bluuebunny/crossref_metadata_2025 huggingface dataset:
1025. Integrating buprenorphine into an urban HIV primary care practice: Outcomes on viral load suppression and opioid use
Authors: Fabricant Scott , Nyaku Amesika , Dalla-Piazza Michelle L
Published: January 2021

Background

Opioid use disorder (OUD) is a correlate of poorer HIV outcomes among people with HIV (PWH). Research has shown promising results for buprenorphine (BUP), a medication for OUD, integrated into HIV primary care. In this study, we explored the effect of BUP on HIV outcomes in a cohort of PWH with OUD in Newark, New Jersey.

Methods

We performed a retrospective chart review of PWH on BUP attending the Rutgers NJMS Infectious Diseases Practice from January 2017 to June 2019 (n=91, median age 56, 59% male, 84% Black, median follow-up 1.5 years). Outcomes were suppressed HIV viral load measurements (VLS) or urine drug screening results (UDS). We analyzed data using descriptive statistics and multivariate logistic regression, which modeled associations of VLS or UDS with demographic, comorbid (substance use, chronic pain, HCV, psychiatric diagnosis), and social (insurance, employment, housing) factors. Results presented as odds ratio; 95% confidence interval.

Results

55% (n=46) of patients demonstrated BUP adherence (> 50% positivity on serial UDS) and 61% (n=51) had ongoing opioid use. Patients with a UDS positive for opioids (primarily opiates) were more likely to have other substance co-positivity on UDS (5.4; 4.0-7.3, p < 0.001), to be employed (5.4; 2.7-10.7, p=0.01), and enrolled in Medicaid (4.6; 2.5-8.5, p=0.01); and less likely to have BUP positive UDS (0.067; 0.050-0.088, p < 0.001). Conversely, BUP positive UDS was negatively associated with the presence of other substances (0.55; 0.44-0.70, p=0.01) and history of alcohol use (0.56; 0.40-0.79, p=0.05), controlling for concurrent opioid positivity and baseline VLS. At baseline, 39% (n=32) of patients did not have VLS; at 1 year follow-up, one-third (n=11) achieved new-onset suppression. VLS during follow-up was positively associated with BUP adherence (2.9; 1.2-7.1, p=0.02) and VLS at baseline (17.0; 10.4-27.8, p < 0.001), and negatively associated with housing insecurity (0.28; 0.15-0.52, p=0.04).

Conclusion

Integration of BUP for OUD into HIV primary care led to a decrease in opioid use and improved outcomes in HIV care. Multidisciplinary approaches addressing other substance use and social services may help achieve even greater progress in ending the dual epidemics of HIV and OUD.

Disclosures

All Authors: No reported disclosures
1026. Is Empiric Coverage Necessary? Incidence of Pseudomonas aeruginosa and Methicillin-Resistant Staphylococcus aureus in Foot Infections
Authors: Bird Scott G , Crum-Cianflone Nancy , Bagsic Samantha
Published: January 2021

Background

Empiric antibiotics for foot infections often include coverage of Pseudomonas aeruginosa (PA) and Methicillin-resistant Staphylococcus aureus (MRSA) due to their presumed frequency and ability to cause severe infection. The purpose of this study was to: 1) determine the incidence of PA and MRSA in foot infections; 2) identify variables associated with the presence of PA or MRSA; and 3) examine empiric antibiotic trends for foot infections to determine if empiric coverage of PA and MRSA is warranted.

Methods

Retrospective study of foot infections at five large urban hospitals in San Diego during 2018. Data were collected from the medical records including demographics, host factors, laboratory data, pathology and imaging data, culture results, and empiric antibiotics. Patients with a foot infection treated as an inpatient in our healthcare system who had a culture collected were included.

Results

310 patients with foot infections were included. Mean age was 61.6 years; 220 (71%) were male; 248 (80%) had diabetes; 40 (13%) had end-stage renal disease (ESRD), and 122 (39%) had peripheral arterial disease (PAD). PA was present in 28 (9%) cases. No patient had a positive blood culture for PA. MRSA was present in 55 (18%) cases. Only one patient had a positive blood culture for MRSA. On univariate analysis, wound location not in the forefoot (p=0.047) and presence of PAD (p=0.048) were associated with PA. These failed to remain significant in multivariate analysis (OR=0.42, p=0.074 and OR=2.54, p=0.0504, respectively). Factors associated with MRSA included shallower depth of wound (OR=0.36; p=0.043). 199/310 patients (64%) received empiric antibiotic coverage for PA while 262/310 patients (85%) received empiric MRSA coverage. Of those who received empiric anti-PA coverage, 174 were overtreated (87%). Of those who received empiric anti-MRSA coverage, 218 (83%) were overtreated.

Conclusion

The incidence of PA in foot infections was overall low, and none had positive blood cultures. MRSA was more often present, however, most patients did not have bacteremia or severe infections. In our study, the majority of empiric anti-PA, as well as anti-MRSA, antibiotic coverage for foot infections was unnecessary questioning the need for upfront, empiric coverage for these pathogens in foot infections.

