bluuebunny/crossref_metadata_2025 huggingface dataset:
1345. Clinical Characteristics and Outcomes of Mild to Moderate COVID-19 Patients with Abnormal Chest Radiologic Findings Treated in the Hospitels in Thailand
Authors: Sayabovorn Naruemit , Phisalprapa Pochamana , Srivanichakorn Weerachai , Chaisathaphol Thanet , Washirasaksiri Chaiwat , Sitasuwan Tullaya , Auesomwang Chonticha , Kositamongkol Chayanis , Nimitpunya Pongpol , Attachitwatin Teerapat , Chayakulkeeree Methee , Phoompoung Pakpoom , Nopmaneejumruslers Cherdchai , Taweemonkongsap Tawatchai , Vamvanij Visit , Tinmanee Rungsima
Published: November 2023

Background

Hospitels are the hotels converted into the healthcare facilities extension in areas with limited resources including hospital beds during the peak of COVID-19 pandemic in Thailand. This study aimed to determine the clinical features and outcomes of asymptomatic and mild to moderate COVID-19 patients who were treated in these facilities.

Methods

We conducted a retrospective study by reviewing the medical records of adult COVID-19 patients who were admitted to Siriraj Hospital’s affiliated hospitels in Bangkok between June and October 2021. Patients’ characteristics, vaccination status, treatment data, and clinical outcomes were collected.

Results

We compared baseline characteristics and clinical features of COVID-19 patients based on their initial chest x-ray (CXR) findings. Of 1,729 patients, 644 (37.2%) had an abnormal baseline CXR, and these patients were older (49.2 vs. 42.2 years, p < 0.001), had higher body weight (68.1 vs. 64.7 kg, p < 0.001) and BMI (26.3 vs. 24.9 kg/m², p < 0.001), and were more likely to have underlying diseases such as diabetes (p = 0.002), hypertension (p < 0.001), obesity (p < 0.001), chronic lung disease (p = 0.029), and autoimmune disease (p = 0.028). They were also more likely to have a risk of disease progression (p < 0.001) and were less likely to be fully vaccinated (p < 0.001). They were more likely to be referred back to the hospital (p < 0.001). We found no significant differences in sex or COVID-19 symptoms between the two groups, except cough and fatigue. The total cost of admission was significantly higher for referred patients than discharged patients (70,545 vs. 12,010 Thai baht, p < 0.001).

Conclusion

A significant proportion of COVID-19 patients with abnormal CXR findings who were admitted to the hospitels had underlying diseases and higher risk of disease progression. Additionally, they were more likely to be referred back to the hospital and had higher healthcare costs. Continued surveillance and monitoring of high-risk COVID-19 patients in hospitels to ensure efficient management and resource utilization were needed.

Disclosures

All Authors: No reported disclosures
1357. Initial and Peak Serum Levels of Krebs von den Lungen-6 for Prediction of Prognosis in Patients with COVID-19
Authors: Kim Geonui , Kwon Hyeonwoo , Ra Sang Hyun , Chang Eui Jin , Bae Seongman , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Lee Sang-Oh , Choi Sang-Ho , Kim Yang Soo , Kim Sung-Han
Published: November 2023

Background

Krebs von den Lungen-6 (KL-6) has been reported to be associated with prognosis in patients with COVID-19. However, there is limited data on the correlation between COVID-19 prognosis and varying KL-6 levels at different time points. We investigated the optimal cutoff values of both initial and peak serum KL-6 levels in order to predict mortality, and also examined their correlation with mortality within 30 days.

Methods

In this retrospective cohort study, data on serially collected serum KL-6 levels in patients hospitalized with COVID-19 between December 2020 and January 2022 at a single tertiary hospital in South Korea were collected. The area under the ROC curve and Youden index were used to determine the cutoff points for the initial and peak KL-6 levels that best predicted 30-day mortality. The association between both initial and peak KL-6 values with 30-day mortality were assessed by univariate and multivariate logistic regression model.

Results

A total of 349 patients were included, and among them, 27 individuals died within 30 days, resulting in a mortality rate of 7.7%. The mean initial and peak KL-6 levels were significantly higher in the non-survivor group compared to the survivor group (898.5 vs. 448.1, p=0.006; 1289.0 vs. 687.3, p=0.003, respectively). The initial and peak KL-6 values that best predicted 30-day mortality were 491.85 U/mL (sensitivity 72.7%, specificity 74.1%, area under curve [AUC] 0.748) and 660.05 U/mL (sensitivity 63.0%, specificity 81.5%, AUC 0.744), respectively. Initial KL-6 greater than 491.85 U/mL (odds ratio [OR], 7.60; 95% CI, 3.10 to 18.59) and a peak KL-6 greater than 660.05 U/mL (OR 7.55; 95% CI 2.56 to 22.26) were found to be significantly associated with 30-day mortality, independent of age, solid cancer, and elevated serum C-reactive protein ( > 7.5 mg/dL).

Conclusion

We found that both initial and peak levels of KL-6 were significantly related to 30-day mortality in hospitalized COVID-19 patients. These findings suggest that serially monitoring blood KL-6 levels could serve as a valuable prognostic indicator for COVID-19.

Disclosures

All Authors: No reported disclosures
1363. Preliminary Safety Results from a Phase 1 First in Human Study of VYD222: an Extended Half-Life Monoclonal Antibody (mAb) in Development for COVID-19 Prevention
Authors: Mahoney Kathryn , Gupta Deepali , Li Yong , Betancourt Natalia , Das Aanika , Campanaro Ed , Schmidt Pete
Published: November 2023

Background

VYD222 is a fully human IgG1 mAb demonstrating broad and potent in vitro neutralizing activity across SARS-CoV-2 variants including XBB.1.5. VYD222 is a re-engineered version of adintrevimab, an Fc-modified mAb that has a robust safety data package and demonstrated clinically meaningful results in Phase 2/3 clinical trials for both treatment and prevention of COVID-19 (NCT04805671, NCT04859517). VYD222 is currently in development for COVID-19 prevention.

