bluuebunny/crossref_metadata_2025 huggingface dataset:
P-478. Assessing HIV Transmitted Drug Resistance and cluster detection among Antiretroviral-Naïve individuals in Hispaniola
Authors: Lora Hector J , Sanchez Martha , Novitsky Vladimir , Hague Joel , McCarthy Meghan , DeLong Allison , Mendoza Diego , Ruiz Ingrid , Jabier Maridania , Paulino-Ramírez Robert , Kantor Rami
Published: January 2025

Background

The use of antiretroviral therapy (ART) has surged globally, heralding an era of life-saving treatment for millions. However, with this widespread adoption of ART, a concerning trend has emerged: the escalation of antiretroviral resistance. Within the confines of La Hispaniola, encompassing the Dominican Republic (DO) and Haiti(HT), the prevalence of HIV stands among the highest in the Caribbean region. Our main objective is to identify and characterize the extent of transmitted drug resistance (TDR) of HIV among treatment naïve participants, its demographic and the clinical associations in the DO and the transmission networks.

Phylogenetic relationships between DRII PRRT sequences and NNRTI SDRMs

Methods

During May 2021-June 2022, we enrolled 148 newly HIV-diagnosed ART naïve adults at Centro de Orientacion e Investigación (COIN) in DO. Demographic and clinical were collected, and blood samples obtained for partial pol genotyping using NGS. Subtyping and resistance interpretation were performed with Stanford Database tools. Maximum likelihood phylogenies were inferred by RAxML and clusters were defined as clades with bootstrap support of ≥0.8. Extended phylogenetic analyses included ∼1,500 publicly available Caribbean sequences including prior data set from our group. Fisher Exact tests and logistic regression were used to test associations of those in clusters.

Phylogenetic relationships of DRI and DRII PRRT sequences

Results

Among participants the mean age was 30 years, 52% male, 48% were Dominican and 52% Haitian, 74% heterosexual. Among those with genotype, 8% (10 out of 127) had NNRTI SDRMs (Figure 1). A minority SDRMs, range of 1% to 20%, were found in the PI, NRTI and NNRTI. At the relaxed criteria, 17% of participants were in 8 clusters, ranging from 2 to 5 members. Those within clusters were less likely to be older, p=0.026 and more likely to be male, p=0029. Combination of current and prior dataset from the DO revealed 21 clusters, ranging from 2 to 6 members per cluster (Figure 2).

Conclusion

In the DO, NNRTI-associated TDR is increasing, aligning with the continued use of Efavirenz as first-line ART highlighting the need for an update in the national guidelines. Identification of minority mutations suggests need for TDR surveillance. Detection and response to clusters is a novel, effective modality to understand HIV transmission networks and address care gaps at individual and systems level.

Disclosures

All Authors: No reported disclosures
P-479. The Impact of the COVID-19 Pandemic on HIV Testing in Peru: An Interrupted Time Series Analysis from 2014 to 2022
Authors: Yrene-Cubas Robinson A , Perez-Castilla Jesus , Reynaga-Cottle Daniel E , Bringas-Queirolo Maria J , Soriano-Moreno David , Fernandez-Guzman Daniel , Gonzales-Zamora Jose A
Published: January 2025

Background

HIV testing is crucial for early treatment and mortality reduction. In Latin America and the Caribbean, 18% of individuals are unaware of their HIV status, which leads to a late diagnosis. Furthermore, COVID-19 lockdowns had a negative impact on HIV testing rates. This study focused on comparing pre-pandemic (January 2014-February 2020) and post-lockdown (August 2020-December 2022) testing rates to support effective HIV screening and public health strategies.Figure 1.Interrupted time series analysis for the frequency of HIV testing per quarter.

Methods

We performed an interrupted time series analysis with cross-sectional data from Peru's National Demographic and Health Survey (ENDES), covering 2014 to 2022. ENDES follows a complex, three-stage sampling method: proportional cluster selection, random household selection within clusters, and individual selection aged 15 or older for the health survey. A segmented regression analysis adjusted for age and gender evaluated changes in testing rates, with an ARIMA model providing counterfactual predictions against actual pandemic-period rates.Figure 2.Interrupted time series analysis for HIV testing.

Results

The study included 211,359 participants aged 15 to 49 years. There was a significant drop in HIV testing by 8.33% (95% CI: -10.73% to -5.93%, p< 0.001) post-lockdown. Before the lockdown, HIV testing rates trend was increasing by 0.30% per quarter (95% CI: 0.21% to 0.40%, p< 0.001); however, after the lockdown, they declined by -0.24% per quarter (95% CI: -0.56% to 0.09%, p=0.125) (Figure 1), with the most pronounced decrease among adolescents (15-17 years), the economically disadvantaged, those who lived in rural areas, and non-capital residents. The ARIMA model indicated a potential non-pandemic decline of -9.20% in testing proportions (95% CI: -13.70% to -4.80%) in comparison with the forecasted values (Figure 2).

Conclusion

COVID-19 lockdown policies markedly decreased HIV testing in Peru, especially affecting high-risk groups. Although limited by potential recall bias and self-reporting, this research, focusing primarily on individuals aged 15 to 49, provides essential data for targeted interventions to restore and ensure HIV testing accessibility post-pandemic.

Disclosures

All Authors: No reported disclosures
P-530. Clinician Utilization of CDC-aligned HIV PrEP Panels
Authors: Walworth Charles M , Gillim Laura , Alfego David , Aikins Ato
Published: January 2025

Background

In Dec 2021, the CDC issued updated guidelines for HIV PrEP. Diagnostic panels were developed to facilitate the baseline evaluation and monitoring of patients for HIV, STIs, HBV, and HCV among PrEP users.