Disclosures

All Authors: No reported disclosures
1030. Medicaid Expansion: How Does it Impact HIV Outcomes in One Non-urban Southeastern Ryan White HIV/AIDS Program Clinic?
Authors: McManus Kathleen A , Srikanth Karishma R , Powers Samuel D , Dillingham Rebecca , McQuade Elizabeth T Rogawski
Published: January 2021

Background

People living with HIV (PLWH) with Medicaid historically have lower viral suppression (VS) rates than those with other insurance. VS rates with Medicaid expansion (ME) are unknown. We examined HIV outcomes (engagement in care, VS) by insurance status for a non-urban Southeastern Ryan White HIV/AIDS Program (RWHAP) Clinic cohort for year after ME.

Methods

Participants were PLWH ages 18-63 who attended > 1 HIV medical visit/year in 2018 and 2019. Log-binomial models were used to estimate the association of characteristics with Medicaid enrollment prevalence and one-year risks of engagement in care and VS in 2019.

Results

Among 577 patients, 241 (42%) were newly eligible for Medicaid due to ME and 79 (33%) enrolled (Figure 1a). For those without Medicare, Medicaid enrollment was higher for those with incomes < 100% FPL (adjusted prevalence ratio [aPR] 1.67; 95% confidence interval [CI] 1.00-1.86) compared to those with incomes > 101% FPL. Those enrolled in Medicaid due to ME had 87% engagement in care compared to 80-92% for other insurance plans (Figure 1b). Controlling for 2018 engagement, older age (adjusted risk ratio [aRR] for 10 years 1.03, 95% CI 1.00-1.05; Table 1) was associated with being engaged in 2019. Engagement was lower for those with employment-based insurance (aRR 0.91, 95% CI 0.83-0.99) and Medicare (aRR 0.87, 95% CI 0.78-0.96). Of those with viral loads in 2018 and 2019 (n=549), those who newly enrolled in Medicaid due to ME had 85% VS compared to 87-99% for other insurance plans (Figure 1c). In univariate analysis, age, income, and baseline viral load status were associated with viral suppression (Table 2), and those with Medicaid due to ME (aRR 0.90, 95% CI 0.81-1.00) were less likely to achieve VS compared with others.

Figure 1

Table 1

Table 2

Conclusion

The low uptake of ME was likely influenced by many PLWH already having Medicare. While the RWHAP supports high quality HIV care, Medicaid enrollment improves access to non-HIV care and should be supported by RWHAP. Given that engagement in care was high for PLWH who newly enrolled in Medicaid, the finding of lower VS is surprising. The discordance may be due to medication access gaps associated with changes in pharmacy logistics. Future studies with larger cohorts will need to examine how ME contributes to PLWH’s overall health and to ending the HIV epidemic.

Disclosures

Kathleen A. McManus, MD, MSCR, Gilead Sciences, Inc (Research Grant or Support, Shareholder) Rebecca Dillingham, MD, MPH, Gilead Sciences, Inc (Research Grant or Support)Warm Health Technologies, Inc (Consultant)
1031. Mobility and Structural Barriers Contribute to Loss to Follow up from HIV Care in Rural South Africa
Authors: Hannaford Alisse , Moll Anthony , Madondo Thuthukani , Khoza Bulelani , Shenoi Sheela
Published: January 2021

Background

Retention in care is critical to achieving and sustaining viral load suppression, and reducing HIV transmission, yet lost to follow-up (LTFU) in South Africa remains substantial. We sought to understand reasons for disengagement and return to care in neglected rural settings.

Methods

Using convenience sampling, surveys were completed by 102 PLWH who disengaged from ART (minimum 90 days) and subsequently resumed care. A subset (n=60) completed individual in-depth interviews. Questions assessed HIV knowledge, stigma, barriers to health care, and reasons for both disengaging and returning to care.

Results

Among 102 participants (53% female), median duration of ART discontinuation was 9 months (IQR 4-22). Participants had HIV knowledge gaps regarding HIV transmission and increased risk of tuberculosis. Two thirds were unaware that ART prevents transmission to other sexual partners. The major contributors to LTFU were mobility and structural barriers. PLWH traveled for an urgent family need or employment and were not able to collect ART while away. Structural barriers included inability to access care, due to lack of financial resources to reach distant clinics, HIV stigma, dissatisfaction with being treated at an HIV specific clinic, pill fatigue and lack of social support. Illness was the major precipitant of returning to care.

Conclusion

Among those returning to HIV care, patient motivation to continue ART was high, but mobility and structural barriers impede longitudinal HIV care in rural South Africa, threatening the gains made from expanded ART access. To achieve 90-90-90, future interventions to improve retention must address barriers relevant to rural settings including emphasis on patient-centered care such as multi-month ART prescriptions, expanding medication distribution sites, including community-based dispensing sites, integrating ART into primary care, and facilitating linkage to remote facilities when away from their home clinic. Healthcare workers should be capacitated to identify patients’ barriers to chronic care and intervene on those at high risk of LTFU.

Disclosures

All Authors: No reported disclosures
1032. More Similar than You May Think: A Comparison of Perinatally vs. Behaviorally Infected Young Adults Living with HIV
Authors: Ng Maria , Wallach Frances , Schwartz Rebecca , Rasul Rehana
Published: January 2021

Background

Many perinatally infected people living with HIV (PLWH) have reached adulthood. It is important to understand differences in key outcomes between this group and those who were behaviorally infected with HIV. We sought to determine if there were differences in HIV-RNA viral load, antiretroviral therapy (ART) adherence, substance use, comorbidities, and healthcare engagement between the two groups.

