. Nemour’s Children’s Hospital in Delaware (NCH) implemented several strategic measures to promote immunization despite these barriers, including educational series and periodic communication of regional supply chain status. The purpose of this project was to analyze characteristics of patients who received nirsevimab at NCH and corresponding trends over the 2023-2024 season.

Methods

We report descriptive summaries of patients who received nirsevimab at NCH from October 2023 to March 2024. Variables analyzed included age, timing of immunization, clinical site and setting, race, sex, insurance status, and state where the patient received the immunization (PA or DE). We compared the distributions of these characteristics by vaccination month using chi-square tests.

Results

1,842 infants received nirsevimab, most of which were under 8 months of age (95.7%) at time of immunization (Table 1). Nirsevimab uptake varied by month (Figure 1), with most patients receiving the immunization in November and December. The distribution of immunizations across visit type (outpatient/inpatient, p< 0.001), insurance type (public/private, p< 0.001), and state (DE/PA) varied significantly across months. The distributions of patient-reported sex and race did not vary significantly by month (Table 2).

Conclusion

Unpredictable supplies of nirsevimab and varying immunization strategies among clinic sites affected distribution and uptake among patients. Some clinics were faced with prioritizing high-risk populations or were restricted by patient insurance policies. These challenges resulted in differing populations having access to nirsevimab based on time of year. Further efforts can focus on unifying immunization promotion techniques and identifying ways to ensure equitable distribution to our target populations.

Disclosures

All Authors: No reported disclosures
P-638. Impact of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screening on Antimicrobial De-escalation in Patients Admitted with Community-Acquired Pneumonia
Authors: Deshpande Abhishek , Schulte Rebecca , Walker Ramara E , Pallotta Andrea , Wang Ming , Klompas Michael , Haessler Sarah , Rothberg Michael
Published: January 2025

Background

Methicillin-resistant Staphylococcus aureus (MRSA) is an important yet uncommon cause of inpatient community-acquired pneumonia (CAP). While the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines recommend rapid MRSA nasal screening to guide anti-MRSA antibiotic (abx) therapy when MRSA CAP is suspected, guideline adherence and its impact on abx use is unclear. We aimed to assess the prevalence of MRSA screening and its effect on abx de-escalation in inpatients with CAP.

Methods

This retrospective cohort study analyzed adult admissions for CAP across 12 U.S. hospitals from November 2022 - January 2024. Anti-MRSA abx utilization and MRSA screening was assessed in both ICU and non-ICU patients. De-escalation was defined as stopping all anti-MRSA agents within 48 hours of the first dose. We compared abx de-escalation rates of patients started on empiric anti-MRSA between those screened vs those not screened. Propensity score adjustment methods were employed to assess the association between MRSA screening and anti-MRSA antibiotic de-escalation, calculating the odds ratio (OR) for de-escalation. Positive and negative predictive values of MRSA screening were also calculated.

Results

Of 12,232 CAP hospitalizations, 1886 were admitted to ICU and the rest to medical wards. Thirty percent of non-ICU and 68% of ICU patients were started on anti-MRSA antibiotics within 48 hours of admission. CAP patients started on empiric anti-MRSA antibiotics were significantly more likely than those not started on them to be screened (95% vs. 74% in ICU and 76% vs. 19% outside ICU, p< 0.001 for both). Patients with a negative MRSA screen were more often de-escalated within 48 hours than those with no screening outside the ICU (84% vs. 71%, p< 0.001) and in the ICU (82% vs. 55%, p< 0.001). In propensity-adjusted analysis, screened patients had significantly greater odds of de-escalation compared to those not screened (non-ICU OR: 2.10 95% CI 1.85-2.38; ICU OR: 3.65 95% CI 3.00-4.45). The positive and negative predictive values of MRSA screening were 3.33% and 99.86% in non-ICU, and 6.83% and 99.78% in ICU, respectively.

Conclusion

MRSA screening was strongly associated with abx de-escalation, especially in the ICU. A negative screen had a very high negative predictive value.