Methods

Retrospective analysis of results reported for HIV PrEP panels ordered between Feb 2023 and Mar 2024. The panels were developed to capture HIV PrEP testing for baseline (BL) evaluation and for monitoring of oral and injectable agents in males and females. Tests were aligned with those recommended by the 2021 updated guidelines and included panels with and without HIV-1 RNA PCR. Standalone testing was also available. Testing intervals were assessed.

Results

31,347 unique patients had PrEP-related testing. Of those, 25,373 had one or more tests with 146 (0.6%) testing positive for HIV at baseline. 14,480 unique patients had two or more HIV PrEP tests on different dates. 98% were male with a median age of 36 years. 20 of those patients tested positive for HIV (0.14%). Of those, 15 tested positive for HIV Ag/Ab, but 14 were negative for HIV RNA. 5 patients were positive for HIV-1 RNA, but tested negative for HIV Ag/Ab. The HIV false positive rate was 0.25%. There were 5 HIV RNA positive tests out of 52,050 negative HIV Ag/Ab tests (0.001%). Testing closely adhered to recommended intervals for both oral and injectable agents. 15,041 out of 25,227 patients (59.6%) had an STI test during the analysis. 2,876 out of 15,041 patients had at least one STI during PrEP treatment (19.1%). Chlamydia was diagnosed in 5.8% and gonorrhea in 9.2%. 6.7% of patients were positive for treponemal antibodies with 5.1% RPR reactive. STI co-infections were also seen. Those with active HBV and HCV infections while on PrEP were each 0.3%.

Conclusion

In this large laboratory cohort of patients utilizing HIV PrEP testing, HIV infections were rare, supporting the low rates seen in HIV PrEP trials. Infections were mainly found at BL screening. False positive HIV Ag/Ab results were consistent with published reports. STI rates are significant with approximately 1/5 of patients testing positive, although active HBV and HCV infections were very low for those utilizing PrEP.

Disclosures

Charles M. Walworth, MD, Labcorp: Employee|Labcorp: Employee|Labcorp: Stocks/Bonds (Public Company) Laura Gillim, PhD, Labcorp: Employee|Labcorp: Stocks/Bonds (Public Company) David Alfego, PhD, Labcorp: Employee|Labcorp: Stocks/Bonds (Public Company) Ato Aikins, PhD, Labcorp: Employee
P-531. Mitochondrial DNA Haplogroups and Circulating Immune Cell Phenotypes in Veterans with and without HIV
Authors: Yan Aiwei , Kundu Suman , Samuels David , Bailin Samuel S , Xu Ke , So-Armah Kaku , Butt Adeel A , Gerschenson Mariana , Goetz Matthew B , Tracy Russell , Marconi Vincent , Justice Amy , Freiberg Matthew , Koethe John R , Hulgan Todd
Published: January 2025

Background

HIV infection and mitochondrial function both influence cellular immune responses, but little is known about this relationship. We examined associations between mitochondrial DNA (mtDNA) haplogroups and peripheral blood mononuclear cell (PBMC) phenotypes among people with HIV (PWH) and without HIV in the Veterans Aging Cohort Study Biomarker Cohort (VACS-BC).

Methods

VACS-BC participants had mtDNA haplogroups determined from genome-wide genotyping and PBMC phenotyping by flow cytometry. Analyses included Kruskal-Wallis and Wilcoxon rank sum tests stratified by self-reported ancestry (non-Hispanic Black or White) and HIV status. Significant univariate associations were assessed in linear regression models adjusted for age and plasma viral load < 50 copies/mL among PWH. These exploratory analyses were not corrected for multiple comparisons.

Results

1939 Veterans (1266 PWH; 95% male; median age 52 years [range 25-91]) had data available. In Black PWH (N=991), African haplogroup L3 was associated with lower % senescent (CD28-negative) CD4+ T cells (p=0.05), and haplogroup L2 was associated with higher % TEMRA CD8+ T-cells (p=0.03). In White PWH (N=275), European haplogroup T was associated with lower % CD38+ CD4+ T-cells (p=0.02) and haplogroup J with lower % IL4+ CD4+ T-cells (p=0.001). Haplogroups T and J were also associated with lower (p=0.05) and higher (p=0.02) % transitional memory CD8+ T-cells, respectively. Different age-adjusted associations were seen in Veterans without HIV, with the most prominent between haplogroups T and L1 and lower % total (CD14+) and classic (CD14+/CD16-) monocytes (p-value range=0.02-0.005).

Conclusion

MtDNA haplogroups were associated with cellular phenotypes, and associations differed by HIV status. Notable findings among PWH were in senescent, CD38+, and IL4-producing CD4+, and effector memory CD8+ T-cells, all important components of immune responses to viral infection. Haplogroup associations with monocyte populations in persons without HIV are intriguing and deserve further study. Limitations include those inherent in PBMC flow cytometry, cross sectional design, and small sample sizes for some subgroups. Validation in independent cohorts and mechanistic studies are needed.

Disclosures

Adeel A. Butt, MD, MS, Gilead Sciences: Grant/Research Support John R. Koethe, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Merck & Co.: Advisor/Consultant|Merck & Co.: Grant/Research Support
P-540. Undesired Weight Gain and Associated Healthcare Outcomes Among People Living with HIV on Antiretroviral Therapy
Authors: Tadese Bekana K , Cambron-Mellott Janelle , Arduino Jean Marie , Balkaran Bridget L , Eslamimehr Shakiba , Zuniga José M
Published: January 2025

Background

Studies indicate that people living with HIV (PLHIV) experience weight gain associated with certain classes of antiretroviral treatment (ART). Managing overall health beyond viral suppression, including weight gain, is essential for improving PLHIV quality of life. This study characterizes undesired weight gain, weight management, and associated healthcare outcomes among PLHIV.