Methods

This retrospective study was performed at Northwell’s Center for AIDS Research and Treatment in Manhasset, NY from November 1, 2016 to December 31, 2018. The sample size included 38 perinatally infected PLWH and 51 behaviorally infected PLWH. Data were extracted from the electronic medical record. The primary endpoint was HIV-RNA viral load. Secondary endpoints included ART adherence, comorbidities, CD4 counts, number of missed HIV care appointments, self-reported sexual activity, and substance use. Comparisons of the two groups were conducted using the Wilcoxon rank sum test and Fisher’s exact test.

Results

Perinatally infected PLWH were more likely to have unsuppressed viral loads, lower CD4 counts, and lower patient reported ART adherence, but these differences were not statistically significant. Perinatally infected PLWH were also more likely to be female and unemployed, and to report consistent condom use. Sexually transmitted diseases were only detected in the behaviorally infected group. Perinatally infected PLWH were also less likely to report alcohol use. However, smoking and illicit drug use were similar between the two groups. There was no difference in racial composition. Asthma and hypertension were the most commonly recorded comorbidities and did not differ in prevalence between the groups (Table 1).The pattern of change in CD4 counts over time was similar between the two groups and both groups maintained average CD4 counts above 200 cells throughout the study (Table 2) (Figure 1). The number and percent of missed appointments were similar between the groups.

Patient Characteristics Compared by Perinatally Infected vs. Behaviorally Infected HIV Status

A Comparison of Outcomes Over Time Between Perinatally Infected PLWH vs. Behaviorally Infected PLWH

Observed Changes in CD4 Count Over Time, Compared by Mode (Perinatally Infected PLWH vs. Behaviorally Infected PLWH)

Conclusion

Despite differences in reported ART adherence, perinatally and behaviorally infected PLWH had similar rates of HIV viral load suppression and comparable absolute values and trends in CD4 count.

Disclosures

All Authors: No reported disclosures
1033. One year of Bictegravir in Mexico City: Differences in the Neuropsychiatric Adverse Events vs. Efavirenz
Authors: Rodriguez Victor
Published: January 2021

Background

In Mexico, Efavirenz (EFV) was considered as first-line regimen for several years. However, the Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) had a history neuropsychiatric effects such as depression, suicidal thoughts, insomnia, hypersomnia, impairment cognition, impairment in quality of life, these adverse events cause poor adherence and abandon EFV regimens. Since June 2019, bictegravir (BIC) in a single tablet regimen was introduced in Mexico as a first-line treatment. Therefore, the objective of the study was to compare the presence of depressive and cognitive symptoms, suicidality, sleep disturbances, quality of life between BIC and EFV regimens.

Methods

Prospective cross-sectional study, non-probability sample, both groups BIC and EFV were matched according to age. Patients were recruited from June 2019 to May 2020 in Condesa Specialized Clinic in Mexico City. All the patients had 1 to 4 months from starting treatment. The evaluation test used were Medical Outcomes Study Short Form-36 (SF-36), Beck Depression Inventory (IDB-IA), Center for Epidemiologic Studies-Depression Suicidal Ideation subscale (CES-D IS), State Impulsivity Scale (SIS) and Pittsburgh Sleep Quality Index (PSQI).

Results

One thousand six hundred patients, 800 in BIC group and 800 in EFV group. The mean age 37 years. Non-statistical difference was found in sociodemographic and HIV-related variables. Statistically significant differences were found between BIC and EFV groups (t = 1.91 - 15.28, p < 0.03). The largest differences were seen in cognitive symptoms such as impulsivity, quality of life mental score and suicidal ideation (t > 10.61). No differences were found in physical role and sleep disorders.

BIC & EFV groups comparison

Conclusion

In this study we found BIC group have fewer neuropsychiatric events than EFV group. The principal differences were in cognitive symptoms, suicidality, functionality associated with central nervous system symptoms. We suggest having a long-term follow-up of the sleep quality variables, to observe patient’s adaptation to treatment for a period over to 12 months.

Disclosures

All Authors: No reported disclosures
1042. The Attitude of Patients With HIV about Telehealth for Their HIV Care
Authors: Dandachi Dima , Dang Bich , Giordano Thomas Giordano
Published: January 2021

Background

The world is facing a pandemic of SARS-CoV-2 that disrupted our healthcare system and the way we deliver healthcare. For people with HIV (PWH), the ability to be retained in care plays a critical role in improving health outcomes and in preventing HIV transmission. Several definitions exist for retention in care, but they are centered around outpatient clinic visits. It is now more important than ever to understand PWH’s attitudes about using telemedicine for HIV care instead of face-to face clinic visits.

Methods

We administered a one-time survey to PWH presenting to an outpatient HIV center in Houston, Texas, from February–June 2018. The survey items were used to assess PWH’s attitudes towards and concerns for telehealth and explanatory variables.

Results

371 participants completed the survey; median age was 51, 36% were female, and 63% African-American. Overall, 57% of respondents were more likely to use telehealth for their HIV care if available, as compared to one-on-one in-person care, and 37% would use telehealth frequently or always as an alternative to clinic visits.