Disclosures

Abhishek Deshpande, MD, PhD, AHRQ: Grant/Research Support|Clorox Healthcare: Grant/Research Support Andrea Pallotta, PharmD, Astra Zeneca: Advisor/Consultant|Viiv: Advisor/Consultant Michael Klompas, MD, MPH, AHRQ: Grant/Research Support|CDC: Grant/Research Support|UpToDate: Royalties Michael Rothberg, MD, MPH, Blue Cross Blue Shield: Advisor/Consultant|CRISPER: Stocks/Bonds (Public Company)|Moderna: Stocks/Bonds (Public Company)
P-639. Development of antimicrobial resistance in patients with pneumonia due to P.aeruginosa treated with cefepime or piperacillin-tazobactam
Authors: Pallotta Raneem H , Aitken Samuel L , Pogue jason M , Wangchinda Walaiporn
Published: January 2025

Background

Pneumonia due to P. aeruginosa is associated with significant morbidity and mortality. Recurrent infections and the development of resistance are common. Cefepime (FEP) and piperacillin-tazobactam (TZP) are both first line treatments, yet no studies to date have compared the relative frequency of resistance development in patients treated with these two agents. This study sought to fill in this data gap.Table 1.Baseline Characteristics

Methods

This was a retrospective, single-center cohort study that included adult patients with culture-positive P. aeruginosa pneumonia treated with FEP or TZP admitted to Michigan Medicine. Pneumonia was defined as respiratory signs or symptoms and radiographic evidence of new pneumonia. Patients were eligible if they had therapy started within 24 hours of the index culture and were treated for with FEP or TZP for ≥ 3 days. Patients with unresolved infections, including COVID-19, prior to initiation of the study drug were excluded. Patients with isolates resistant to FEP and/or TZP, regardless of treatment group, were excluded. The primary outcome was development of new resistance to the study drug within 30 days, defined as a repeat culture with non-susceptibility per CLSI criteria to either FEP or TZP on repeat cultures. This was assessed using a Fine-Gray competing risk regression treating death as a competing risk and adjusting for baseline severity of illness, antimicrobial dose, and use of extended infusion.

Results

214 patients (TZP, n=126; FEP, n=88) were included. Baseline characteristics were similar between the two groups, with the notable exceptions of age, creatinine clearance, and Charlson Comorbidity Index (Table 1). Frequency of need for new ICU admission (TZP 27%, FEP 31%; p = 0.65), ventilator-associated pneumonia (25% vs 28%, p = 0.75), and use of extended infusion (14% vs 17%; p = 0.70) were comparable between groups. New resistance to the study drug occurred in 13% of TZP recipients vs 6% receiving FEP (subhazard ratio [sHR] 2.61, 95% CI 0.92 – 8.97, p = 0.07).

Conclusion

We identified statistically similar, but numerically increased risk of new resistance in patients with Pseudomonas pneumonia treated with TZP relative to FEP. These findings may help to inform definitive antimicrobial selection.

Disclosures

Samuel L. Aitken, PharmD, MPH, Basilea: Advisor/Consultant|bioMerieux: Advisor/Consultant|Melinta: Advisor/Consultant|Shionogi: Advisor/Consultant jason M. Pogue, PharmD, Entasis: Advisor/Consultant|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Venatorx: Advisor/Consultant
P-642. A High Prevalence of Liver Steatosis and Metabolic Syndrome Among Hospitalized Patients with Community-acquired Pneumonia
Authors: Gjurasin Branimir , Krznaric Juraj , Vrsaljko Nina , Papic Neven
Published: January 2025

Background

Community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality. While metabolic syndrome has been identified as a risk factor for CAP outcomes, the role of metabolic dysfunction-associated steatotic liver disease (MASLD) in CAP is less clear. This study aimed to investigate the prevalence and severity of MASLD in hospitalized patients with CAP.