Methods

A cross-sectional Web-based survey was fielded from February-June 2022 to PLHIV in the US aged ≥18 years, and on ART. Demographic and clinical factors, weight change, weight gain associated burden/concern and health outcomes were explored. Undesired weight gain in the past 12 months was captured. Multivariable logistic regression analyses were conducted to examine associations between undesired weight gain and factors and healthcare outcomes.

Results

A total of 781 PLHIV were included; median age 41 years (range:18-76); 56% cisgender male; 52% White; 25% Black. Most (86%) had undetectable viral load; 55% were living with HIV ≥5 years. About half (52%) were either overweight or obese. A total of 230 (29%) reported experiencing weight gain in the past 12 months, of which 172 (75%) reported undesired weight gain. Among those with undesired weight gain, the median (IQR) increase in weight was 20 lbs (10, 40). PLHIV with undesired weight gain were more likely to report multimorbidity and duration of HIV infection >10 years vs 1-5 years (p< 0.05). Over half (54%) and 23% reported that their HIV clinicians sometimes or never/rarely, respectively, discuss their weight.

In the multivariable regression, PLHIV had higher odds of undesired weight gain in those who switched their ART regimens ≥ 3 times vs those who have not (OR:3.14; 95% CI: 1.69 -5.93), obese (OR: 3.44; 95% CI: 1.97- 6.03) or overweight (OR: 2.37; 95% CI: 1.45-3.18) vs normal baseline BMI, and lower odds of undesired weight gain in cisgender female vs cisgender male (OR:0.53; 95% CI:0.33-0.84).

Conclusion

This study highlights the burden of undesired weight gain and its association with obesity, comorbidities, and switching ART regimens among PLHIV. The results underscore the need for regular weight monitoring and management approaches including careful consideration of individual risks when selecting ART regimen to avert excessive weight gain.

Disclosures

Janelle Cambron-Mellott, PhD, Oracle Life Sciences, Oracle Corporation: Employee of Oracle Life Sciences who received funding from Merck to conduct study.|Oracle Life Sciences, Oracle Corporation: Stocks/Bonds (Public Company) Jean Marie Arduino, MS, ScD, Merck & Co., Inc., Rahway, NJ: Employee|Merck & Co., Inc., Rahway, NJ: Stocks/Bonds (Public Company) Bridget L. Balkaran, MPH, Merck: Advisor/Consultant|Merck: funding for this work|Oracle Life Sciences: Employee|Oracle Life Sciences: Ownership Interest|Oracle Life Sciences: Stocks/Bonds (Public Company)
P-543. A Descriptive Report of Discontinuation Rates, Blips, and Viremia Associated with Cabotegravir/Rilpivirine at One Ryan White HIV/AIDS Program-funded site in Northern Virginia
Authors: Prather Caitlin , Richey Katie , Verderese John Paul
Published: January 2025

Background

Cabotegravir/rilpivirine (CAB/RPV) is the first and only long-acting complete regimen for the treatment of HIV-1 infection. Rates of discontinuation, viral blips, and viremia were low in Phase III clinical trials for CAB/RPV, but data from additional locations in real-world conditions remains lacking. This descriptive report explores the frequency of these occurrences in patients treated with CAB/RPV at one Ryan White HIV/AIDS Program (RWHAP)-funded site.

Methods

This was a single-center, retrospective, observational chart review of people living with HIV at one institution in Northern Virginia. Patients were included if they received at least one dose of injectable CAB/RPV between January 2021 and April 2024. Data collected from the electronic medical record included demographics, body mass index (BMI), history of antiretroviral drug mutations, HIV viral load, and HIV treatment history.

Results

A total of 107 patients were included in this study with a mean age of 45 years. Of these, 2% were assigned female at birth and 49% were Black. In the study period, 16% of patients discontinued the medication. The most common causes for discontinuation were adverse effects, insurance denials, patient preference for oral therapy, and frequently missing appointments. Of the 17 patients who discontinued therapy, only one was discontinued due to virologic failure. As of April 2024, 85 patients remain on CAB/RPV. Of these, 43% have experienced at least one blip, 25% have experienced low-level viremia, and 61% have experienced either a blip or low-level viremia since starting CAB/RPV. Duration of therapy ranged from 1 to 1020 days (average 579 days) since first injection and longer duration of therapy weakly correlated with prevalence of blips or viremia. 92% of doses have been administered within the allowable 14-day treatment window. There was no significant difference between BMI at the start of treatment to April 2024.

Conclusion

Among patients treated with CAB/RPV, viral blips and low-level viremia are common but are not associated with treatment discontinuation or treatment failure. Rates of discontinuation due to adverse effects were higher than what was observed in Phase III randomized controlled trials of CAB/RPV, though treatment failure was uncommon as expected.

Disclosures

All Authors: No reported disclosures
P-548. Higher rate of two-drug regimen discontinuation due to reasons unrelated to virologic failure among people with HIV aged 50 years or above
Authors: Tang Tommy , Kwong Tsz Shan , Chan Philip , Lam K W , Chan Helen , Choy Annabel K T , Chu M Y , Fong Jason , Lam Wilson , Leung W S , Ting W M , Wu T C , Yung S K , Lee M P
Published: January 2025

Background

Previous studies demonstrated that integrase strand transfer inhibitor (INSTI)-based two-drug regimens (2DRs) reliably maintain HIV suppression. Corresponding data in older people with HIV (PWH) remain limited. This retrospective study compared the real-world maintenance outcomes of INSTI-based 2DRs between PWH aged 50 or above (PWH >=50) and those below 50 years (PWH< 50). It was approved by the Research and Ethics Committee, Kowloon Central/Kowloon East Cluster, Hospital Authority (KC/KE-23-0195/ER-4).