Participants reported many benefits including ability to fit better their schedule, decreasing travel time, and privacy but expressed concerns about the ability to effective communication and examination and the safety of personal information. Factors associated with likelihood of using telehealth include personal factors (US-born, men who have sex with men, higher educational attainment, higher HIV-related stigma perception), HIV-related factors (long standing HIV), and structural factors (having difficulty attending clinic visits, not knowing about or not having the necessary technology). There was no association between participants with uncontrolled HIV, medication adherence, and likelihood of using telehealth.

Survey items and response distribution

Conclusion

Telehealth programs for PWH can improve retention in care. A modification of the definition for retention in care, incorporating telehealth, should be considered. Availability and confidence using various telehealth technologies need to be addressed to increase acceptability and usage of telehealth among PWH.

Disclosures

All Authors: No reported disclosures
1047. Weight change associated with switching to bictegravir/emtricitabine/tenofovir alafenamide in virally suppressed people with HIV
Authors: Vo Daniel , Goss Charles W , Lian Qinghua , O’Halloran Jane A
Published: January 2021

Background

Integrase strand transfer inhibitor (INSTI) associated weight gain has been observed in a number of recent studies but with limited data on bictegravir. Here we examine weight change associated with the switch to co-formulated bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF).

Methods

We performed a retrospective analysis of consecutive PWH attending an academic outpatient clinic who received a prescription for B/F/TAF from 02/07/2018-02/07/2019 and had a baseline HIV RNA < 200 copies/mL prior to starting B/F/TAF. Baseline demographics and clinical parameters were obtained from chart review. Parameters of interest were collected for one year (at a minimum) before and one year after starting B/F/TAF. Linear mixed model analyses were conducted for PWH before/ after switch. Separate analyses were performed examining factors associated with ≥ 10% BMI increase versus < 10% increase.

Results

156 PWH switching to B/F/TAF were identified, of whom 107 (69%) identified as men, 105 (67%) were African American. Median age was 49 years (IQR 35-57), weight 184 lb (IQR 153-208), and BMI 27.5 (IQR 23-32.3). At time of switch, 3% were underweight, 31% normal weight, 24% overweight, and 41% obese. 74% switched from INSTI-based regimen, 17% from NNRTI- and 16% from PI-based regimens. Of the INSTI, elvitegravir (54.3%) or dolutegravir (41.7%) were most frequently used. 50% were on TAF pre-switch with 28% on tenofovir disoproxil. The mixed model analysis indicated that there was not a significant shift in the mean BMI (P=0.2017) or BMI rate of change over time (P=0.792) after participants switched. 19.2% had ≥ 10% increase in BMI; and when compared to those with < 10% increase, younger age (42.8±13.8 vs. 48.9±13.2 years, P=0.036), switch from a non-PI based regimen (P=0.004), and switch from a TDF containing regimen (36.4% vs. 12.6%, P < 0.001) were associated with greater weight gain.

Conclusion

Overall, there were no significant changes in BMI between pre and post switch to B/F/TAF time periods; however the majority of PWH switched from an INSTI-based regimen. Analysis of PWH who experienced ≥ 10% increase compared to < 10% BMI increase, indicated that factors including younger age, switch from a non-PI containing regimen and switch from TDF were associated with greater weight gain.

Disclosures

All Authors: No reported disclosures
1049. Weight Gain in Persons Living with HIV (PLWH) Treated with Bictegravir Compared to Other Integrase Strand Transfer Inhibitors
Authors: Fang Michelle , Ma Ariel , Johns Scott T , Lacro Jonathan
Published: January 2021

Background

Recent studies have given rise to the concern that some integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy may lead to weight gain in PLWH. The objectives of this study were to compare the incidence of weight gain following initiation of bictegravir (BIC) compared to other INSTIs, and to assess whether any differences were associated with changes in metabolic indices.

Methods

Patients from the VA San Diego Healthcare System (VASDHS) were included in this retrospective cohort study if they were at least 18 years old and being treated for HIV with an INSTI that was started exclusively with FTC/TAF for at least 6 months. INSTI-containing regimens were excluded if initiated with non-FTC/TAF antiretroviral agents or if the patient was pregnant, using prescription weight loss drugs, or did not have weights recorded after the start of the studied regimen. The primary outcome was weight gain at 12 and 18 months after the start of the studied regimen. Secondary outcomes included changes in parameters used to define metabolic syndrome. Statistical analysis was performed using Mann-Whitney U, Chi-square, and Spearman’s Rho tests.

Results

560 patients with 809 instances of new INSTI prescriptions from VASDHS during November 2015 to October 2019 were reviewed for inclusion. Raltegravir-based regimens were excluded from analysis due to the limited number of eligible regimens. Study groups included group 1 (BIC, n=265), group 2 (elvitegravir/cobicistat, n=123), and group 3 (dolutegravir, n=35). There were no significant differences in baseline weight between groups. Median weight change at 12 months was 2.8 lbs. in group 1, 4.4 lbs. in group 2 (p=0.328 vs. group 1), and 5.3 lbs. in group 3 (p=0.133 vs. group 1). At 18 months, median weight change was 4.5 lbs. in group 1, 3.4 lbs. in group 2 (p=0.597 vs. group 1), and 7.7 lbs. in group 3 (p=0.585 vs. group 1). Within group 1, there was a significant increase in weight at 3, 6, 12, and 18 months compared to index date.

