bluuebunny/crossref_metadata_2025 huggingface dataset:
1509. Clinical Features and Outcomes of COVID-19 in People Living with HIV in South Korea: a Nationwide Population-based Cohort Study
Authors: Yoon Young Kyung , Kim Jeong Yeon , Jeong Yujin , Ahn Hyong Gin , Suh Jin Woong , Kim Sun Bean , Sohn Jang Wook
Published: November 2023

Background

The aim of this study was to assess whether people living with HIV were at increased risk of severe or critical COVID-19, compared with HIV-negative individuals with COVID-19.

Methods

This nationwide descriptive epidemiological study was performed in South Korea between January 2020 and February 2022. Demographic and clinical characteristics were analyzed using National Health Insurance claims data collected through the Health Insurance Review and Assessment service (HIRA). We performed descriptive statistics and Cox proportional hazards regression analysis using the inverse probability weighting (IPW) to compare clinical features and outcomes between the HIV-positive and the HIV-negative COVID-19 patients.

Results

The database contains claim records for 3,653,808 individuals who were diagnosed with COVID-19 and for whom hospitals issued claims to the HIRA. Of them, 1,311 subjects (0.04%) were people living with HIV. The proportion of male patients in the HIV-positive group was significantly higher than that in the HIV-negative group (88.6% vs. 46.3%, P< 0.001). The most common age groups were less than 20 years old in the HIV-positive group and 30 years old in the HIV-negative group, respectively. There was no significant difference in the mean Charlson's comorbidity index between the two groups. The mortality and morbidity rates in all COVID-19 patients were 0.24% and 15.7%, respectively. The hazard ratios (HRs) of hospitalization and in-hospital mortality in the HIV-positive group were 1.07 (95% CI 0.99-1.17; P=0.10) and 2.16 (95% CI 0.82-5.70; P=0.12) respectively, compared to those in the HIV-negative group. However, the odds ratios (ORs) of oxygen therapy (OR 2.82; 95% CI 2.26-3.52; P< 0.001), use of vasopressors or inotropes (OR 4.74; 95% CI 3.07-7.32; P< 0.001), and renal replacement therapy (OR 15.35; 95% CI 5.94-39.68; P< 0.001) were higher in the HIV-positive group, compared to those in the HIV-negative group.

Conclusion

In conclusion, people living with HIV were not found to be at higher risk for mortality of COVID-19. However, they had a significantly higher risk of severe or critical COVID-19 than HIV-negative individuals. Our findings suggest the need for an immunization policy that prioritizes vaccination with the COVID-19 vaccine for people living with HIV.

Disclosures

All Authors: No reported disclosures
1510. Evaluation of Quantitative (1,3)-β-D-glucan in Prediction of Pneumocystis jirovecii Pneumonia in Patients Living with HIV in New York
Authors: Yune Philip , Felson Uriel , Fazzari Melissa , Orner Erika , Grossberg Robert
Published: November 2023

Background

(1,3)-β-D-glucan (BDG) has been utilized as an indirect marker for Pneumocystis jirovecii pneumonia (PJP). The clinical utility of BDG, however, is limited because of uncertainty in interpreting quantitative values. A correlation was drawn between quantitative BDG and the diagnosis of PJP in hospitalized patients living with human immunodeficiency virus (HIV) at four affiliate campuses of the Montefiore Health System in the Bronx, NY.

Methods

All Pneumocystis direct fluorescent assays (DFA), polymerase chain reactions (PCR) either from bronchoalveolar lavage (BAL) fluid or sputum, and quantitative BDG assays either from serum or BAL fluid were retrieved from the Montefiore microbiology laboratory (date range: 8/1/18 - 8/31/22). Results from hospitalized patients with HIV whose CD4 count within 3 months were available, with either PJP DFA or PCR result within 7 days of serum BDG and lactate dehydrogenase (LDH) test were selected (n = 146). CD4 count was grouped into < 50 (n = 106), 50-100 (n = 15), 100-200 (n = 16), and >200 (n = 9). BDG, LDH, and CD4 were considered as input variables in a logistic regression model for true PJP status. The area under the curve (AUC) of the empirical receiver operating characteristic (ROC) curve with 95% confidence intervals (CI) was estimated based on trapezoidal area. Comparisons between ROC curve areas were performed via contrast matrix to take differences of the AUC of the empirical ROC curves and chi-square testing.

Results

Of the 146, 29 had PJP detected and 117 did not. When BDG only was considered, the AUC of the ROC curve was 0.78. When LDH quartiles (cutoffs: 232, 334, and 480 U/L) were considered with BDG, there was a statistically significant increase in AUC (0.84 vs. 0.78; p = 0.025). Adding CD4 group did not influence AUC.

Figure 1

ROC curves for BDG only, BDG with CD4 count, BDG with LDH quartile, and BDG with CD4 group and LDH quartile combined

Table 1

Area under the curve calculated for the ROC curves for BDG only, BDG with CD4 count, BDG with LDH quartile, and BDG with CD4 group and LDH quartile combined

Conclusion

The test characteristics (AUC) improved when LDH quartiles were used in conjunction with BDG, suggesting a better prediction of PJP diagnosis when BDG and LDH were considered together. This result supports further investigation of clinical markers of PJP given the limitations of establishing a microbiologic diagnosis. Further steps of the investigation will involve analyzing if other clinical factors including HIV viral load, oxygen saturation, and radiographical reading, influence predictability of PJP.