Methods

PWH who switched from suppressive standard three-drug antiretroviral therapy (ART) to oral INSTI-based 2DRs at the HIV Clinic of the Queen Elizabeth Hospital, Hong Kong, China were identified through electronic records. The formulations of 2DRs and outcomes of those who reached 96 weeks after switch, before 1 March 2024 were retrieved. HIV suppression and virologic failure (VF) were defined as plasma HIV-1 RNA < 50 copies/mL and >200 copies/mL respectively.

Results

Since January 2014, 237 PWH switched to INSTI-based 2DRs. Their pre-switch characteristics are summarized in Table 1. On 29 February 2024, 96 weeks has lapsed from their 2DR switch dates in 87 PWH< 50 and 101 PWH >=50. Eight (4.3%) of them died due to causes unrelated to HIV. Twenty-two of them (11.7%) discontinued 2DRs during the 96-week period: six (6.9%) were PWH< 50 and 16 (15.8%) were PWH >=50, with reasons summarized in Table 2.

By log-rank test, PWH >=50 trended toward significance for a higher risk of 2DR discontinuation when compared to PWH< 50 (p=0.058) (Figure 1). VF occurred in only 3 (1.6%) users, with similar rates between both groups (p=1). One PWH< 50 developed VF due to non-adherence, continued 2DR and achieved subsequent viral suppression. Another two had negative drug resistance mutation tests afterwards. 2DRs discontinuation due to non-VF causes was numerically higher in the PWH >=50 group without statistical significance (p=0.06).Figure 1.Kaplan-Meier estimator for the cumulative risk of 2DR discontinuation

Conclusion

In this real-world study comparing the maintenance outcomes of virally suppressed PWH who switched to INSTI-based 2DRs, occurrence of VF was uncommon in both older and younger PWH. However, discontinuation due to non-VF causes was more common in older PWH above 50 years old than those below, with a majority contributed by intolerance and non-HIV deaths.

Disclosures

Wilson Lam, n/a, Gilead: Advisor/Consultant|Gilead: Honoraria|GSK: Advisor/Consultant|GSK: Honoraria|Moderna: Honoraria|Pfizer: Conference sponsor
P-609. Assessment of Parents’ Awareness and Attitudes towards Respiratory Syncytial Virus and its Prevention in the US
Authors: Choi Yoonyoung , Berjonneau Erwan , DWYER Brian , Chun Bianca , Petigara Tanaz , Guillaume Xavier
Published: January 2025

Background

To assess the awareness and attitudes of parents towards respiratory syncytial virus (RSV) infection in the United States.

Methods

We developed an online, quantitative survey consisting of 34 questions, informed by a literature review, qualitative interviews, and cognitive tests. Between October 20th and November 25th, 2023, individuals who were expecting a child or had children aged ≤2 years were recruited through panels.

Results

In total, 153 individuals were recruited, of which 73% were female and 57% had completed some schooling beyond high school. On average, they were 33.9 years old (standard deviation:7.2) and 78% had at least one child aged ≤2 years in their household, while 48% were expecting a child.

Most parents (88%) agreed that having their children immunized is a good way to protect them from diseases, and 84% agreed that they follow their healthcare provider’s recommendation for their children’s immunizations. However, 66% said they were concerned about serious side-effects of immunizations, and 54% question the value of some types of immunizations.

Level of knowledge about RSV varied among parents, with 35% reporting that they knew a lot about it, 39% that they were somewhat knowledgeable and 20% that they knew what it is but not much else. Very few (5%) had only heard of RSV but knew nothing more, and just 1% had never heard of RSV at all. Among parents who were aware of RSV (n=151), 63% were moderately or extremely concerned about RSV in children, with 33% extremely concerned. 34% of parents with children had at least one child who had ever been diagnosed with RSV, of which 60% visited urgent care or an emergency department and 46% were hospitalized.

About half of parents (46%) were aware of immunizations newly available for RSV. 90% strongly or moderately agreed that RSV prevention is important for children, and 78% would be eager to ask their physician about RSV immunization options.

Conclusion

Findings show that most parents in the US are concerned about RSV in children and almost all think that RSV prevention is important for children. While a majority follow their provider’s recommendation, they also expressed concerns related to immunizations.

Disclosures

Yoonyoung Choi, PhD, MS, RPh, Merck: Employee|Merck: Stocks/Bonds (Private Company) Bianca Chun, MPH, Merck Sharp & Dohme LCC, a subsidiary of Merck & Co., Inc., Rahway, NJ.: Employee Tanaz Petigara, PhD, Merck & Co., Inc.: Employee|Merck & Co., Inc.: Stocks/Bonds (Public Company)
P-611. Improving Rabies vaccination delivery and access: A Quality Improvement Project
Authors: Dutta Ankhi , Taylor Margaret , Foster Catherine , Holzmann-Pazgal Galit , James Megan , Morgera Valerie , Velasco Michelle , Oliver Holly
Published: January 2025

Background

Rabies remains a global public health concern.Barriers affecting rabies post exposure prophylaxis include lack of access to the rabies vaccine, coordination of care, and costs. Due to the challenges of vaccine access and coordination, most rabies vaccines are given in Emergency Centers (ECs). Barriers faced by patients in the EC include increased wait times, costs, and lack of appropriate referral or follow up coordination. We initiated a quality improvement project (QIP) to improve access to rabies vaccination and delivery of appropriate doses of the vaccine in the Infectious Diseases (ID) Clinic at our institution.