Conclusion

These results support the growing body of evidence associating INSTI use with weight gain, which was persistent over 18 months in all groups and in the context of a consistent FTC/TAF backbone in this study. No significant differences in magnitude of weight gain were observed between INSTIs.

Disclosures

All Authors: No reported disclosures
1056. At the Intersection of Drug Use, Motherhood, and Hepatitis C: An Evaluation of Our Present State
Authors: Niestrath Rebecca G , Green Julianne , Espinosa Claudia M
Published: January 2021

Background

The epidemic of drug abuse has led to increased incidence of hepatitis C virus (HCV) infection in young adults, including women of childbearing age. Infected pregnant women can transmit HCV vertically to their infants, and exposed infants require close follow-up. Few studies focus on illicit drug use during pregnancy in HCV positive mothers. We sought to describe rates of illicit drug use during pregnancy in a convenience cohort of infants perinatally exposed to HCV in an area with high rates of HCV and illicit drug use.

Methods

Infants born to HCV positive mothers in the Louisville, KY metro area and surrounding hospitals were followed at a pediatric infectious disease clinic after institution of a clinical protocol. Records of exposed infants attending the clinic between 2012 and 2018 were analyzed retrospectively. Cases were identified using V01.79 (ICD9) and Z20.5 (ICD10) billing codes. Maternal information was extracted from the infant electronic medical record or the maternal record if available. Demographic and clinical information was collected using a standardized instrument. Descriptive statistics described the data and logistic regression was used to assess associations.

Results

A total of 505 infants attended the clinic for evaluation of perinatal exposure to HCV. Records with no information regarding maternal drug use during pregnancy were excluded, leaving 440 for analysis. Mean maternal age was 28 years (IQR 25-31), and parity 2 (IQR 1-3). The majority of mothers (89.0%, N=380) had a history of any illicit drug use and 81.1% (N=355) had a history of intravenous drug use (IVDU). Most (63.2%, N=278) reported continued illicit drug use during pregnancy. The most common drugs used during pregnancy were heroin (45.4%), THC (22.9%), and amphetamines (25.4%). Prenatal care was associated with less maternal illicit drug use during pregnancy (aOR, 0.33; p < 0.0001).

Conclusion

HCV positive pregnant women have high rates of prior and continued use of illicit and IVDU during pregnancy. Pregnancy represents a unique opportunity to link HCV infected women to care. Public health programs supporting these women and elimination of state restrictions to treat this population will prevent future exposures. Additional qualitative studies to identify needs for this population are needed.

Disclosures

Claudia M. Espinosa, MD, MSc, AstraZeneca (Speaker’s Bureau)Gilead (Grant/Research Support)Kentucky Rural Association (Consultant)Merck (Grant/Research Support)Sanofi (Consultant)
1058. Demographics of Hepatitis C Virus Antibody and RNA Positivity within an Emergency Department Screening Program
Authors: Segal Talia A , Ata Ashar , Rowden Adam , Wales Danielle P , Waxman Michael
Published: January 2021

Background

In support of the recent United States Preventive Services Task Force’s (USPSTF) revised recommendations for non-targeted HCV screening, we have noted a shift away from active infections within the birth cohort (patients born between 1945-1965), as these individuals have often undergone successful treatment, and a shift towards younger adults who are RNA positive, especially people who use intravenous drugs (PWID).

Methods

Located in Northeastern New York State, Albany Medical Center conducts routine emergency department (ED) HCV screening, with active linkage to care. We performed a retrospective study of our HCV linkage to care data from April 2019 to June 2020. Patients were offered screening if they belonged to the birth cohort, were PWID, or at staff discretion. We estimated the effect of birth cohort, intravenous drug use and other potential risk factors on RNA positivity via Chi-square tests and Modified Poisson Regression.

Results

There were 242 people that were HCV antibody positive. The mean age was 50.9 years-old, with 118 (46.8%) in the birth cohort and 103 (42.56%) PWID. As compared to the birth cohort, a significantly greater proportion of non-birth cohort patients were PWID (62% vs 21.2%, p< 0.01) and homeless (17.7% vs 9.3%, p=0.05). Birth cohort patients were 0.55 times (95%CI: 0.39 to 0.79) less likely to be RNA positive. PWID were 2.22 times (95% CI: 1.58 to 3.13) and homeless people were 2.05 times (95% CI: 1.50 to 2.80) more likely to be RNA positive. After multivariable adjustment, birth cohort was not a significant risk factor for RNA positivity but PWID (RR: 1.84; 95% CI: 1.26 to 2.68) and homelessness (RR: 1.69; 95% CI: 1.20 to 2.39) were significantly associated with RNA positivity.

Conclusion

These data suggest that the RNA positivity rate is higher among the non-birth cohort age group but is explained by the higher prevalence of drug use and homeless. The findings support USPSTF’s new guidelines for testing all adults and shed light on the demographics of populations at risk for active infection vs. populations who are antibody positive and RNA negative. Further research might explore (a) whether these findings are applicable to other clinical settings and geographic locations and (b) the feasibility of targeting patients with active infection in settings such as the ED.