Methods

This is an ongoing Phase 1, first in human, blinded, randomized, placebo (PBO)-controlled, single ascending dose study of VYD222 administered as slow intravenous (IV) push to healthy adults aged 18-65 years (NCT05791318). Participants were randomized 8:2 in each of 3 cohorts (n=8 VYD222, n=2 PBO): VYD222 1500 mg, 2500 mg, and 4500 mg. Safety and tolerability will be assessed as incidence of treatment emergent adverse events, including serious adverse events (SAEs). Serum pharmacokinetic (PK) parameters will be calculated for VYD222 using noncompartmental analysis methods. Serum virus neutralizing antibody (sVNA) titers of VYD222 ex vivo against relevant SARS-CoV-2 variants will be assessed using a validated assay. Safety, tolerability, PK, and sVNA titers will be assessed through 12 months post-dose. Here we report preliminary blinded safety results from cohorts 1 and 2.

Results

Overall, 12 participants received VYD222 or PBO. Through a minimum of 14 days post dose, among 10 participants in cohort 1 (VYD222 1500 mg n=8, PBO n=2), there were 9 AEs (adverse events) reported, all of which were mild in severity and considered unrelated to study drug. No participant experienced SAEs, infusion-related reactions, or hypersensitivity reactions. Through 2 days post dose, 2 sentinel participants in cohort 2 (VYD222 2500 mg n=1, PBO n=1) experienced zero AEs, study drug related AEs, SAEs, infusion-related reactions, or hypersensitivity reactions. Enrollment continues in cohort 2 as of the data cutoff (04/25/2023) for this abstract. Data remain blinded currently.

Conclusion

To date, a single dose of VYD222, up to 2500 mg IV push, was well tolerated across all healthy participants receiving either VYD222 or PBO in this ongoing phase 1 study. These findings support continued clinical development of VYD222.

Disclosures

Kathryn Mahoney, PharmD, Invivyd, Inc.: Employee|Invivyd, Inc.: Stocks/Bonds Deepali Gupta, BSc, Invivyd, Inc.: Employee|Invivyd, Inc.: Stocks/Bonds Yong Li, PhD, Invivyd, Inc.: Employee|Invivyd, Inc.: Stocks/Bonds Natalia Betancourt, MS, Invivyd, Inc.: Employee|Invivyd, Inc.: Stocks/Bonds Aanika Das, PharmD, Invivyd, Inc.: Employee|Invivyd, Inc.: Stocks/Bonds Ed Campanaro, MS, Invivyd, Inc.: Employee|Invivyd, Inc.: Stocks/Bonds Pete Schmidt, MD, Invivyd, Inc.: Employee|Invivyd, Inc.: Stocks/Bonds
1377. Rabies and Tetanus Post-Exposure Prophylaxis Initiation in the US and Overseas: Consistent with ACIP Recommendations?
Authors: Chirumamilla Siri L , Breiman Jennifer , Fairley Jessica K , Wagonner Jesse J , Collins Matthew H , Wu Henry M
Published: November 2023

Background

Appropriate management of animal bites is critical to prevent rabies encephalitis and tetanus. In the US, rabies post-exposure prophylaxis (PEP) is typically started in emergency departments (EDs). For travelers seeking care overseas, World Health Organization (WHO) PEP guidance differs from those of the Advisory Council on Immunization Practices (ACIP). WHO does not recommend rabies immune globulin (RIG) for minor scratches; furthermore, RIG availability can vary worldwide. Outpatient follow-up of patients not given RIG is challenging because RIG is often not given in clinics. We assessed whether patients referred to a travel medicine clinic for rabies PEP vaccination were initially managed in accordance with ACIP guidance.

Methods

Medical records of patients presenting for rabies PEP at the Emory TravelWell Center from 2017-21 were reviewed. Initial management after exposure at the patient’s first healthcare interaction was assessed for consistency with ACIP recommendations for rabies and tetanus PEP.

Results

Fifty-six patients were seen for rabies PEP from 2017-21. The median age was 38 years (range 5 to 67). Most patients were exposed in the US (71%). Animal bites accounted for most exposures (57%), followed by suspected contact without visible bite or scratch (38%), and scratches (5%). Frequently involved animals were bats (41%), dogs (30%), cats (14%), and monkeys (7%). A tetanus booster was indicated but not given in 59% of patients. Most patients (82%) received ACIP-consistent rabies PEP. Among the 10 patients who did not, seven (70%) had initiated PEP overseas without RIG. Three patients who initiated PEP in the US received PEP that was inconsistent with ACIP guidance; two did not receive RIG and one received gluteal vaccination. None developed symptomatic rabies or tetanus infection.

Conclusion

Patients seen at a travel clinic for rabies PEP often start it elsewhere, and in this series 18% of patients had PEP initiation inconsistent with ACIP guidance. Returned travelers who initiated PEP in accordance with WHO guidance account for most situations where RIG was not given. Errors in rabies and tetanus PEP also occurred in US EDs. US providers administering rabies and tetanus PEP should ensure practices adhere to ACIP guidance.

Disclosures

All Authors: No reported disclosures
1399. Pancreatic Abscess in Disseminated Melioidosis
Authors: Saw Yen Tsen , Lee Heng Gee , Yong Kylie Sze Tyng , Kok Suet Hwa
Published: November 2023

Background

Melioidosis is an infection caused by the gram-negative bacterium Burkholderia pseudomallei that is widely distributed in the tropical regions of Southeast Asia. It is commonly associated with intraabdominal abscesses, particularly the liver and spleen. However, there is scarce literature regarding pancreatic involvement in melioidosis. We describe a case series of pancreatic manifestations of disseminated melioidosis in a tertiary hospital in Sabah, Malaysia.