Disclosures

All Authors: No reported disclosures
1514. Evaluating Missed Opportunities for Confirmatory HIV Testing at a Midwest Medical Center
Authors: Caster Lauryn E , Sayles Harlan R , Fey Paul D , Bares Sara H
Published: November 2023

Background

Current recommendations for HIV testing begin with a 4th generation antigen/antibody (Ag/Ab) combination immunoassay followed by an antibody differentiation confirmatory assay. Discordant results may represent a false positive on the screening test or early HIV infection and must be followed up by a confirmatory HIV RNA test, but this is not done reflexively. As a result, there is a potential for missed opportunities for this confirmatory testing.

Methods

We conducted a retrospective chart review of adult patients at a Midwest academic medical center with discordant results on the screeningHIV-1/2 Ag/Ab combination assay between Jan. 2017 and Feb. 2021. We assessed if appropriate confirmatory testing was performed, identified barriers to missed opportunities for confirmatory testing, and used Wilcoxon rank sum tests, chi-square tests, and Fisher’s exact tests to evaluate differences between those who did and did not receive confirmatory testing.

Results

Of the 64 patients with a positive HIV antibody component of the Ag-Ab immunoassay and a negative confirmatory test, 35 (55%) patients completed a HIV RNA viral load. Of the 35 patients receiving the test, 3 (9%) patients tested positive for HIV. Younger age was significantly associated with completion of appropriate confirmatory testing (p=0.03), but other factors including sex, race, insurance status, having a primary care provider, specialty of ordering provider, encounter location, and test indication were not.

Conclusion

Our review identified multiple missed opportunities for confirmatory HIV testing following a positive antibody component on the HIV screening test, with younger age being a significant factor in whether an RNA test was completed or not. Our results suggest that missed opportunities to diagnose patients with HIV is occurring over a heterogenous group of patients and providers. Therefore, systemic interventions are needed to address both provider and patient centered factors preventing early diagnosis of HIV. The findings of this study emphasize the need for reflexive HIV RNA viral loads on patients when the results of the HIV Ag-Ab immunoassay and confirmatory test are discordant.

Disclosures

Sara H. Bares, MD, Gilead Sciences: Expert Testimony|GSK ViiV Healthcare: Grant/Research Support|Janssen: Grant/Research Support
2065. Efficacy of D-peptide-conjugated Antisense Compounds Against Pseudomonas aeruginosa
Authors: Koch Rachelle E , Moustafa Dina A , Pybus Christine A , Goldberg Joanna B , Greenberg David E
Published: November 2023

Background

Pseudomonas aeruginosa (PA) causes significant morbidity and mortality in immunocompromised hosts and those with cystic fibrosis. Peptide-conjugated phosphorodiamidate morpholino oligomers (PPMOs) are antisense compounds designed to target specific genes and prevent translation. PPMOs with L-isomer peptides (L-PPMOs) were previously shown to have in vitro and in vivo activity. However, L-PPMOs are vulnerable to degradation by host proteases. We hypothesize that PPMOs with a D-isomer peptide (D-PPMOs) may be a more stable and potent alternative. We aimed to characterize the activity of L- and D-isomers in PA strains using planktonic and biofilm assays as well as an infected mouse model.

Methods

All L- and D-PPMOs were synthesized by Sarepta Therapeutics, Inc. We tested L- and D-isomers of the (RXR)4XB (X for 6-aminohexanoic acid and B for β-Ala) and R6G peptide [(Arg)6-Gly]. PMOs for rpsJ (ribosomal protein) and acpP (fatty acid synthesis protein) were conjugated to the 3’ end of each peptide. Minimum inhibitory concentration (MIC) assays were performed in unique lab and clinical (including MDR) isolates using MOPS medium. Strain PAO1 biofilms were grown in MBEC plates for 24 hours, with PPMOs then dosed every 8 hours for 24 hours, followed by colony enumeration. For in vivo studies, mice were infected with strain PA103 intratracheally and given intranasal PPMO at 6 hours post-infection. Lung burden was determined at 24 hours post-infection.

Results

MIC values of D-R6G-RpsJ and D-R6G-AcpP were comparable to their L-isomers, but D-RXR-RpsJ showed an improved MIC90 of 0.5 μM compared to the L-RXR-RpsJ MIC90 of 16 μM (Table 1). Both isomers demonstrated reduction of 48-hour biofilm to various degrees. D-PPMO biofilm reduction ranged from 1.5 logs to > 3 logs (D-R6G-AcpP and D-RXR-RpsJ, respectively). L-PPMO biofilm reduction ranged from 2 logs to > 4 logs. D-PPMOs were superior to their L-PPMO counterparts in our delayed in vivo acute pneumonia model, with most D-PPMOs resulting in an additional 50% decrease in lung burden.

Conclusion

D-PPMOs show similar or improved activity in vitro and in vivo when compared to L-PPMOs at the same dosage. Future studies will investigate the pharmacology of D-PPMOs, as they may represent a more biologically robust alternative to L-PPMOs for PA infections.

Disclosures

David E. Greenberg, MD, University of Texas Southwestern Medical Center: Dr. Greenberg has numerous patents on PPMOs
1516. High Incidence of Newly Infected Syphilis, Hepatitis B and C Virus among People Living with HIV Who Have Reached U=U
Authors: Ge lingyun , Peng Qiaoli , He Yun , Liu Jiaye
Published: November 2023

Background

The concept of “Undetectable equals Untransmittable (U=U)” has been widely accepted. However the risk of acquiring other sexually transmitted diseases (STDs) such as syphilis (TP), hepatitis B virus (HBV) and hepatitis C virus (HCV) in people living with HIV (PLWH) in the context of “U=U” remains unclear. This study evaluated the incidence of newly STDs in PLWH in Shenzhen, China.