Prevalence of metabolic syndrome and MASLD in patients with community-acquired pneumonia

Methods

A prospective observational cohort study (SepsisFAT) included hospitalized adult patients with CAP at three clinical departments at the University Hospital for Infectious Diseases Zagreb. At admission, patients were screened for metabolic syndrome, the degree of liver steatosis was estimated using the controlled attenuation parameter and patients were subesquently diagnosed with MASLD according to current guidelines.

Results

One hundred and fifty patients were included (86 males, median age of 63, IQR 51-73 years). The prevalence of MASLD was 45% (n=68) and metabolic syndrome of 31% (n=46). 43 (29%) patients had insulin resistance, 74 (49%) arterial hypertension, HDL < 1.03 or < 1.29 mmol/L 77 (51%) patients, 46 (31%) triglycerides ≥ 1.7 mmol/L and central adiposity 80 (53%). Steatosis was graded as mild in 21 (14%), moderate in 16 (11%) and severe in 31 (21%) patients, and 20 (13%) patients had fibroleastography > 9.0kPa. The prevalence of MASLD was higher in the severe than non-severe CAP group (43% vs. 34%).

Conclusion

The prevalence of MASLD among hospitalized patients with CAP is higher than estimated in the general population, with the highest prevalence in severe CAP treated at the intensive care unit. This highlights the need for further studies to examine the clinical impact of MASLD on CAP outcomes.

Disclosures

All Authors: No reported disclosures
P-644. Clinical and Sociodemographic Changes in Reported Pertussis Cases, Los Angeles County, 2014-2023
Authors: Foo Chelsea , Washburn Faith , Kim Andrea
Published: January 2025

Background

In 2020, the pertussis national case definition was revised to classify any symptomatic PCR-positive case as confirmed, no longer requiring a cough illness of at least 14 days. The revision intended to improve case ascertainment, but the annual number of pertussis cases reported to Los Angeles County (LAC) Department of Public Health (DPH) has decreased since 2020 due to the pandemic. We sought to describe demographic and clinical differences among pertussis cases reported to LAC before 2020 versus 2020 onwards.

Methods

All confirmed, probable, and suspect pertussis cases reported to LAC DPH from 2014 through 2023 were analyzed. Cases were categorized as pre-2020 (reported 1/1/2014 to 12/31/2019) or post-2020 (reported 1/1/2020 to 12/31/2023). Pearson’s chi-square test was used to assess bivariate associations between report period and case demographics and reported symptoms (paroxysms of coughing, inspiratory whoop, post-tussive vomiting, apnea with or without cyanosis, and cough illness lasting ≥14 days). A logistic regression model was built with report period as the outcome and symptoms and demographics as model covariates.

Event modeled is post-2020 with pre-2020 as reference group.

Results

Of 6,594 cases reported, 391 (5.9%) cases were reported post-2020. Post-2020, the average annual case count decreased 91% from 1,034 to 98. Between time periods, case populations differed with respect to age and ethnicity (p< .001); sex remained similar (p=0.39). Post-2020, median case age decreased from 11 (interquartile range (IQR): 4-16) to 5 (IQR: 2-13). The prevalence of all symptoms decreased post-2020 (p< .001) (Figure 1). In the multivariable model, the association remained significant for cough illness lasting ≥14 days) (odds ratio (OR): 0.47 95% confidence interval (CI): 0.36-0.61) (Figure 2). This finding suggests that among those reporting cough illness lasting ≥14 days, the odds of diagnosis post-2020 versus pre-2020 were lower, after adjustment for age, sex, ethnicity, and other symptoms.

Conclusion

The revised 2020 case definition may have increased case sensitivity in certain populations and among pertussis cases with less severe symptomology. Clinicians may consider PCR testing as soon as pertussis illness is suspected, which could enable sooner public health intervention and prevention of secondary transmission.

Disclosures

Chelsea Foo, MPH, Assertio Holdings: Stocks/Bonds (Public Company)|Bionano Genomics: Stocks/Bonds (Public Company)|eHealth, Inc.: Stocks/Bonds (Public Company)|Johnson & Johnson: Stocks/Bonds (Public Company)