Methods

We conducted a retrospective case review of 63 patients with culture-positive melioidosis admitted in Queen Elizabeth Hospital, Sabah between December 2021 and March 2023 and identified cases with pancreatic involvement diagnosed by radiological imaging.

Results

Pancreatic involvement was reported in 3 patients (4.8%). Median duration of symptoms was 20 days. All three patients had risk factors for melioidosis (3 had poorly controlled diabetes mellitus and 1 had chronic kidney disease), and had infection involving other organs (lungs, liver, spleen and prostate). Pancreatic lesions were all detected by computed tomography scans in the tail region and ranged from small microabscesses to large solitary lesions (largest dimension 5.6 cm) with peripancreatic fat stranding. One patient required emergency hemodialysis and intensive care. Drainage of concurrent prostatic abscess was done for one patient. All 3 patients were treated with antibiotics alone (median 38 days of intensive therapy) without drainage of pancreatic abscess and showed regression of pancreatic lesions upon reassessment imaging.

Patient demographic and disease details. DM, diabetes mellitus; CKD, chronic kidney disease; CT, computed tomography.

Figure 1

(A) Contrast-enhanced computed tomography image showing a heterogenous hypodense lesion at the pancreatic tail (arrow) and multiple ill-defined splenic lesions (arrowhead). (B) Smaller lesions at the pancreatic tail and spleen after 35 days of antibiotics (Case 1).

Conclusion

Surgical drainage is required for source control of large melioidotic abscesses, however it may not be feasible for smaller pancreatic abscesses which are often multifocal and deep seated. In our study, the patients with pancreatic abscesses showed good clinical improvement with antibiotics therapy without drainage. Further studies are needed on the role of debridement for pancreatic melioidosis. Published guidelines recommend treatment of melioidosis with deep-seated abscesses with four weeks of intravenous ceftazidime as intensive therapy, followed by three to six months of oral trimethoprim-sulfamethoxazole or doxycycline as eradication therapy.

Disclosures

All Authors: No reported disclosures
1419. Evaluation of a vaporized hydrogen peroxide sterilization technology for duodenoscopes
Authors: Varghese Martin M , Cadnum Jennifer , Memic Samir , Torres-Teran Maria M , Rutala William , Donskey Curtis
Published: November 2023

Background

Current methods for reprocessing duodenoscopes, including double high-level disinfection, are not effective in eliminating bacterial contamination. Thus, there is a need to develop effective and safe sterilization technologies for duodenoscopes.

Methods

We examined the effectiveness of a new hydrogen peroxide gas plasma sterilizer designed for terminal sterilization of flexible endoscopes. The technology directs vaporized hydrogen peroxide into all internal endoscope channels with a short exposure time and includes a sterilization container that facilitates sterile storage after processing. Test organisms included Bacillus atrophaeus and Clostridioides difficile spores, Escherichia coli, Enterococcus faecium, and Candida auris inoculated on steel wires or dispersed throughout the internal channels with 5% fetal calf serum.

Results

The technology reduced >108 colony-forming units (CFU) of the vegetative organisms to undetectable levels. B. atrophaeus and C. difficile spores on steel wires were eliminated by the technology ( >6 log10 CFU reduction) and spores disperse throughout the channels were reduced by >5 log10 CFU. No damage to the endoscopes was observed.

Conclusion

The sterilization technology was highly effective in reducing contamination of duodenoscopes in laboratory testing. Our results support further investigation of this technology in reducing contamination of in-use endoscopes.

Disclosures

William Rutala, MS, MPH, PhD, Ideate Medical: Advisor/Consultant|Ideate Medical: Stocks/Bonds|Kinnos: Advisor/Consultant|Kinnos: Stocks/Bonds|PDI: Advisor/Consultant|PDI: Honoraria
1420. Optimizing the detection of environmental fungal contamination by comparing sample collection and detection methods
Authors: Warren Bobby G , Graves Amanda M , Barrett Aaron , Nelson Alicia , Stiegel Matthew , Smith Becky A , Schwartz Ilan , Anderson Deverick J
Published: November 2023

Background

The use of environmental sampling to surveil the healthcare environment for invasive fungal species to prevent or respond to outbreaks is limited due to the absence of established threshold values and standard practices. This study aims to fill this gap by comparing sampling and detection methods in a controlled experimental setting.

Methods

We compared the sampling efficacy of commonly used healthcare sampling techniques and the detection efficacy of culture-based and qPCR quantification on common healthcare surface materials. The primary outcome was recovery of organisms, defined as total recovered CFU compared to known inoculum CFU.

Mock 10x10cm study surfaces (aluminum, formica, linen, and HEPA material) were inoculated with ∼104 CFU of Aspergillus fumigatus or Candida parapsilosis and allowed to air dry. Foam sponges and flocked swabs pre-moistened with neutralizing buffer were used to sample the complete surface area of surfaces. RODAC plates filled with species-specific media were pressed to the middle of the study surface and removed. Sponges were processed using the stomacher technique and swabs were vortexed in PBS. Eluents from sponges and swabs were used for both culture-based quantification and qPCR using FungiQuant primers and probe for the fungal 18S rRNA gene.