Methods

128 virally suppressed PLWH were investigated from March 21 to April 7 2023 at the Third People’s Hospital of Shenzhen. Information on sexual behavior, the awareness rate of U=U and clinical records were collected. Results of HBSAg, HCV RNA, TP antibody before ART(calculating baseline prevalence) and in follow-up(calculating incidence) were collected. The STD incidences among various subgroups were compared.

Results

At baseline, the prevalence of TP, HBV and HCV were 29.7%(38/128), 15.6%(20/128), and 1.56%(2/128). 78(60.9%) PLWH were not coinfected with any STDs, of which were male with a median age of 36.8 years (IQR 29, 42) and median duration of ART 4.9 years (IQR 2.3, 7), 75(96.2%) were men who have sex with men(MSM). Twelve TP, six HBV and five HCV new infections occurred over 382.9 person-years; the corresponding incidences were 3.13/100 person-years, 1.57/100 person-years and 1.31/100 person-years, respectively. One participant had TP/HBV co-infection, one had HBV/HCV, and one had TP/HCV. Surprisingly, all six newly HBV-infected PWLH received a TDF/TAF+XTC-based regimen. Among the 45 participants who had reached the awareness of U=U and 33 who had not, the new TP incidence were 2.35/100 and 4.11/100 person-years, the new HBV incidence were 1.88/100 and 1.76/100 person-yearsand, the new HCV incidence were 1.88/100 and 1.17/100 person-years(p > 0.05), respectively.

Conclusion

The high incidence of newly acquired TP, HBV and HCV infection after reaching U=U highlights the necessity of STD screening and prevention in viral suppression population in PWLH.

Disclosures

All Authors: No reported disclosures
1532. Guideline Adherence to Hepatitis B Virus (HBV) Screening and Vaccination in Patients Prescribed Human Immunodeficiency Virus (HIV) Pre-exposure Prophylaxis (PrEP)
Authors: Awad Reham S , Badowski Melissa E , Michienzi Sarah M
Published: November 2023

Background

HIV PrEP with daily oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) or emtricitabine/tenofovir alafenamide (FTC/TAF) has been found to be safe and effective in reducing HIV acquisition. The US Public Health Service PrEP guideline offers recommendations for the screening and vaccination for HBV in patients prescribed oral PrEP. The purpose of offering HBV screening and vaccination is twofold. One is to reduce HBV transmission, the other is to ensure appropriate treatment and monitoring for patients with HBV infection, as abrupt discontinuation of FTC/TDF and FTC/TAF could lead to an acute flare of HBV. The goal of this study was to compare guideline adherence to the rate of HBV screening and vaccination.

Methods

This study was a retrospective comparative study evaluating the rate of HBV screening and vaccination in patients ≥ 18 years who received a prescription for oral PrEP at the University of Illinois Hospital and Health Sciences System (UI Health) during two time periods, 07/01/2014 - 09/30/2018 and 10/01/2018 - 10/01/2022. Patients receiving HBV treatment or with a positive HIV immunoassay blood test at baseline screening were excluded. The primary outcome compared appropriate screening and vaccination rates for HBV according to the US Public Health Service PrEP guideline. Secondary outcomes included documentation of immunity and/or vaccination to hepatitis A virus, human papilloma virus, and meningitis. The primary outcome was analyzed using a chi-square test.

Results

A total of 145 patients were included in cohort 1 and served as historical control data. Of 230 patients screened for in cohort 2, 145 were included. Baseline characteristics are presented in Table 1. HBV screening prior to PrEP initiation occurred in 78.6% of patients in cohort 1 compared to 67.6% of patients in cohort 2 (p = 0.034). HBV vaccination was initiated by or at first follow-up in 37.9% of patients in cohort 1 compared to 21.8% of patients in cohort 2 (p = 0.035). Secondary outcomes are outlined in Table 2.

Conclusion

HBV screening and rates of vaccination declined over time in patients prescribed oral PrEP. Overall, there is an increased need for education among providers prescribing oral PrEP to ensure pre-treatment HBV serologies are obtained.

Disclosures

All Authors: No reported disclosures
1534. A Quality Improvement Initiative for HIV Prevention in Underserved Communities
Authors: Clement Meredith E , Settle Angie D , Martorell Claudia T , Carter Jeffrey D , Rodriguez Melissa , Chadha Chelsie Anderson , Douglas Bonnie , Simone Laura , Molloy Leah
Published: November 2023

Background

HIV prevention services like pre-exposure prophylaxis (PrEP) remain underutilized. This project aimed to support health care professionals (HCPs) in settings like federally qualified or community health centers and free and charitable clinics in expanding HIV prevention services for underserved populations, including immigrant communities.

Methods

Baseline surveys were administered to interdisciplinary care teams in 6 clinics across the eastern US from January – March 2022. Survey data informed 4 live virtual education sessions featuring pre- and post-program surveys and team-based action planning. To promote exchange of clinical strategies, clinics with different levels of HIV prevention experience were paired together. Content was extended nationwide in an on-demand video.

Results

Baseline survey respondents (N = 121) noted the greatest challenges in PrEP implementation were limited HCP knowledge/awareness (47%) and lack of training on PrEP workflows (33%). HCPs identified common barriers to patient PrEP uptake as lack of PrEP knowledge/awareness (58%), low perception of self-risk (47%), and low health literacy (38%). HCPs felt training was most needed in patient outreach/engagement (36%) and sexual history taking (32%), and 65% reported their team could most improve on normalizing sexual health conversations. 119 HCPs attended the education sessions (Table 1). HCP knowledge of laboratory monitoring for patients on PrEP rose from 40% to 57% (p = .037), as did the proportion of HCPs reporting high confidence in initiating/monitoring PrEP use (65% vs 93%, p < .001). Action plans included improving communication/care coordination (46%), increasing staff training/education (35%), and increasing patient outreach (35%) and education (35%). System champions from each clinic reporting 90-day outcomes (n = 16) agreed their clinics had improved in identifying patients for PrEP (94%) and evidence-based PrEP use (69%). As of March 2023, 1,531 HCPs had accessed the online video.Table 1.Education Session Attendees by Health Care Profession.