Rabies post exposure prophylaxis in infectious diseases clinic

Methods

Our outcome measure was to increase the total number of patient encounters for rabies vaccination in the ID Clinic across the 3 campuses at TCH by 25% in 3 months. Process measures were 1) Increase the number of referrals placed to ID by EC on first encounter by 25% in 3 months. 2) Increase the percentage of patients seen in ID clinic for all subsequent doses. Balance measure was collecting surveys to evaluate patient satisfaction with the vaccine process, including any perceived barriers. Our PDSA cycles included: 1) Education on the process to the EC providers at each campus, pharmacy, and nursing leads 2) Creating an Epic smart phrase to include the rabies vaccine schedule with appropriate dates, ID clinic phone numbers, and rabies vaccine education for families. 3) Providing small cards with the Epic smart phrase and ID referral reminder to attach to EC provider workstations at each campus. 4) Request for a standardized order set to be built in Epic to include orders for HRIG (as indicated), rabies vaccine, and referral to ID.

Results

Figure 1 represents the percentage of vaccine encounters seen in the ID clinic with interventions marked. We had excellent patient satisfaction scores in the ID clinic related to less wait times, easy access and costs. There was a significant cost differential between the EC and ID clinic.

Conclusion

Rabies Vaccine encounters increased from 16% to 61% between September 2023 through April 2024 across all three campuses of the hospital. Vaccines were provided with appropriate indications. Patient satisfaction was high with significant cost savings. There are currently ongoing PDSA cycles to improve access to rabies vaccine further.

Disclosures

All Authors: No reported disclosures
P-637. Infection Incidence and Trajectory of Immune Recovery in Children, Adolescents, and Young Adults After Chemotherapy for Acute Lymphoblastic Leukemia
Authors: Zalot Morgan , Chehab Leena , Rossoff Jenna , Hoogstra David , Karthikeyan Subhi , Newmark Monica , VanDuine Ryleigh , Readwin Mary Beth , Vella Laura A , Fisher Brian T
Published: January 2025

Background

Advances in chemotherapy for acute lymphoblastic leukemia (ALL) have improved survival rates, but survivors remain vulnerable to infection after completing chemotherapy. Data have shown increased infection risk for pediatric ALL survivors compared to healthy children, yet few studies have prospectively tracked infection rates alongside immune recovery. This study aims to quantify infection incidence and describe the trajectory of immune reconstitution in the year after ALL therapy completion.

Methods

Patients aged 3-30 completing ALL therapy at a pediatric center are being followed for the first year off-therapy. Total immunoglobulin-G (IgG) and antibody (Ab)-specific IgG levels for varicella, measles, and 23 pneumococcal serotypes are measured at 3, 6, and 12 months. Infection events are recorded monthly to calculate infection incidence per 1000 patient-days.

Results

To date, 21 patients have been followed for ≥ 6 months. Median age at ALL diagnosis was 7.3 years (IQR: 3.4-10.1). 67% of patients had ≥ 1 infections; 93% of those with infections had ≥ 2. The overall infection incidence rate was 6.1 per 1000 patient-days. Of 46 infections, upper respiratory illness (20, 43.5%) and gastroenteritis (6, 13%) were most common (Table 1). 17 of 21 patients had not received intravenous immunoglobulin replacement (IVIG) within 6 months of therapy completion; their mean total IgG was 859.6 mg/dL at 3 months and 918.2 mg/dL at 6 months (Table 2). All 17 received ≥ 1 pneumococcus, varicella, and/or measles vaccine before ALL diagnosis. None had evidence of pneumococcus or varicella Ab recovery at 6 months, regardless of pre-ALL partial or full vaccination status (Tables 2-3). 7/11 patients fully vaccinated and 3/6 partially vaccinated for measles before diagnosis had normal Ab indices at 6 months off-therapy (Table 4).

Conclusion

Infections were common during the first year off-therapy, with many experiencing multiple illnesses. Total IgG levels were reasonable at 3 and 6 months, but there was no recovery of varicella or pneumococcus Ab, and only a subset of patients retained measles Ab. Continued assessment until 12-month follow-up for all 85 enrolled patients is necessary but preliminary data suggest potential need for Ab-informed revaccination.

Disclosures

Brian T. Fisher, DO, MPH/MSCE, Allovir: Grant/Research Support|Astellas: Data Safety Monitoring Board|Merck: Grant/Research Support|Pfizer: Grant/Research Support
P-656. Investigating the Current Status and Exploring Issues for the Construction of Ventilator-Associated Pneumonia Surveillance
Authors: Kanai Osamu , Ito Takanori , Fujita Kohei , Tanizawa Kiminobu
Published: January 2025

Background

Ventilator-associated pneumonia (VAP) is a major infectious complication in invasive mechanical ventilation (IMV)-controlled patients. Because VAP adversely affects multiple outcomes, including risk of death, length of intensive care unit (ICU) stays, and length of hospital stay, appropriate preventive measures need to be constructed. To establish preventive measures for VAP in our hospital, we surveyed the occurrence of VAP and summarized the issues identified in the process.