Results

20 experiments were completed for each combination of species (n=2), study surface (n=4), sampling method (n=3) and quantification method (n=2) resulting in 960 total samples. Overall, median percent recovery for culture-based and qPCR-based detection methods were 6.4% (IQR: 2.8-12.9) and 26.7% (10.5-48.1), respectively, (p< 0.01). Median percent recovery for sponges and swabs were 17.9% (11.4-30.0) and 3.8% (1.9-6.7) via culture (p< 0.01) and 36.2% (25.7-78.4) and 10.5% (7.7-36.0) via qPCR (p< 0.01). RODAC median percent recovery via culture was 3.4% (1.0-7.1).

Fungal Recovery Characteristics by Fungal Species and Sample and Detection Methodology

Conclusion

qPCR-based detection had the highest median percent recovery compared to culture-based detection overall, regardless of sample method or study surface. Sponge samples had the highest median percent recovery for both culture- and qPCR-based detection methods, overall. Future studies are needed to assess our study’s identified optimized sample collection and detection techniques in a real-world healthcare environment.

Disclosures

All Authors: No reported disclosures
1435. A Comparison Study of Hand-Wash Rate of Medical Personnel Before and After Automatic Hand-Wash Detector Usage in Medical Intensive Care Unit
Authors: Mahapasuthanon Warinthip , Nilaratanakul Voraphoj
Published: November 2023

Background

Healthcare-associated infections affect patient safety and can lead to significant complications. Pathogens can easily spread to the surrounding environment and contaminate the hands of healthcare workers (HCWs) while performing routine activities. Hand hygiene (HH) has been emphasized as an important measure to prevent the spread of infections among patients. However, compliance with HH is still considered below acceptable thresholds.

Methods

This study utilized a quasi-experimental design to compare hand hygiene compliance among HCWs before and after the implementation of an electronic HH monitoring system. After system installation and test, we performed pre-intervention phase to measure baseline rates of HH episodes using the real-time location system (RTLS). HH compliance will be observed without real-time feedback and alarm.

Phase of the study

Model diagram of the medical intensive care unit (MICU) and the system

Results

The sensitivity and specificity of the system that capture HH actions were 90% and 100%, respectively. For capturing HH opportunities, the system showed 100% and 90% sensitivity and specificity, respectively. During the study period, a total of 30 participants were included. All were either nurses (n=21) or nurse assistants (n=9) working in the medical ICU. 93.3% of participants were female, and almost all (96.7%) had previous experience with HH workshops. After installing the system, HH compliance was observed, and the result showed that the mean HH compliance rate before patient contact was 56.19% (95%CI, 53.27-59.99%) while the rate after patient contact was 71.06% (95%CI, 67.45-73.85%). When we compared these rates with participants’ self- estimated HH compliance, we found that system-measured HH rates were lower, with a mean difference of -16.31 (95%CI, -22.61 to -11.07, p< 0.001) and -18.94 (95%CI, -24.20 to -13.58, p< 0.001) before patient contact and after patient contact, respectively.

Conclusion

We demonstrated a method to measure HH compliance through the implementation of an electronic HH monitoring system with real-time feedback via wireless technology. The preliminary results showed that the system based on ultra-wide bandwidth (UWB) can replace human observers. Further ongoing phases of the study will be necessary to determine whether the use of the monitoring system can effectively improve HH compliance in HCWs.

Disclosures

All Authors: No reported disclosures
2002. Infectious Diseases fellowship training on caring for people who use drugs: A national survey-based needs assessment
Authors: Vasishta Shilpa , Jawa Raagini , Kurz Sarah , Nolan Nathan
Published: November 2023

Background

Infectious complications of substance use are rising nationally among people who use drugs (PWUD), highlighting the need to integrate Infectious Diseases (ID) practice with addiction care. Training experiences among ID fellows, whose practice patterns are likely to be impacted by this syndemic, remain unknown. We conducted a national survey to understand U.S. ID fellows’ training, practices, and perspectives regarding care of PWUD.

Methods

An 18-item survey was developed to assess program characteristics, clinical practices, and perspectives regarding knowledge, comfort, and scope of practice. Recruitment was conducted via emails to fellowship programs, social media (Twitter, Mastodon), and IDSA platforms. Responses were collected over three weeks. Statistical analyses were conducted by chi square test. The study was deemed exempt from institutional review.

Results

196 U.S. ID fellows completed the survey (≅24% response rate), with representation from 9 of 9 geographic regions. All respondents cared for PWUD during their training. 49% had formal curriculum in their programs and 64% reported faculty advocates. 50% typically (in half or more encounters) counseled on harm reduction; 37% referred to outpatient resources and 33% recommended medications for opioid use disorders (MOUD) and naloxone. Respondents were unsure of community resources (e.g. syringe services, 48%; supervised consumption, 57%). 69% rated harm reduction counseling as extremely within scope of ID practice, versus 20% for the practice of recommending MOUD; 25% and 11%, respectively, reported feeling extremely comfortable with these skills. Engagement in discussions of harm reduction, MOUD, naloxone, and outpatient resources was significantly associated with presence of a faculty advocate (p< 0.01 for all).

Self-reported engagement in clinical practices among Infectious Diseases fellows

Perspectives on comfort level and scope of practice among Infectious Diseases fellows

Availability and knowledge of resources at Infectious Diseases training sites

Conclusion

U.S. ID fellows frequently care for PWUD but infrequently engage in integrated care practices. Harm reduction counseling is seen as highly within ID scope of practice, however, comfort and knowledge are low. Both comfort and perception of scope are low for discussing MOUD, though this appears to be impacted by faculty modeling. Our findings highlight an opportunity to formalize training in ID fellowship to better address the need for integrated ID/addiction care nationally.