Conclusion

HCPs gained confidence and knowledge in patient engagement and PrEP use and made action plans that helped improve PrEP implementation, emphasizing the potential impact of targeted education on HIV prevention services in underserved communities.

Disclosures

Meredith E. Clement, MD, Gilead Sciences: Grant/Research Support|ViiV Healthcare: Advisor/Consultant Claudia T. Martorell, MD MPH, AbbVie: Honoraria|Gilead Sciences: Honoraria|GSK: Grant/Research Support|Theratechnologies: Grant/Research Support|ViiV: Honoraria
1543. Elevated HIV Risk/Low Risk Perception in Rural Colorado
Authors: Rivera Amanda , Epern Alexa Van , Fiorillo Suzanne , Lawrence Lisa , Litzau Shynia , Allen Lorna , Frasca Katherine , Castillo-Mancilla Jose , McGregor Donna V
Published: November 2023

Background

The increasing impact of HIV in rural populations highlights the need for expanding HIV Pre-exposure Prophylaxis (PrEP) access in rural communities. Little is known about HIV risk perception, or PrEP awareness, and acceptability in rural populations.

Methods

We analyzed baseline survey data from 69 residents as part of a larger study aiming to increase PrEP utilization in rural Colorado with virtual PrEP visits (TelePrEP) and mailed lab kits. The baseline survey on HIV risk, PrEP awareness, and access was conducted in 3 low-income rural Colorado counties from March 2022-February 2023. Residents were recruited from rural community settings, including a syringe service program, a substance treatment program, a migrant housing complex, a Native American Pow Wow, a college campus, and a public health clinic. All survey respondents were given the opportunity to enroll in TelePrEP services if eligible. Respondent demographics, HIV risk factors, risk perception, PrEP awareness, and access were examined. Descriptive statistics were used to characterize the cohort.

Results

Seventy-five % of the rural cohort identified as female; 23.2% as male; and 1.5% as other gender. Thirty-three % of the cohort were White; 34.8% were Hispanic; 26.1% were Native American; and 2.9% were Black. Seventy-eight % self-identified as heterosexual; 13% as bisexual; 8.7% as homosexual. Sixty-seven % self–rated personal HIV risk as low, though almost a third of the cohort reported 2 or more sexual partners, 58% reported condomless sex, and 59% reported heavy alcohol or drug use, in the prior six months. Almost 40% of the cohort reported that they or a partner had a history of incarceration. Sixty-three % reported seeing a regular health care provider (HCP). Forty-two % had heard of PrEP previously, but only 5 respondents had heard of PrEP from an HCP. Seventy-two % of the cohort felt that taking PrEP was a good way to protect themselves from HIV; however, none of the respondents chose to enroll in PrEP services.

Conclusion

Despite elevated risk for HIV acquisition and the majority having regular access to a health care provider, PrEP awareness and utilization was low in this cohort of rural residents. A gap in perceived versus objective HIV risk exists.

Disclosures

Lorna Allen, FNP-C, MERCK: Grant/Research Support Donna V. McGregor, MSN, ANP-BC, Gilead Sciences: Grant/Research Support
1545. Evaluation of Pre-exposure Prophylaxis Re-engagement Outreach Initiative for the Prevention of Human Immunodeficiency Virus Transmission
Authors: Molino Suzanne , Ramnarain Justin
Published: November 2023

Background

Pre-exposure prophylaxis (PrEP) is an effective method for preventing Human Immunodeficiency Virus (HIV) transmission through sex and injection drug use. However, studies have shown that HIV prevention services are limited in underserved populations. Nationally in non-research settings, data estimates 15-62% PrEP retention in care. At our clinic, approximately 15% of patients were retained in PrEP care between 2018 and 2022, with limited data on reasons why. The objective of this study is to provide data on PrEP patients lost to follow-up.

Methods

This was a single-center, retrospective, descriptive study of PrEP patients seen at the clinic who received at least one PrEP prescription and were lost to follow-up between September 2018 and June 2022. Between July and December 2022, patients lost to follow-up were contacted via telephone to re-engage in care and administered a patient questionnaire. Patients were included if they were 18 years or older, at high risk for HIV acquisition per the Centers for Disease Control, and were lost to follow up for PrEP services, defined as at least three months' time from last clinic visit. Patients were excluded if they had a previous HIV diagnosis or a clinic encounter for HIV post-exposure or HIV/sexually transmitted infection screening only. Endpoints included baseline demographics for all patients and questionnaire results from those who consented to participate. Data collection via EPIC™ chart review and statistical analysis via Microsoft Excel. Descriptive statistics were used to present results.

Results

Sixty-one patients were included. Patients had an average age of 37 years, 70% were male, and 77% were Black/African American. Most patients engaged in high-risk heterosexual behavior with multiple sexual partners of unknown HIV status and inconsistent condom use. Thirty-five patients participated in the questionnaire. Twenty-four patients endorsed self-discontinuing PrEP therapy due to: medication cost/access (6/24); difficulty adhering to clinic visits (8/24); changes to perceived risk of HIV transmission (9/24).

Conclusion

Medication cost/access, adherence to clinic visits, and perceived risk were the top three reasons for PrEP discontinuation. Further research is needed to address barriers to retaining PrEP patients in care.