Disclosures

Talia A. Segal, BS, GILEAD FOCUS Foundation (Grant/Research Support) Ashar Ata, MD, MPH, PHD, GILEAD FOCUS Foundation (Grant/Research Support) Adam Rowden, DO, GILEAD FOCUS Foundation (Grant/Research Support) Danielle P. Wales, MD, MPH, Gilead (Grant/Research Support) Michael Waxman, MD, MPH, Gilead FOCUS Foundation (Grant/Research Support)
1065. Hepatitis C Virus Care Cascade Assessment–One Step Closer to Micro-Elimination
Authors: Chowdhury Jehan F , Winston Anna , Zeina Tanya , Shim Hong Gi , Vindenes Tine
Published: January 2021

Background

Hepatitis C virus (HCV) is a leading cause of advanced liver disease and death. In the United States about 3.5 million people are living with HCV, but only 50% are aware of the infection, 16% are prescribed treatment, and only 9% achieve sustained viral response. The World Health Organization published an HCV elimination goal for 2030 that strives to achieve a 65% reduction in HCV-related deaths and 90% reduction in transmission. An important step toward this goal is micro-elimination at local hospitals by addressing care gaps in the HCV care cascade.

Figure 1

Methods

We created a retrospective cohort of patients who tested positive for HCV antibody (HCV Ab+) between 2016 and 2018 at Tufts Medical Center in Boston, Massachusetts. We assessed achievement of care cascade steps including HCV viral load (VL) testing, linkage to care, treatment initiation, and sustained viral response (SVR). We also assessed patient demographics, clinical factors and HCV risk factors. We used STATA/IC 14.1 to conduct bivariate analysis to identify factors associated with loss to follow-up across each care cascade step.

Results

A total of 24,308 HCV antibody tests were done during this timeframe, of which 5% (n=1,222) were HCV Ab+. After excluding duplicate tests, 1,041 unique patients with HCV Ab+ were included. This cohort had a mean age of 47 years and were 61% male, 66% white, 72% on public insurance, 12% HIV-positive, 13% HCV treatment-experienced. The most frequent HCV risk factor was injection drug use, occurring in 64% of patients. Of patients with HCV Ab+, 76% (n=791) were tested for an HCV VL, of which 50% (n=393) had detectable VL and 50% (n=398) had undetectable VL. Of the patients with a detectable VL, 58% (n=226) were linked with care. Following care linkage, 69% (n=155) initiated treatment, of which 90% (n=139) completed treatment, of which 97% (n=135) achieved SVR (Figure 1). Factors that were significantly associated with getting a VL test and linking to care included private insurance, HIV co-infection, absence of intravenous drug use and cirrhosis; however, these factors were not significantly associated with achieving subsequent steps.

Conclusion

Assessment of the HCV care cascade at our hospital allowed us to identify clear care gaps and areas needing improvement towards a local micro-elimination.

Disclosures

All Authors: No reported disclosures
1069. Loss to follow-up does not impact SVR for HCV infection
Authors: Kottilil Sita K , Kamat Mrunal , Gupte Amit , Shah Samir
Published: January 2021

Background

Recent advances in hepatitis C treatment using direct acting antiviral (DAA) agents can lead to sustained virologic response (SVR) in almost all treated subjects. These data along with the availability of generic DAAs have generated optimism to eliminate HCV infection globally. However, recent pilot projects aimed at HCV elimination have resulted in disappointing SVR due to lack of follow up of patients after they complete treatment. In this study, we evaluated the SVR among those who did not follow up for the 12 week post treatment visit versus that of those who did,

Aim – To determine SVR among those who follow up compared to those who have delayed follow up to assess SVR.

Table

Methods

226 patients who underwent treatment for hepatitis C in a subspecialty clinic in Mumbai, India between 2014-16, with complete laboratory and clinical data available were included in this analysis. All patients completed 12 weeks of treatment with an approved DAA regimen. 137 patients had adequate follow up post treatment for SVR (Group A) and 89 patients were “no shows” for SVR (Group B) and had to be actively followed to obtain HCV RNA levels at least 4 weeks after SVR visit. Graph Pad prizm and student t test were used to determine the difference between SVR among the two groups.

Results

Demographics of both groups of patients are shown in the table below. SVR for the patients with good follow up (Group A) was 97.1% (133/137) and that of patients with poor follow up (Group B) was 97.8% (87/89), which was not statistically different (p >0.05). There were no baseline demographics that was associated with poor follow up, including age, gender, genotype, baseline fibrosis score, ALT levels, previous treatment status, or duration of treatment (P >0.05)

Conclusion

Lack of follow up after completion of treatment with DAAs is associated with identical SVR compared to those with adequate follow up. These findings suggest lack of follow up after completion of treatment should have minimal effect on HCV elimination projects. In the future, HCV elimination projects need not focus on determination of SVR as long as treatment follow up is ensured

Disclosures

All Authors: No reported disclosures
1071. Social Determinants of health (SDOH) among PWID living with HCV
Authors: Corro Luis Gonzalez , Gutierrez Nataly Rios , Cunningham Chinazo O , Litwin Alain H , Norton Brianna L , Norton Brianna L
Published: January 2021

Background

Though people who inject drugs (PWID) represent the overwhelming majority of those living with HCV, most have not been treated. Many HCV+ PWID represent the most marginalized persons in society, often experiencing poverty and poor access to care. We set out to determine the social determinants of health (SDOH) among a population of HCV+ PWID and determine if poor SDOH were related to reduced HCV treatment uptake.