Disclosures

All Authors: No reported disclosures
1466. Povidone-Iodine Irrigation versus Saline Irrigation for Reduction of Surgical Site Infections in Patients Undergoing Total Knee and Total Hip Arthroplasty: a large retrospective, propensity matched cohort study
Authors: Simon Samantha , Grant Andrew R , Smith Eric , Hollenbeck Brian L
Published: November 2023

Background

Surgical site infection (SSI) after total hip and total knee arthroplasty (THA/TKA) is a serious surgical complication. Perioperative irrigation with antiseptic compounds such as povidone-iodine have been used and are recommended by the World Health Organization and the Centers for Disease Control to reduce this risk. However, evidence supporting its superiority relative to non-antiseptic substances such as saline has been inconsistent. Therefore, we aim to identify if irrigation with povidone-iodine in THA/TKA reduces incidence of SSI in patients compared to saline irrigation.

Methods

In this retrospective, cohort study of 21,482 patients who underwent TKA or THA, we compared SSI rates between patients who received povidone-iodine irrigation and saline irrigation. Univariate and multivariable analyses were performed to identify risk factors for SSI. We also performed a propensity matched analysis. Each patient’s propensity for receiving povidone-iodine irrigation was calculated using select patient and surgical variables. Standardized mean differences were calculated to confirm reduction of potential confounding between the matched groups.

Results

There were 8,486 patients given saline irrigation and 12,996 patients given povidone-iodine irrigation (Table 1). In the univariate analysis, we did not identify a difference between povidone-iodine and saline (p = 0.76). Multivariate analysis showed diabetes, general anesthesia, and a procedure time of 2-3 hours increased risk of SSI, but povidone-iodine irrigation was not significantly different from saline (OR 1.1; CI 0.6-1.9) (Table 2). After propensity score matching there were 21 (0.25%) SSI in the povidone-iodine group and 19 (0.23%) in the saline group. Standardized mean differences were below 0.2 for all selected variables (Table 3). Odds of SSI were no different between the two matched groups (OR 1.1; CI 0.6-2.1).Table 1.Overview of patient and surgical variables by irrigation solution.Table 2.Multivariable analysis adjusted for age, sex, diabetes mellitus, anesthesia type, and procedure time. Showing odds of developing a surgical site infection.Table 3.Graph of standardized mean differences before and after matching. Blue dots represent unmatched cohort. Orange dots represent matched cohort. Table shows odds of developing a surgical site infection for the matched cohort.

Conclusion

Our analysis indicates no difference between povidone-iodine and saline irrigation in reducing SSI after THA/TKA. In situations where financial cost may be a factor in determining whether to use saline or povidone-iodine, we conclude that saline irrigation is equally efficacious and therefore a reasonable choice.

Disclosures

Eric Smith, MD, Conformis: Advisor/Consultant|Depuy: Advisor/Consultant
1491. Life's Simple 7 (LS7) is Not So Simple in Newly Diagnosed People Living with HIV: Evaluating Associations Between HIV and LS7 in ART-Naive People Living with HIV in Tanzania
Authors: Khan Safah , Manyangu Gloria J , Peck Robert N , Praygod George
Published: November 2023

Background

People living with HIV (PLWH) have complex cardiovascular health (CVH) profiles due to a combination of traditional, HIV-specific and lifestyle factors. Thorough characterization is necessary to guide primary prevention efforts. Previous studies that evaluated CVH in PLWH were mainly done in those on stable antiretroviral therapy (ART) and data in newly diagnosed PLWH is scarce. Therefore, we applied Life's Simple 7 (LS7) to compare CVH in ART-Naive PLWH and HIV-uninfected adults in Tanzania.

Methods

A cross-sectional analysis was conducted on a cohort of ART-naive PLWH and HIV-uninfected adults recruited from HIV clinics in Mwanza, Tanzania (CICADA cohort). We applied modified Life's Simple Seven (LS7) definitions (Table 1) and compared the distribution of LS7 metrics between study groups. Each LS7 was dichotomized as "ideal" (1 point) and "not ideal" (0 points) to obtain a total LS7 score. Poisson regressions were employed to investigate associations between HIV status and count of ideal total LS7 components (0-7). Logistic regression was employed to investigate individual LS7 metrics. Regressions were adjusted for age, sex, education, income.

Results

Our study included 1,224 participants (860 PLWH, 364 controls). PLWH had higher total LS7 scores (4.16 vs 3.85, p=0.015) and higher prevalence of ideal overall CVH (40% vs 35%, Figure 1). This difference remained significant even after adjusting for potential confounding (coef=0.07 [95%CI= 0.007-0.13], p=0.028). Distribution of LS7 metrics varied between groups (Figures 2a and 2b). PLWH were more likely to have ideal BMI (aOR=3.27 [95%CI= 2.41-4.45], p< 0.001), ideal blood pressure (aOR=3.35 [2.56-4.37], p< 0.001) and ideal total cholesterol (aOR=1.67 [1.24-2.24], p= 0.001). By contrast, PLWH were less likely to have ideal smoking (aOR=0.40 [0.26-0.59], p< 0.001), ideal blood glucose (aOR=0.39 [0.30-0.51], p< 0.001).

Conclusion

Early HIV influences several key determinants of cardiovascular health encompassed in Life's Simple 7 score. Our findings indicate favorable cardiovascular health in newly diagnosed PLWH, driven by lower rates of metabolic risk factors. However, such patients would still benefit from primary prevention efforts prioritizing smoking cessation, diabetes screening to mitigate remaining CVD risk.

Disclosures

All Authors: No reported disclosures
1512. Stakeholder Perspectives on Universal HIV Screening in Philadelphia Emergency Rooms
Authors: Aitcheson Nancy , O’Brien Caroline , Momplaisir Florence
Published: November 2023

Background

Decreasing new HIV infections requires reaching populations at increased risk of acquiring HIV who do not access regular testing. Emergency Departments (EDs) provide a disproportionate amount of care for socially vulnerable populations and are often the only place uninsured patients obtain healthcare. In Philadelphia, where HIV prevalence is 1.2%, further investigation is needed to optimize EDs as HIV testing venues for vulnerable populations. This study sought to elucidate perceived barriers and facilitators to universal HIV screening in EDs among hospital system stakeholders across Philadelphia.