Disclosures

All Authors: No reported disclosures
1549. Risk Factors, Risk Perception, and Long-acting PrEP Awareness and Interest among US Women: A National Survey
Authors: Poteat Tonia , Sarkar Supriya , Ragone Leigh , Bogan Danielle , Gallington Kyli , Coyne Karin S , Daniele Patrick , Rawlings Keith , Rinehart Alex R , Vannappagari Vani
Published: November 2023

Background

Cisgender women account for approximately 20% of incident HIV diagnoses in the US. However, only 10% of women who could benefit from HIV pre-exposure prophylaxis (PrEP) have been prescribed PrEP. US women face several challenges that may affect their seeking HIV prevention services, such as lack of PrEP awareness. Understanding these challenges may improve PrEP uptake, especially as innovative PrEP options, such as long-acting (LA) injectable PrEP, become available. This study explored interest in using LA-PrEP by factors that may increase risk of HIV acquisition.

Methods

Cisgender women were recruited between November 2021 – March 2022 though targeted social media ads on Facebook, Instagram, and Tinder to complete an online, self-administered survey. Eligible participants were cisgender women who were: 18+ years, current US residents, reported penetrative sex in the past six months, and reported an unknown or negative HIV status. The survey included questions on demographics, sexual health and behavior, LA-PrEP awareness, and LA-PrEP interest. Descriptive statistics were calculated using SAS v9.4.

Results

1,834 eligible women completed the survey (median age: 28 years (IQR: 25, 33); Geography: South – 65%, West – 21%, Northeast – 7.3%, Midwest – 6.8%; Race: Black, non-Hispanic – 34%, White, non-Hispanic – 25%, Hispanic – 27%, Another race – 14%). Women were more likely to have heard of LA-PrEP if they had reported injection drug use in the past year (71%), had an STI diagnosis (70%) or HIV test (66%) in the past two years, and were currently using contraception (65%). Interest in using LA-PrEP was consistently high; the difference between LA-PrEP awareness and interest was greatest among women with non-private health insurance and those with perceived likelihood of future HIV acquisition.

Conclusion

Although interest in using LA-PrEP is high among US women, these results demonstrate the large gap between LA-PrEP awareness and interest in using it.

Disclosures

Tonia Poteat, PhD, MPH, PAC, Viiv Healthcare: Advisor/Consultant Supriya Sarkar, PhD, MPH, GlaxoSmithKline: Stocks/Bonds|Viiv Healthcare: Employee Leigh Ragone, MS, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Employee Danielle Bogan, BSN, MPH,DrPH, ViiV Healthcare: Contract worker Keith Rawlings, MD, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Employee Alex R. Rinehart, PhD, ViiV Healthcare: Employee Vani Vannappagari, MBBS, MPH, PhD, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Employee
1552. HIV Pre-Exposure Prophylaxis Awareness, Uptake, and Persistence Among People at Risk for HIV in Two Communities in Western Kenya
Authors: Romo Matthew L , Schluck Glenna , Gayle Britt , Kosgei Josphat , Akoth Christine , Bor Rael , Langat Deborah , Yacovone Margaret , Ake Julie A , Sawe Fred , Crowell Trevor A
Published: November 2023

Background

Despite the increasing availability of evidenced-based HIV prevention tools like pre-exposure prophylaxis (PrEP), HIV incidence remains disproportionately high in sub-Saharan Africa, especially among key populations. To inform the ongoing scale-up of PrEP in Kenya, we examined PrEP awareness, uptake, and persistence among participants at enrollment into an HIV incidence cohort.

Methods

For these cross-sectional analyses, we used interim data from the screening and enrollment visits for the ongoing longitudinal Multinational Observational Cohort of HIV and Other Infections (MOCHI) in Homa Bay and Kericho, Kenya. Participants were at risk for HIV based on recent history of sexually transmitted infection, transactional sex, condomless sex, and/or injection drug use. At enrollment, participants were asked about PrEP awareness and use, agreement with statements related to concerns about PrEP and interest in different types of PrEP, and reasons for stopping PrEP.

Results

Between December 2021 and March 2023, 384 participants were enrolled (213 in Homa Bay, 171 in Kericho). The mean age was 22 years (SD 4), 302 (79%) were female, and 242 (64%) were sex workers. All participants were eligible for PrEP based on national guidelines, 262 (68%) had heard of PrEP, 65 (17%) had taken PrEP, and 20 (5%) were currently using PrEP, with greater PrEP awareness and uptake in Homa Bay vs. Kericho (figure 1). Of the 197 participants who were aware of PrEP but never used it, 100 (51%) were concerned about side effects of taking a medication every day, 70 (36%) were concerned about PrEP costs, and 65 (33%) did not perceive themselves to be at risk for HIV. Among those aware of PrEP but never used it,115 (58%) had interest in daily oral PrEP and 146 (74%) had interest in long-acting injectable PrEP. Of the 65 participants who had taken PrEP, 36 (55%) reported ever stopping it, with ‘trusting my partner’ as the most common reason (figure 2).

Conclusion

We identified substantial gaps in PrEP awareness, uptake, and persistence among individuals in Kenya who were eligible for PrEP. Potential strategies to improve PrEP engagement include education about HIV risk, addressing concerns about daily oral PrEP, and implementing additional options including long-acting injectable cabotegravir.

Disclosures

All Authors: No reported disclosures
1563. Incidence of Errors in an INSTI-Based Era: A Comparison of Error Rates Between Single Versus Multiple Tablet INSTI-Based Regimens in the Inpatient Setting
Authors: Blackmon Kayla , Kelley Denise , Rose Dusten T T , Nguyen Brian L
Published: November 2023

Background

Errors related to antiretroviral therapy (ART) occur in up to 86% of hospitalized patients living with human immunodeficiency virus (HIV) and may contribute to treatment failure, increased drug resistance, adverse effects, and toxicity. ART can be administered as a single tablet regimen (STR) or multiple tablet regimen (MTR), with limited data on whether the number of tablets affects inpatient error rates. The purpose of this study is to evaluate the incidence of medication errors in adult patients admitted to an Ascension Seton hospital who are maintained on a bictegravir-based STR or a MTR with dolutegravir.