Methods

The HCV-GET UP study was a randomized controlled trial to assess the effectiveness of an HCV group evaluation intervention vs. individual HCV treatment among PWID within a primary care clinic in the Bronx, NY. HCV treatment was provided according to national guidelines.. Here, we include all patient characteristics and baseline social determinants of health (SDOH), obtained through questionnaires using Audio Computer-Assisted Self-Interview (ACASI) technology. We performed bivariate analyses between treatment initiation and the various factors of the SDOH using chi square tests.

Results

The majority of the 84 participants enrolled were black (35%) or Hispanic (60%) males (77%), aged 51 (SD11). The majority are on NY State Medicaid insurance (68%), indicating that their income is less than 138% of the Federal Poverty Level. 42% of participants report running out of money for basic needs on a daily or weekly basis, 69% receive food stamps, and 23% are homeless. Nearly half (45%) of participants have less than a high school education, 57% have ever been incarcerated, 48% report not having transportation to get to a medical appointment, and 25% do not trust doctors. A total of 57% of participants initiated HCV treatment, and no factors of SDOH were associated with treatment initiation.

Conclusion

We found that HCV+ PWID have extremely poor SDOH. Despite this, over half of participants initiated HCV treatment, indicating participants willingness to receive HCV treatment, and resilience in overcoming SDOH. Poor SDOH, such as homelessness, should not be a reason to delay HCV treatment in this population; however, we risk severely muting the health benefits of HCV cure in this population, if we do not address the underlying SDOH that will certainly lead to poor health outcomes, and early death.

Disclosures

Chinazo O. Cunningham, MD, MPH, General Electric Health (Other Financial or Material Support, My husband is currently employed by General Electric Health and receives stock and stock options.)Quest Diagnostics (Other Financial or Material Support, My husband was previously employed by Quest Diagnostics and received stocks and stock options.) Alain H. Litwin, MD, MPH, MS, Gilead (Advisor or Review Panel member)Merck (Advisor or Review Panel member)
1073. The Time is Now for Rapid Initiation of Hepatitis C Virus (HCV) Treatment
Authors: Radford Colton P , Deming Paulina , Walraven Carla
Published: January 2021

Background

An estimated 65,000 New Mexicans are infected with HCV, accounting for ~3% of the state’s population with intravenous drug use being the most common risk factor for the acquisition of HCV. In 2020, the US Preventive Service Task Force recommended universal HCV screening for all adults aged 18 to 79 years old. HCV screening requires a two-step process involving a HCV antibody (Ab) test followed by a confirmatory HCV ribonucleic acid (RNA) test to detect active infection. Acute HCV infections are typically asymptomatic leaving many individuals unaware of their diagnosis for years. New Mexico was one of the first states to abandon the requirement for specialist referral, fibrosis staging, and abstinence from substance abuse to facilitate HCV treatment. Despite removal of these barriers, major gaps in access to HCV treatment still persist. The objective was to develop a HCV connect-to-care cascade for the University of New Mexico Hospital (UNMH) to understand the potential barriers preventing patients from receiving appropriate care.

Methods

This was a retrospective, single center, descriptive study conducted at UNMH, a level 1 trauma, tertiary care academic medical center with 527 beds. All patients with a positive HCV Ab, RNA, or genotype obtained in 2018 were included in this study. There were no exclusions.

Results

In 2018, over 11,000 unique patients received HCV testing in any form resulting in a total of 14,566 HCV tests being performed.

2018 UNMH Connect-to-Care Cascade

Conclusion

Of the patients who screened positive, only 61.7% were referred for treatment, representing the largest gap in the cascade. However, once patients were seen in the clinic, 88.5% completed treatment with 100% having sustained virologic response (SVR). With the pan-genotypic HCV treatments having fewer side effects and high clinical success rates, it’s feasible that HCV treatment may no longer require a specialist. Similar to the rapid initiation of antiretrovirals in newly diagnosed HIV patients, where immediate access to treatment within days of diagnosis resulted in improved retention in care, decreased time to viral suppression, and decreased viral transmission, rapid initiation of HCV treatment may be the wave of the future.

Disclosures

All Authors: No reported disclosures
1078. Renal Transplant Recipient Resistomes Reveal Expansive Sub-Clinical Burden of Resistance After Treatment for ESBL-Producing Bacterial Infections
Authors: Woodworth Michael , Conrad Roth , Strudwick Amanda F , Babiker Ahmed , Pouch Stephanie M , Pouch Stephanie M , Mehta Aneesh , Friedman-Moraco Rachel , Adelman Max W , Konstantinidis Kostas , Kraft Colleen
Published: January 2021

Background

Renal transplant recipients have frequent infection and colonization with antibiotic resistant (AR) bacteria. However, little is known about the burden of AR following targeted antibiotic treatment.

Methods

This was a prospective study conducted as part of a single center clinical trial at Emory University. Demographic and clinical data regarding transplant and AR bacterial infection were abstracted. Stool samples were collected from renal transplant recipients treated with antibiotics for ESBL-producing gram negative infections. Bacterial cultures with AR-selective media and Illumina short-read sequencing were performed on stool samples. Confirmatory phenotypic isolate AR testing was performed with the Vitek2 platform. Resistome profiles were produced by assembling short reads into scaffolds using MetaSPAdes, predicting protein coding sequences using Prodigal and classifying proteins as antimicrobial resistance determinants using AMRFinderPlus. AMRFinderPlus results for patients were then compared to fecal metagenomes from 3 healthy Human Microbiome Project controls. Differences in AR genes in renal transplant patients vs controls were compared.