Methods

We conducted a qualitative study using semi-structured interviews with physicians, administrators, and care navigators across five health systems in Philadelphia. Participants were recruited using snowball sampling. An interview guide based on the Consolidated Framework for Implementation Research explored facilitators and barriers to HIV testing in EDs. Interviews were audio-recorded and transcribed verbatim. We analyzed interviews using a modified grounded theory approach to code interview transcripts. Interrater reliability was assessed between multiple coders.

Results

14 individuals were interviewed: 3 registered nurses, 1 social worker, 2 program managers, and 8 physicians. Participants reported EDs play a critical role in providing care to patients who otherwise do not engage with the health care system, who tend to be of lower socioeconomic status and multiply marginalized. The facilitator that most significantly increases ED provider buy-in is a non-ED provider to follow up on HIV test results. Barriers to robust HIV testing programs included competing priorities, lack of personnel, and lack of sustainable funding.

Conclusion

This contextual inquiry revealed shared barriers and facilitators to HIV testing across multiple health systems in a city with a high burden of HIV. The development of a dedicated staff position to deal with indeterminate and reactive HIV testing (removing this responsibility from ED) is the single most important intervention to facilitate HIV testing in EDs. This study provides a clear target for municipal funding in Philadelphia and may be generalizable to HIV testing implementation in EDs in other urban centers.

Disclosures

All Authors: No reported disclosures
1515. Implementing “Opt-Out” Screening to Identify and Link Patients to Care With HIV: Experience from Memorial Healthcare System
Authors: Eckardt Paula A , Niu Jianli , Piche Elizabeth J
Published: November 2023

Background

The program is an opt-out HIV testing program aiming to improve HIV screening and provide linkage to care for patients who test positive. Here we present project results of implementing opt-out” screening to identify and link patients to care with HIV in a large community hospital in South Florida.

Methods

Patients aged 18-75 years entering the emergency departments (EDs) for medical care were screened for eligibility automatically utilizing an EPIC-based screening tool. The program data from its inception in June 2008 to the end of December 2022 were retrospectively reviewed. Data included demographics and HIV testing results with linkage to care information. All HIV positive results were confirmed by Broward County Department of Health to identify new versus previous HIV positive cases. Data was entered in a spreadsheet and then imported for descriptive statistical analysis.

Results

Of the 79,309 patients tested in the program between June 2018 and December 2022, 471 were identified as HIV positive with an overall rate of 0.6% (Figure 1). Of those tested HIV-positive, 134 (28.5%) were newly diagnosed. The majority of those newly diagnosed were male (64%), African American (66%), and 26-35 years of age (27.2%). 74.6% of the newly diagnosed patients were linked to care (Figure 2). Of those 337 previously diagnosed patients, 189 (56.1%) were confirmed in HIV care, 20 were known to have died, and 68 (53.1%) of 128 patients out of care at testing achieved care re-engagement (Figure 2). Additionally, the number of opt-out tests decreased from 22,092 in 2019 to just 10,359 in 2020 due to the COVID-19 pandemic. However, as the pandemic subsided in 2021 and 2022, the number of opt-out tests increased to 14,705 and 22,264 respectively (Figure 1).Figure 1.The FOCUS testing HIV data at MHS, June 2018−December 2022.Figure 2.Linkage to medical care in HIV-positive cases, June 2018−2022.

Conclusion

The results showed that the FOCUS program on HIV testing and linkage to care can be successfully integrated into a community healthcare system. The high rate of newly diagnosed HIV-positive cases in the program highlights the need for increased access to HIV testing and healthcare services. The rate of HIV re-engaged in care among those previously diagnosed also indicates the need for opt-out HIV testing in the community to increase reengagement in care.

Disclosures

All Authors: No reported disclosures
1518. Prevalence of Integrase Inhibitor Resistance within an Urban Clinic Network After Adoption as First-line Therapy
Authors: Januszka Jenna E , Drweiga Emily N , Badowski Melissa E
Published: November 2023

Background

Limited data outside of randomized controlled trials exist reporting the prevalence of integrase inhibitor resistance (INSTI-R) since the approval and recommendation of INSTIs as first-line treatment for HIV. National surveillance data in 2018 estimated INSTI-R to be 6.3% in people with HIV (PWH) who had never achieved viral suppression, with 0.8% attributed to transmitted drug resistance (TDR). The purpose of this study was to describe the prevalence of INSTI-R in patients from a single urban clinic network on INSTI-containing regimens. Prevalence amongst University of Illinois Chicago Community Clinic Network (UCCN) patients on INSTI-containing single-tablet regimens specifically was previously reported.

Methods

This was a retrospective study of adult PWH followed at UCCN prescribed an INSTI-containing regimen between September 2017 and September 2020 with > two recorded HIV-1 RNA viral loads collected > 12 months apart. The primary endpoint was the difference in INSTI-R in UCCN patients compared to national data. Other outcomes included development of virologic failure (VF), defined as > 200 copies/mL in two consecutive HIV-1 RNA viral loads, and patient specific factors associated with VF. The primary endpoint was analyzed using a chi-square test. All other data are presented as descriptive statistics.