Methods

This is a multicenter, retrospective, observational study conducted in patients ≥18 years diagnosed with HIV and admitted to an Ascension Seton hospital between January 1, 2017 through September 1, 2022. Patients receiving the STR bictegravir-emtricitabine-tenofovir alafenamide fumarate or provided a dolutegravir(DTG)-based MTR (in place of the patient’s home DTG-based STR) while admitted will be included. DTG-based MTRs including lamivudine, or abacavir and lamivudine will be evaluated. The primary outcome is a composite ART-related error rate between groups. Statistical analysis of the primary outcome was evaluated using a chi-squared test with an α level of 0.05 for significance. Secondary outcomes include: each error type overall and between the two groups; time to error correction, defined as time between error occurrence and resolution of identified ART-related errors; and an acquisition cost-analysis of anticipated differences between dispensing DTG-based regimens as MTR versus commercially available STR.

Results

Overall, 726 patient encounters were screened and 514 patient encounters were included (257 encounters in each arm). Patients included in the study were 79.4% male and 48 years of age on average. The primary outcome occurred in 59/257 (23%) encounters in the STR bictegravir group compared to 81/257 (31.5%) encounters in the MTR dolutegravir group (p = 0.029). A total of 68 and 99 errors were identified in the bictegravir and dolutegravir groups, respectively.

Conclusion

Composite error occurrence was significantly higher in the MTR dolutegravir group compared to the STR bictegravir group.

Disclosures

All Authors: No reported disclosures
2071. Strongyloides stercoralis Testing in a Hospital in Bronx, NYC; A 3-year Experience
Authors: Vargas-Pena Coral N , Alyssa Policarpio Maria , Chan Bailey , Kladias Michael , Coyle Christina
Published: November 2023

Background

Once a parasitic infection limited to tropical/subtropical regions, as international travel and immigration continues to rise, Strongyloidiasis is now a disease also prevalent in non-endemic regions, including the United States. Its disease spectrum spans from an asymptomatic infection to a hyper-infection syndrome, predominantly in patients with HTLV-1 and/or on steroids, where it can be deadly if not recognized early.

Methods

Retrospective descriptive study describing patients who tested positive for Strongyloides stercoralis between 2019-2023 at Jacobi Medical Center, a safety net hospital in Bronx, NYC. Patients were diagnosed with a serum recombinant immunodiagnostic antigen from S. stercoralis-specific larvae.

Results

108 patients were included; the mean age was 53.7+/-16 years, 63% were male. The most common place of birth was Latin America, Caribbean, Mexico in descending order. Prolonged steroid use (more than 1 week) reported by 7.4% and 8.3% had been exposed to chemotherapy/cytotoxic drugs. 92.5% of individuals were asymptomatic. Reason for testing was eosinophilia in 56.5% and migrant screening in 36.1%. The remaining (8%) patients were tested for diarrhea, urticaria and abdominal pain. Infectious diseases performed 76% of testing while primary care tested 15%. Mean time from immigration was 19.9 years. Stool testing was performed in 60 patients; larvae were seen 21.7% of these. Eosinophilia (abs >500/uL) was found in 70.4% of cases. Of the 29.6% w/o eosinophilia, 64.6 % of individuals reported an outdoor toilet. Ivermectin was given to 98% of cases.

Conclusion

Most cases were asymptomatic and identified on screening. Eosinophilia was seen in 2/3 of cases of strongyloidiasis, but 1/3 did not have eosinophilia. Larvae were reported in 21% of patients who had a stool for O/P underscoring the importance of establishing this diagnosis with serology. In patients without eosinophilia, strongyloidiasis should be considered if living conditions in country of birth put them at risk. As expected, patients had been in the US for many years prior to testing and only 15% of patients were screened by primary care. Increased awareness of the disease must be encouraged, especially amongst primary care physicians.

Disclosures

All Authors: No reported disclosures
1582. Dolutegravir/Rilpivirine STR Switch Study in Persons with HIV-1 and Chronic Kidney Disease: 48-week Assessment of Viral Suppression, Treatment Adherence and Quality of Life
Authors: Kwakwa Helena , Stokes Tawanaha , Gebreselassie Millen , Maslankowski Lisa , Chernak Esther
Published: November 2023

Background

Single tablet regimens (STRs) are widely utilized in HIV treatment in the Western world largely because they improve convenience of oral regimens and eliminate differential adherence. US Blacks are disproportionately impacted by HIV, and are also disproportionately affected by chronic kidney disease (CKD) for a variety of reasons, especially in their later years. For PWH and CKD, STR options are limited due to pharmacokinetic considerations. We evaluate the impact on viral suppression, adherence, treatment satisfaction and quality of life (QOL) of switching to DTG/RPV STR for a largely Black aging US cohort with HIV and CKD.

Methods

In this 48-week open label single arm switch study conducted in a community health center setting, adults with HIV, a GFR< 60 mL/min/1.73m2, an HIV RNA < 50 copies/mL and no known prior resistance to DTG or RPV were switched to DTG/RPV STR. HIV RNA and CD4 were monitored per standard national clinical guidance following switch. Standardized tools for medication adherence, treatment satisfaction and QOL were administered at baseline, 24 weeks and 48 weeks. We present final 48-week data.