Methods

Patients who received 48 hours or more of IMV at our hospital in 2023 were included in this study. We retrospectively studied the number of ventilator-associated conditions (VAC), infection-related ventilator-associated complications (IVAC), and probable/possible VAP (PVAP) events using the ventilator-associated events (VAE) algorithm from the Centers for Disease Control and Prevention National Healthcare Safety Network. We used the records of ventilator settings used by medical engineers (ME) for daily ventilator check-ups to screen for VAC events. Clinical findings, including the results of bacteriological tests of lower respiratory tract specimens, were investigated using electronic medical records.

Results

Of the 143 patients (157 IMV events) who underwent IMV during the study period, 102 (113 IMV events) were eligible patients. There were 23, 8, and 3 events of VAC, IVAC, and PVAP, respectively. The incidence of VAC, IVAC, and PVAP per 100 IMV events was 20.4, 7.1, and 2.7, respectively. The main causes of VAC events other than IVAC and PVAP were pulmonary edema in 4 events and septic shock in 3 events. During this study, screening for VAC events was readily available in the ME inspection records. In contrast, because of the overlap in ordering methods for culture of lower respiratory tract specimens under ventilatory management and self-discharged sputum, it became necessary to comprehensively review the electronic medical record of the patient in question for bacteriological testing.

Conclusion

In our VAP surveillance, the proportion of IVAC and PVAP events in VAC events was small. To ensure smooth VAP surveillance, the method of ordering bacteriological tests needs to be revised.

Disclosures

All Authors: No reported disclosures
P-657. Mycoplasma pneumoniae Pneumonia in Korean Children and Adolescents in 2023, Multicenter Study
Authors: Wook Yun Ki , Jeong Moon Hye , Kee Lee Joon , Lee Taekjin , Cho Youngmin , Kang Da Yun , Lee Hyunju , Choi Eun Hwa
Published: January 2025

Background

Mycoplasma pneumoniae (MP) is the leading cause of community-acquired pneumonia in the post-pneumococcal conjugate vaccine era, particularly in children. Following the COVID-19 pandemic, a resurgence of MP pneumonia has been observed. Thus, we aimed to investigate the clinical manifestations, macrolide resistance patterns, and therapeutic approaches related to the recent MP pneumonia epidemic.

Numbers and percentage of antibiotics and corticosteroid utilization in managing Mycoplasma pneumoniae pneumonia

Methods

This multicenter study, conducted in South Korea, enrolled children and adolescents diagnosed with MP pneumonia between September and December 2023, spanning outpatient clinics and hospitalized settings. Clinical data were retrospectively collected from 13 referring hospitals using standardized microbiological criteria, including a positive PCR result or a four-fold increase in serologic tests. Statistical analyses were then performed to evaluate demographic characteristics, treatment modalities, and clinical outcomes.

Treatment options for Mycoplasma pneumoniae pneumonia according to defervescence

Results

In total, 474 patients were enrolled, of whom 374 met the microbiological confirmation criteria. The median age of the patients was 7.7 (IQR, 5.4–9.6) years, and the hospitalization rate was 88.6%. Most patients experienced fever (98.9%), and lobular/lobar consolidation (59.1%) was the most common radiological finding. The macrolide resistance rate remained high at 87.0% but did not significantly influence the radiological findings or outcomes. Patients with consolidation showed a longer fever duration (median 8 vs. 7 days, P = 0.020) and higher hospitalization rates (92.3% vs. 83.0%, P = 0.008). Macrolides and steroids were used in 83.0% and 50.6%, respectively. A total of 82 (23.6%) participants were considered to have defervesced naturally in 5 (IQR 4-7) days. The total duration of fever was 7 (IQR 5-9) days in those who used only macrolides (n=68, 19.5%) and 8 (IQR 6-10) days in those who used macrolides with other treatments (tetracyclines, quinolones, or steroids; n=129, 37.1%). There was no difference in complications or readmission rates between the two groups.

Therapeutic Management and Clinical Response of Children and Adolescents with Mycoplasma pneumoniae Pneumonia

Conclusion

This study highlights the ongoing challenge of macrolide resistance in MP pneumonia and the need for tailored therapeutic approaches. Macrolides remain commonly prescribed despite high resistance; corticosteroids are often used concurrently.

Comparison of Clinical Characteristics, Management, and Outcome of Mycoplasma pneumoniae Infection According to Radiologic Findings

Disclosures

All Authors: No reported disclosures
P-663. Evaluating the Effectiveness of a Real-Time Electronic Alert to Monitor the Duration of Antibiotic Therapy in Hospitalized Pneumonia Patients in the Asian Healthcare Setting
Authors: Biju Sanju , Paulson Shon
Published: January 2025

Background

Limiting the duration of antibiotic prescribing to the shortest effective period is recognized as a strategy to mitigate the risk of antibiotic resistance. This study aims to assess the impact of a Real-Time Electronic Alert system designed to monitor the duration of antibiotic therapy in hospitalized pneumonia patients, with the goal of reducing unnecessary antibiotic exposure.

Methods

The intervention involved the implementation of a dashboard capable of generating real-time alerts whenever hospitalized patients diagnosed with community- or hospital-acquired pneumonia received antibiotics for more than five consecutive days. The study was conducted between December 2022 and January 2024 at two medical college hospitals in South Asia. Alerts generated by the dashboard were regularly reviewed by an antibiotic stewardship (AS) team, who intervened when patients exceeded the guideline-recommended duration of antibiotic therapy for pneumonia without additional clinical indications warranting continued antibiotic use. To evaluate the effectiveness of the intervention, the inappropriate duration of antibiotic therapy was compared before and after the implementation of the dashboard. A similar hospital with comparable patient demographics served as a comparative group.