Results

Of 948 patients screened, 321 were included and followed an average of 30 months. Baseline characteristics are presented in Table 1. A total of 5 subjects had INSTI-R prior to switch resulting in a prevalence of 1.6%, which was significantly less than the national prevalence of 6.3% (p< 0.001). Of note, all patients with INSTI-R were previously treated with first generation INSTIs and none were deemed TDR. Study-defined VF occurred in 26 subjects (8.1%). Seven subjects (26.9%) were not taking antiretrovirals for > six weeks at the time of study-defined VF. Outcomes of patients with VF are outlined in Table 2. Subjects with a pre-treatment viral load > 100,000 were more likely to experience VF (p=0.0485).

Conclusion

Among UCCN patients on INSTI-containing regimens, INSTI-R rates were lower than the estimated national prevalence; however, this comparison is limited due to the large proportion of subjects with viral suppression at baseline.

Disclosures

All Authors: No reported disclosures
1521. High frequency of vitamin D deficiency in hospitalized patients with HIV: A prospective study in Colombia
Authors: Ortiz-Martínez Yeimer , Herrera-Caviedes Leidy , Figueroa-pineda Claudia , Melo-Amaya María J , Martínez Andrés F Henao
Published: November 2023

Background

Vitamin D deficiency is prevalent in people living with HIV (PLWH) and is linked to various negative health outcomes. Despite numerous studies in other regions, information regarding vitamin D status and its determinants among PLWH in Latin America is scarce. This study aimed to determine the frequency of vitamin D deficiency in hospitalized patients with HIV in Colombia and identify associated risk factors.

Methods

We conducted a prospective cohort study of hospitalized patients with HIV at a tertiary university hospital in Bucaramanga, Colombia, between December 2022 and April 2023. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured at admission and categorized as suboptimal (≤30 ng/ml), insufficient (≤25 ng/ml), deficient (≤20 ng/ml), or severely deficient (≤10 ng/ml). Demographic, clinical, and paraclinical data were collected, and multivariate logistic regression was performed to identify factors associated with vitamin D deficiency.

Table 1

Results

A total of 73 PLWH were included in the study. 75.3% were men with a mean age of 40.6 ± 11.85 years. 50.6% were on antiretroviral therapy (ART) at the time of admission. 69.8% had a CD4 count ≤ 200 cells/mm3, and 63% had a viral load > 10,000 copies/ml. The in-hospital mortality was 19.35%. The median (IQR) 25(OH)D level was 21.28 ng/mL (13-27.8). Vitamin D deficiency was present in 49.3% of the participants, with 19.1% having severe deficiency. Insufficiency and suboptimal levels were found in 56.1% and 79.4%, respectively. No significant association was found between vitamin D deficiency and mortality or HIV-related factors, including ART, viral load, and CD4 count (Table 1). However, after multivariate analysis, albumin less than 3 g/dL was significantly associated with vitamin D deficiency (aOR 3.86, 95% CI: 1.37-10.85; p=0.01).

Conclusion

This is the first prospective study in Colombia that highlights the high frequency of vitamin D deficiency in hospitalized patients with HIV. The finding of a significant association between hypoalbuminemia and vitamin D deficiency suggests that malnutrition or TNF-mediated cachexia may be contributors to this problem. Further studies are needed to explore the implications of vitamin D deficiency in this population and to develop appropriate interventions.

Disclosures

All Authors: No reported disclosures
1541. HIV Risk Assessment in Boston Community Health Center Dental Clinics
Authors: Konstandt Daryl , Chafjiri Pegah Mohammah Alizadeh , Bolter Eric , Collins Elisabeth , Lodi Sara , Henshaw Michelle , Bazerman Lauri , Cho Janice , Coleman Caitlin , Paul Mina , Powell Elizabeth , Beckwith Curt
Published: November 2023

Background

Suffolk County (Boston), Massachusetts is identified by the CDC as a geographic hotspot for new HIV infections. The Ending the HIV Epidemic Initiative (EHE), implemented by the Department of Health and Human Services, aims to decrease new HIV infections by 90% in the next decade. Although HIV treatment radically improves lives, individuals must know their status to receive treatment. Fourteen percent of persons with HIV are unaware of their diagnosis and 23% of dental patients do not access primary medical care. Therefore, community health center dentists are uniquely positioned to contribute to the “Diagnose” pillar of EHE. Dental clinics can provide new opportunities for HIV testing for persons at increased risk for HIV within EHE designated jurisdictions. The purpose of this study was to assess HIV risk factors [sexually active men who have sex with men (MSM), multiple sexual partners, condomless sex, and intravenous drug use (IDU)] among community health center dental patients in the Boston area.

Methods

An anonymous, voluntary, 25 question survey was disseminated in English, Spanish and Haitian Creole within 5 community health center dental clinics in Boston. The data were compiled and analyzed with descriptive statistics using REDCap survey software and EXCEL.

Results

Of the 299 dental patients who completed the survey, the majority were female (55%), black (54%), non-Hispanic (52%) and 22-54 years old (56%). 24% of respondents reported at least one risk factor for HIV within the past year including 53 individuals with multiple sexual partners, 18 sexually active MSM and 3 IDU in the past year. Of the 188 persons that had sexual contacts in the past 12 months, 37% never used a condom. Thirty-four percent report never having an HIV test.

Conclusion

One-quarter of dental clinic patients who completed the survey reported HIV risk factors, making community health center dental clinics an underutilized venue for HIV testing and prevention interventions. The goals of EHE require the implementation of HIV testing in new settings to reach persons who are missed by traditional HIV testing sites. Dental providers represent an important, yet untapped, workforce that can contribute to EHE.