Results

Between August 2019 and December 2021, 35 participants were enrolled. One dropped out after 19 weeks and one after 22 weeks due to drug-drug interaction concerns following renal transplantation. 94% of participants were Black, 57% were female and 43% were 65 years and older. At baseline, 20% had a GFR < 30 mL/min/1.73m2 per race-based calculation (36% per race-free calculation). At 48 weeks, 97% of participants maintained viral suppression with an HIV RNA < 50 copies/mL in a per protocol analysis (91% in an intent-to-treat analysis). One participant with an HIV RNA of 62 copies/mL at 48 weeks subsequently re-suppressed on DTG/RPV. 69% reported an improvement in adherence, 77% noted an improvement in treatment satisfaction and 66% reported an improvement in QOL. The only adverse event reported in >5% of participants was nausea (5.7%). There were no serious adverse events.

Conclusion

For this diverse aging cohort with HIV and CKD in a real-life community health center setting, DTG/RPV STR was efficacious, well-tolerated and associated with improvements in adherence, treatment satisfaction and QOL, sustained over 48 weeks. DTG/RPV is a feasible oral ARV option for PWH and CKD.

Disclosures

Helena Kwakwa, MD, MPH, ViiV Healthcare: Grant/Research Support
1584. Retrospective Study Comparing the Rate of HIV Blips With Combined Antiretroviral Therapy
Authors: Makhoul Jennifer , Uppal Surabhi , Barnes Anne A , Werner Logan A , Simon Gary , Siegel Marc O
Published: November 2023

Background

With the advancement of combined antiretroviral therapy (ART), control of viral replication has improved so that most patients living with HIV (PWH) can maintain undetectable viral. However, HIV blips (defined as non-sustained detectable low-level viremia) are still commonly encountered in practice. Although these generally do not indicate treatment failure or ART resistance, their clinical significance remains a topic of debate. The aim of our study is to compare the rate of blips in patients on bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), rilpivirine/emtricitabine/tenofovir (RPV/FTC/TAF) or dolutegravir/abacavir/lamivudine (DOL/ABC/3TC).

Methods

We analyzed HIV viral load (VL) data of PWH who were treated in our clinic with either BIC/FTC/TAF, RPV/FTC/TAF or DOL/ABC/3TC between 3/2017 and 10/2021 for blips. We defined low level blips as HIV VL of 51-200 copies/mL and high-level blips of201-1000 copies/mL. The incidence of blips between these regimens was examined using Chi squared test.

Results

A total of 324 patients were included; 138 patients on BIC/FTC/TAF, 91 patients on RPV/FTC/TAF, and 95 patients on DOL/ABC/3TC). Patients on DOL/ABC/3TC were over twice as likely to have a viral blip (36%) compared to both BIC/FTC/TAF (16%, p=.0003) and RPV/FTC/TAF (14%, p=.0004). There were no statistically significant differences between patients taking BIC/FTC/TAF or RPV/FTC/TAF. Although the DOL/ABC/3TC group had a higher rate of high-level blips (6.3%) compared to BIC/FTC/TAF (3.6%) and RPV/FTC/TAF (4.4%), the total number of patients with high blips was low (n=15) and the differences were not statistically significant. Patients on DOL/ABC/3TC had average of 8 HIV VLs checked over the study period compared to 5 for patient on RPV/FTC/TAF and 3 for patient on BIC/FTC/TAF.

Conclusion

Our data suggests that PWH on DOL/ABC/3TC have higher rates of blips compared to PWH on BIC/FTC/TAF or RPV/FTC/TAF. Additional studies are needed to determine if this might be due to the lack of tenofovir alafenamide in the DOL/ABC/3TC or due to increased HIV VL testing in this population.

Disclosures

All Authors: No reported disclosures
1585. The Annual Cost per Newly Virally-Suppressed Person with HIV in Those Starting Long-Acting Injectable Antiretroviral Therapy with Detectable Viremia in a Safety-Net Clinic in San Francisco
Authors: Marseille Elliot , Walker Ryan , Oskarsson Jon , Grochowski Janet , Hickey Matt , Imbert Elizabeth V , Szumowski John , Koester Kimberly , Smith Mollie , Neilands Tor , Johnson Mallory , Sauceda John , Montgomery Elizabeth , McNulty Moira , Colasanti Jonathan , Christopoulos Katerina
Published: November 2023

Background

Long-acting injectable cabotegravir/rilpivirine (CAB/RPV-LA) holds promise to effectively treat people with HIV (PWH) who are unable to achieve or maintain viral suppression on oral antiretroviral therapy (ART).

Methods

We employed standard micro-costing techniques to identify the resources and associated annual costs to provide CAB/RPV-LA to those initiating it with detectable viremia at San Francisco General Hospital’s Ward 86 clinic, accounting for q4week vs. q8week injections. Through structured interviews with service providers and administrators, we elicited the time in minutes for each staff member to perform each task, using mid-points for ranges. Person-minutes were applied to the personnel compensation rate to derive the total personnel cost per person. One-time costs required for CAB/RPV-LA initiation were distributed over 29.3 years, the expected average duration of treatment. We used the Medi-Cal reimbursement rate for the cost of CAB/RPV-LA and a literature-based estimate of other medical care costs of treating people with viral suppression to derive the total variable cost of CAB/RPV-LA treatment from the payer’s perspective. This result was adjusted by the viral suppression success rate at Ward 86 (96.5%) to derive the cost per new virally-suppressed PWH. We deducted the cost of standard ART and medical care to derive the incremental cost per additional virally suppressed PWH. Costs were adjusted to 2022 dollars.