Results

During the intervention period, the AS team reviewed a total of 218 patients flagged by the dashboard, resulting in 117 documented interventions. Reasons for lack of intervention included the presence of additional infection diagnoses necessitating prolonged antibiotic therapy, co-infections, and delayed clinical improvement. Post-implementation, the mean excess duration of antibiotic therapy for pneumonia decreased to 0.48 days compared to the pre-implementation mean of 2.13 days. In contrast, the comparative hospital, which did not employ the alert system, experienced a post-intervention mean excess duration of 1.97 days compared to a pre-intervention mean of 2.04 days.

Conclusion

The pneumonia dashboard represents a potentially valuable stewardship tool for reducing unnecessary antibiotic exposure in pneumonia patients.

Disclosures

All Authors: No reported disclosures
P-686. Risk of COPD Exacerbations, Asthma Exacerbations, and Hospitalizations for Heart Failure after RSV Hospitalization Among US Adults Aged at Least 50 Years
Authors: Singer David , Wang Yan , Wu Aozhou , La Elizabeth M , Gerber Susan , Lee Lydia , Liu Hongjiao , Betts Keith A
Published: January 2025

Background

Older adults and adults with comorbidities are at increased risk of severe respiratory syncytial virus (RSV) disease. Limited data are available on the long-term impact of RSV on comorbid diseases. This study evaluated the association between RSV hospitalization and the risk of future acute disease worsening in adults aged ≥ 50 years.

Figure 1

Methods

This retrospective cohort study analyzed Optum’s de-identified Clinformatics Data Mart Database (CDM) healthcare claims from October 2015 to June 2023. Adults aged ≥ 50 years with ≥ 12 months of continuous enrollment were assigned to cohorts based on RSV hospitalization (RSV cohort), influenza hospitalization (flu cohort), or not having a recent acute respiratory illness (ARI) (controls). Index date was the start of an ARI episode that included hospitalization and an RSV or influenza diagnosis for the RSV and flu cohorts, respectively. Controls were matched 5:1 with the RSV cohort. Outcomes included acute exacerbations of (AE) chronic obstructive pulmonary disease (COPD), AE asthma, and hospitalizations for heart failure (HHF), were measured during the follow-up period (Fig. 1), and analyzed as recurrent events. AE COPD, AE asthma, or HHF risks were compared between the RSV vs influenza and RSV vs control cohorts using the Andersen-Gill formulation of Cox proportional hazards models in the overall population and subgroups.

Results

The study included 14,759, 77,468, and 73,795 adults in the RSV, flu, and control cohorts, respectively (Table 1). Mean cumulative event counts were highest in the RSV cohort (Table 2). In adjusted analyses, adults with an RSV hospitalization had a higher risk of AE COPD (for those with COPD: hazard ratio [HR] = 1.15 vs flu cohort, p < 0.001; HR = 2.78 vs control cohort, p < 0.001), AE asthma (for those with asthma: HR = 1.53 vs flu cohort, p < 0.001; HR = 6.51 vs control cohort, p < 0.001), and HHF (for those with heart failure: HR = 1.08 vs flu cohort, p < 0.001; HR = 3.07 vs control cohort, p < 0.001) (Table 3).

Conclusion

Increased risk of AE COPD, AE asthma, and HHF was observed among adults with RSV hospitalization compared to influenza hospitalization and compared to adults without a recent ARI. These findings build on previous research demonstrating the importance of RSV prevention in older and comorbid adults.

FUNDING: GSK (VEO-000616)

Disclosures

David Singer, PharmD, MS, GSK: employee|GSK: Stocks/Bonds (Public Company) Yan Wang, ScD, Analysis Group: Employee Aozhou Wu, PhD, Analysis Group: Employee Elizabeth M. La, PhD, GSK: employee|GSK: Stocks/Bonds (Private Company) Susan Gerber, MD, GSK: Employee Lydia Lee, PharmD, MS, GSK: Fellowship Sponsorship Hongjiao Liu, PhD, Analysis Group: Employee Keith A. Betts, PhD, Analysis Group: Employee
P-701. Adenovirus associated with acute respiratory illness in Korean military trainees: incidence and adenovirus serotypes
Authors: Heo Jung Yeon , Kwon Soon-Hwan , Jang Jeyoun , Sang Oh Hong , Kim Young Rong , Hyun Hak Jun , Kim Eun Jin , Choi Young Hwa
Published: January 2025

Background

Previous studies suggested that that human adenovirus (HAdV) is the most prevalent in patients with acute lower respiratory tract infection and is the most common cause of pneumonia in Korean military. A sentinel surveillance program was initiated to investigate the incidence of acute respiratory illness (ARI) and characteristics of type-specific HAdV respiratory infections in Korean military trainees.

Weakly incidence of acute respiratory infection per 1,000 persons in military trainees

Methods

To calculate the incidence of ARI, all new trainees with febrile respiratory illness (FRI) who were required to visit the infirmaries at three military training centers were enrolled from September 2016 to August 2017. Of soldiers with FRI, 10 nasopharyngeal or throat swab specimens were weakly collected for for HAdV molecular typing.

Weakly proportion of adenovirus infection in trainees with acute respiratory infection

Results

The incidence of ARI, which was defined as the number of weakly ARI cases per 1,000 trainees, was estimated at 7.5-375.5 cases per 1,000 trainees with peaks between 41th week and 10th week in 2016-17 season. Of 1,079 patients with FRI, HAdVs were detected in 518 (48.0%) patients. HAdV type 55 was the most prevalent virus (98.6%, 511 cases). HAdV type 2 was only identified in 7 cases. Although HAdV associated ARI occurred throughout the year, Patients with HAdV infection were primarily observed during winter and spring. The clinical diagnoses in patients with HAdV associated ARI were almost pharyngotonsillitis (96.3%). Pneumonia (2.2%) was uncommon manifestation. There was no statistically significant difference in demographic characteristics and presenting symptoms and signs between HAdV-positive and HAdV-negative patients.