Disclosures

All Authors: No reported disclosures
1564. Virological Suppression in People with HIV-1 (PWH) Receiving Dolutegravir/Lamivudine Was High and Similar across Age Groups despite Older PWH Having Increased Rates of Comorbidities and Polypharmacy (TANDEM Subgroup Analysis)
Authors: Brogan Andrew P , Slim Jihad , Verdier Gustavo , Harper Gavin , Mycock Katie L , Wallis Hannah , Donovan Cynthia
Published: November 2023

Background

Aging with HIV has unique challenges, including comorbidities and drug-drug interactions. TANDEM was a retrospective medical chart review conducted across 24 US sites. This subgroup analysis examines stable-switch PWH receiving dolutegravir/lamivudine by age.

Methods

Eligible PWH were adults initiating dolutegravir/lamivudine prior to September 30, 2020, with ≥6 months of clinical follow-up (Figure 1). Stable-switch PWH were defined as having HIV-1 RNA < 50 copies/mL and on a stable antiretroviral regimen for ≥3 months upon dolutegravir/lamivudine initiation. Clinical characteristics, treatment history, and outcomes were analyzed for 3 age groups among dolutegravir/lamivudine stable-switch PWH. Analyses were descriptive.

Results

The number of dolutegravir/lamivudine stable-switch PWH in each age group was 86 (< 50 years), 106 (≥50 years), and 20 (≥65 years). A greater proportion of PWH in the older age groups were female sex at birth (14.0% < 50 years; 20.8% ≥50 years; 30.0% ≥65 years). More PWH in older age groups had reported comorbidity (12.8% < 50 years; 34.9% ≥50 years; 45.0% ≥65 years) and polypharmacy (5.8% < 50 years; 17.9% ≥50 years; 30.0% ≥65 years; Figure 2). Avoidance of long-term toxicities was the biggest driver for initiating dolutegravir/lamivudine in the older age groups (32.1% ≥50 years; 30.0% ≥65 years) while simplification/streamlining of treatment was the most common (27.9%) primary reason for PWH to switch to dolutegravir/lamivudine in the < 50 years group (Figure 3). For PWH < 50 years, 95.3% remained virologically suppressed for the study period. Similarly, 96.2% of PWH ≥50 years and 95.0% of PWH ≥65 years remained virologically suppressed for the study period (Figure 4). Three PWH with nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) resistance at baseline remained suppressed.

Conclusion

Virological suppression rates were high and similar by age group among dolutegravir/lamivudine stable-switch PWH despite higher rates of comorbidities and polypharmacy in the older age groups. This real-world analysis is consistent with clinical study data supporting dolutegravir/lamivudine as an effective treatment strategy in older PWH.

Disclosures

Andrew P. Brogan, PhD, ViiV Healthcare: Stocks/Bonds Jihad Slim, MD, FACP, ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support Gustavo Verdier, BSc, BPharm, MBA, ViiV Healthcare: Stocks/Bonds Gavin Harper, BA, ViiV Healthcare: Grant/Research Support Katie L. Mycock, MChem, ViiV Healthcare: Grant/Research Support Hannah Wallis, MS, ViiV Healthcare: Grant/Research Support Cynthia Donovan, PharmD, ViiV Healthcare: Stocks/Bonds
1578. Evaluation of comparative HIV care continuum outcomes following three years of program implementation of the PositiveLinks smartphone intervention among people with HIV with and without substance use
Authors: Hodges Jacqueline , Caldwell Sylvia , Otero Kori , Williams Brooke , Elliott Ben , Richey Lauren , Waldman Ava Lena , Dillingham Rebecca , Ingersoll Karen
Published: November 2023

Background

People with HIV (PWH) and substance use (PWSU) have demonstrated inferior HIV care continuum outcomes, including lower retention in care (RIC), poorer ART adherence, and lower rates of viral suppression (VS) relative to peers without substance use within the literature. We compared 3-year outcomes among people with and without substance use who are enrolled in a smartphone intervention, PositiveLinks (PL), to determine the relative impact of PL for this subgroup of PWH.

Methods

We performed retrospective chart review of clinical encounter and laboratory data and ICD-diagnoses for 600 PWH enrolled in PL from 2017-2020. Substance use was categorized by diagnoses of illicit substance use and/or substance use-related visits conducted at the UVA Ryan White Clinic. Patients with no documented substance use, or documented tobacco or reported alcohol use with no criteria for a substance use disorder were considered non-substance using. We analyzed HIV clinical outcomes (VS, RIC by HRSA-1 measure) for PL members in each group at baseline (April 2017) and three years later (April 2020, t-test).

Results

Chart review for the 3-year period of interest for 600 PWH enrolled in PL revealed 117 PWH meeting criteria for substance use and 483 not meeting criteria. A mean of 13 Ryan White Clinic visits were conducted per person among 117 PWSU, compared to 8 visits each among 483 PWH without documented substance use (p< .01) over 3 years. Among PWSU, RIC increased from 56% to 79% (p< .01) while among PWH without substance use, RIC increased from 47% to 69% (p< .01). VS increased significantly among PWSU from 71% to 90% (p< .01), while among PWH without documented substance use, VS increased from 70% to 87%, (p< .01). Differences between groups for RIC and VS were not statistically significant at either time point.

Conclusion

A sample of 600 PWH using PL demonstrated comparable HIV clinical outcomes across 3 years regardless of substance use status. This sample selects for PWSU who stayed enrolled in PL at 3 years, and may not reflect outcomes expected for a broader population of variably engaged PWSU offered non-tailored mobile health interventions for HIV care. Further analysis is planned to determine whether covariates including demographic characteristics and PL usage patterns influence outcomes observed.

Disclosures

Sylvia Caldwell, MPH, DHSc, Warm Health Technology: Advisor/Consultant Ben Elliott, MSW, Warm Health Technology: Advisor/Consultant Ava Lena Waldman, M.H.S., CHES, CCRP, Warm Health Technology: Advisor/Consultant Rebecca Dillingham, MD MPH, Warm Health Technology: Advisor/Consultant