Results

The annual variable cost of providing CAB/RPV-LA was $36,511, $35,252 for CAB/RPV-LA medication and $1,259 for other variable costs, mainly personnel. Including other medical care costs yielded a total annual medical care cost of $43,945 per newly virally-suppressed person. Deducting the cost of standard care, $42,276, from this sum suggests an incremental annual variable cost for CAB/RPV-LA of $1,668 per newly virally-suppressed person. If the cost of CAB/RPV-LA were reduced slightly, e.g. to 90% of current cost, CAB/RPV-LA would generate net savings of $1,985.

Table 1

Annual Cost of Providing CAB/RPV-LA and Cost per Newly Suppressed Person with HIV

Conclusion

We found that the additional cost per newly-suppressed PWH was $1,668. CAB/RPV is likely to be highly cost-effective for this population. Modest reductions in CAB/RPV-LA price could render it cost-saving from a health care payer perspective.

Disclosures

Jonathan Colasanti, MD, MSPH, DKB MED LLC: Honoraria|Prime Education LLC: Advisor/Consultant Katerina Christopoulos, MD, MPH, Gilead Sciences: Advisor/Consultant
1621. "False-Positive" Cytomegalovirus (CMV) Screening Tests in Neonates: A Real Dilemma!
Authors: Lewald Zachery S , Crisan Rachelle , Pifer Traci , De Alba Romero Conception , Shimamura Masako , Mejias Asuncion , Medoro Alexandra Katherine , Salamon Doug P , Wang Huanyu , Leber Amy , Findlen Ursula M , Adunka Oliver , Malhotra M D S , Sanchez Pablo J
Published: November 2023

Background

PCR testing of clinical specimens has been associated with false-positive test results. Detection of CMV DNA by PCR in saliva and urine has been used to identify neonates with congenital CMV infection, but the frequency of false-positive PCR results is not fully known. Our objective is to describe the frequency of "false-positive" saliva and urine CMV PCR tests when performed as screening for congenital CMV infection.

Methods

From 2018 to 2023, neonates were screened for CMV infection if they had abnormal clinical, laboratory, or radiographic findings, referred on the newborn hearing screen, and since 2019, on admission to the 9 neonatal intensive care units (NICU) of the Nationwide Children’s Hospital neonatal network, Columbus, OH. Pertinent demographic, clinical, audiologic, laboratory, and radiographic data were obtained and managed using REDCap. Infants who had an initial positive PCR screening test for CMV but subsequent negative PCR tests were identified.

Results

During the 6 year study period, 139 infants were diagnosed with congenital CMV infection. An additional 28 (17%) neonates tested positive for CMV DNA in saliva (n=26) or urine (n=2) but subsequent tests of urine specimens were negative for CMV. Most of the infants were tested as part of universal NICU screening (n=22), 5 had symptomatic disease, 3 referred on the newborn hearing screen, and 1 had thrombocytopenia. The infants were tested at a median (IQR) age of 3 (2-6) days. Their median (IQR) birth weight and gestational age were 2458 (1865-3360) grams and 37 (33-39) weeks, respectively. Four infants had their dried blood spot tested for CMV by PCR and were negative. 17 (77%) of 22 infants had known maternal milk exposure in the neonatal period.

Conclusion

Neonatal saliva and/or urine screening for congenital CMV infection was associated with a “false-positive” test result in 17% of neonates who tested positive for CMV DNA by PCR. These results suggest that confirmation of a diagnosis of congenital CMV infection by PCR requires testing of multiple specimens with one of them being urine.

Disclosures

Asuncion Mejias, MD, PhD, MsCS, Astra-Zeneca: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Sanofi-Pasteur: Advisor/Consultant Alexandra Katherine Medoro, MD, Merck: Grant/Research Support Amy Leber, PhD, Biomeriux: Grant/Research Support|BioRad: Advisor/Consultant|Cephied: Grant/Research Support|Diasorin: Grant/Research Support
1625. Challenges in Addressing Congenital Syphilis in a Large Hospital System
Authors: Rodriguez Gilhen , Shrager Sebastian , Hernandez Stacy Gomez , Heresi Gloria , Thiviyanathan Asvini , Murphy James , Perez Norma
Published: November 2023

Background

Congenital Syphilis (CS) has increased markedly in the Houston-TX metropolitan region; the rate per 100,000 live births was 138.6 in 2018. Therefore, we reviewed CS exposures presented to our network of institutions to identify possible changes in practice having the potential to improve CS management.Table 1.RPR-Reactive Newborns of Mothers Receiving Prenatal Care.

Methods

Retrospective record review. From June 2015 through July 2022, 754 RPR+ at-delivery mothers were identified. A random sample of 25% was selected for an ongoing investigation. Eighty-seven mothers and their 89 newborns have had their medical records extracted and analyzed for the presented analysis. Prenatal care was defined as ≥ 3 visits to an obstetrics provider. Maternal treatment of syphilis was categorized as complete when the CDC criteria were met. The χ2 test was used, and significance was set to P ≤ 0.05. The institutional IRB approved the study.

Results

Notable characteristics of the 87 mothers were 68% African American, 81% not Hispanic, 79% single parents with median gestation of 3 (1-11) and age of 26 (±6).

Of the 89 newborns, 54% were female, 57% were full-term, and 51% were delivered by C-section. In addition, 53% were RPR-reactive at birth, and 57% were treated for CS.

Analyses targeting interventions doable within our institutional circumstances revealed that 36% of mothers who received prenatal care and delivered newborns who were RPR-reactive at birth had no record of receiving recommended treatment for syphilis, Table1.

Conclusion

Our population has a well-established pattern of risk factors for CS, including the use of illicit drugs. In addition, our medical record review identified a possible failure to provide or record treatment for syphilis for women who received prenatal care and delivered RPR-reactive infants. Therefore, an effort is being directed to improve these outcomes.

Disclosures

All Authors: No reported disclosures