Conclusion

HAdV-55 was the most prevalent type in Korean soldiers with HAdV-associated ARI. Adenovirus type 55 was revealed to be the most important causative agent of acute respiratory infection in military trainees. Further studies are required to verify which HAdV types are associated with ARI in military recruits.

Disclosures

All Authors: No reported disclosures
P-703. Manifestations of parainfluenza type 4 infections and viral loads in children
Authors: Funakoshi Hanako , Shibata Meiwa , Tame Tomoyuki , kinoshita Kazue , Saitou Osamu , Horikoshi Yuho , Kuruma Kenta
Published: January 2025

Background

Although parainfluenza virus type 4 (PIV-4) typically causes mild respiratory illnesses in children, it can cause severe diseases occasionally. It is not known Whether viral load of PIV-4 could correlate with severity. This study aimed to assess the relationship between PIV-4 viral load and disease’s severity in children.

Viral load and severity

This figure shows the relationship between severity of illness and viral load.There was no correlation between viral load and severity.

Methods

A retrospective study at Tokyo Metropolitan Children's Medical Center from April to October 2023 screened hospitalized children using multiplex PCR. PIV-4 positive samples were assayed for viral load of all detected viruses using real-time PCR. Cases with PIV-4 were included if PIV-4 was only detected or the viral load of PIV-4 was higher than other co-detected viruses. Demographic data, underlying diseases, laboratory, co-infections, diagnoses, and outcomes were collected from electrical charts. Cases with PIV-4 were categorized into mild cases with no oxygen demand, moderate cases with low-flow oxygen demand and severe cases with high flow nasal cannula oxygen or non-invasive/invasive mechanical ventilation or PICU admission.The viral loads of PIV-4 and number of co-infected virus were compared among severity groups.

Characteristics, Symptoms and Laboratory Data of PIV-4 positive patients

Results

Nasal swab samples were collected from 2884 cases. PIV-4 was detected in 185 samples. As 108 cases were excluded for higher viral loads of other viruses, 77 cases were included for analysis. The severity of PIV-4 comprised 37 mild, 24 moderate, and 16 severe cases. The rate of lower respiratory tract infections in mild, moderate and severe cases were 8%, 96%, and 75%, respectively. There was only one PIV-4-related mortality at 28 days. Co-detection with rhinovirus/enterovirus was the most frequent. Median viral loads (log10 copies/mL) in mild, moderate and severe cases were 5.98 (IQR 3.58-6.89), 6.09 (IQR 4.93-6.66) and 5.98 (IQR 3.57-7.03), respectively. No significant correlation was found between viral load and severity, but severity correlated with the number of viral co-infections.

Treatment and Outcome of PIV-4 positive patients

Conclusion

Moderate or severe Pediatric PIV-4 infections primarily show as lower respiratory tract infections, with no relation between viral load and illness severity, though the number of co-infected virus may play a role.

Severity and co-infection viruses

Disclosures

All Authors: No reported disclosures
P-705. Non-Clinicians Effectively Perform Lung Ultrasound in Patients with Influenza-like Illness
Authors: Pauli Liam R , Wilson Claire S , Blair Paul W , Siddarthan Trishul , Herrara Phabiola , Hossen Shakir , McBryde Breana , Zimmerman Lauren , Avornu Gideon D , Rothman Richard E , Hansoti Bhakti , Fong Tiffany
Published: January 2025

Background

Point-of-care ultrasound (POCUS) is a low-cost, portable imaging modality with greater sensitivity than chest x-ray to evaluate acute respiratory infections including influenza-like illness (ILI). However, clinical scale has been limited by the availability of proficient operators and unclear training requirements. We aim to assess the feasibility of implementing study coordinator-performed lung POCUS into a longitudinal study of patients with ILI.

Methods

From November 2021 to December 2023, we conducted an observational study to characterize the pathophysiology of ILI among outpatients. Patients were recruited from two urban academic hospital emergency departments and affiliated clinics. Study coordinators were trained through a 4-hour didactic session reviewing ultrasound physics and lung anatomy and pathology, together with a hands-on training session. Peer proctoring of two POCUS enrollment encounters followed. POCUS lung scans were obtained from patients by study coordinators at their enrollment visit (Day 0) and follow-up visits (Day 7, 14, 28). Scans were evaluated by blinded expert image reviewers. Data was analyzed using descriptive statistics including the proportion of images deemed technically adequate.

Results

Fifteen study coordinators without previous ultrasound experience completed POCUS training over the course of the study. Using a standardized 12-zone imaging protocol, a total of 5311 POCUS lung scans were collected from 340 encounters. POCUS images were reviewed by study physicians and 100% of studies were considered adequate for diagnosis, with 96.0% of individual lung ultrasound clips judged to be technically adequate.

Conclusion

Our study demonstrated that after a 4-hour training session, non-clinical research staff could successfully acquire protocolized lung POCUS images during a 2-year study to longitudinally monitor patients with ILI. This supports the feasibility of implementing POCUS into infectious diseases research and demonstrates the potential effectiveness for training new POCUS users to assess ILI.

Disclosures

Richard E. Rothman, MD, PhD, abbvie: Grant/Research Support|CEPHEID: Advisor/Consultant|CEPHEID: Grant/Research Support|CEPHEID: Honoraria