Results

Metagenome sequencing was performed for 6 (5 female) patient stool samples. Stools were collected a median of 30 days after infection. The median number of AR genes per patient metagenome was 48.5 (range 23 to 87 genes). The median number of AR genes per control metagenome was 24 (range 16 to 25 genes). We detected 97 unique AR genes across all samples, 63 of which (65%) were detected in patient samples but not controls. All AR genes found in control metagenomes were present in at least one patient metagenome. No AR genes detected in patients were common to all patients. Subsets of clinically relevant genes corresponded with patient stool AR bacteria culture results.

Antimicrobial resistance gene detection heatmap for renal transplant recipient stool samples after antibiotic treatment for ESBL infection.

Conclusion

Viable AR bacteria and diverse AR gene profiles were frequently detected from renal transplant recipient stool samples after antibiotic treatment for infection. These data suggest that AR bacterial colonization and AR gene profiles may require distinct treatments other than systemic antibiotics for eradication.

Disclosures

All Authors: No reported disclosures
1081. Characteristics and Outcomes of Nocardiosis in a Solid Organ Transplant Cohort
Authors: Gianos Andrew T , Lewis Jessica , Wray Dannah , Gnann John W , Jandhyala Deeksha
Published: January 2021

Background

Solid organ transplant (SOT) recipients are at increased risk for nocardiosis, an infection associated with high risk of relapse and/or mortality. Novel antimicrobial regimens may be associated with improved outcomes. Here we describe a cohort of SOT recipients with Nocardia infection, to address knowledge gaps regarding the epidemiology of, risk factors for, and outcomes of nocardiosis in SOT.

Methods

This is a single center retrospective study performed at a 700 bed academic transplant center. Cases of nocardiosis were identified via review of microbiology laboratory records; transplant status was ascertained via the electronic medical record. All SOT recipients with a culture growing Nocardia species between 1/1/2007 and 12/31/2019 were included.

Figure 1. Epidemiologic curve

Results

We identified 27 SOT recipients with nocardiosis. The incidence of nocardiosis increased over the study period (Figure 1). Demographic data are shown in Table 1. Induction immunosuppression varied; 37% received an interleukin-2 receptor antagonist, 30% received anti-thymocyte globulin, and 18% received steroids alone. The majority of positive cultures were from respiratory specimens (63%) and the most common species identified were N. nova complex and N. farcinica (Table 2). The majority of patients were lymphocytopenic and received treatment for rejection. 92% of subjects received a sulfonamide agent as part of their treatment regimen and 73% received an oxazolidinone (Table 3). 73% of subjects had resolution of infection without relapse; 15% expired.

Conclusion

The epidemiology and risk factors for nocardiosis in this SOT cohort are consistent with established literature. Less than a third of cases occurred in subjects who had received lymphocyte-depleting induction immunosuppression; however, most subjects were lymphocytopenic at diagnosis. While nearly all subjects received a sulfonamide as part of their treatment, the majority also received an agent from the newer drug class of oxazolidinones. Overall outcomes were positive, but treatment varied, thus limiting the ability to determine if a particular combination regimen is beneficial. Multicenter randomized studies are needed to better address knowledge gaps particularly pertaining to treatment.

Disclosures

All Authors: No reported disclosures
1083. Clinical Efficacy of Tedizolid for the Treatment of Mycobacterium abscessus complex Infections in Solid Organ Transplant Recipients
Authors: Poon Yi Kee , Monogue Marguerite , Sanders James , Hoz Ricardo M La
Published: January 2021

Background

Mycobacterium abscessus complex is a rapidly growing mycobacteria notoriously refractory to therapy due to inherent antimicrobial resistance mechanisms. Tedizolid is an oxazolidinone with in vitro activity against many nontuberculous mycobacteria species, including M. abscessus complex. This study describes the clinical outcomes of solid organ transplant (SOT) recipients with M. abscessus complex infection treated with tedizolid at a single medical center.

Methods

This retrospective cohort study included adult SOT recipients who met the ATS/IDSA criteria for nontuberculous mycobacterial infection and were treated with a multi-drug regimen that included tedizolid for at least four weeks between January 1, 2010 to August 31, 2019. Symptomatic improvement was defined as either decreased cough or sputum production for pulmonary infection and decrease in size of the primary lesion for skin or surgical site infection. The criteria for a microbiologic response was more than one negative culture with the causative species and sustained until the end of treatment. Clinical cure was defined as improvement of symptoms without proven negative cultures during and sustained until the end of treatment. A patient was considered cured if both symptomatic (if applicable) and microbiologic criteria were fulfilled. The clinical outcomes were compared from the initiation of tedizolid-containing regimen to the end of any M. abscessus complex treatment.

Results

Twelve patients were included. Mycobacterium abscessus abscessus (7/12, 58%) was the most common subspecies. The distribution of infections were as follows: five (42%) disseminated infections, five (42%) pulmonary infections, five (42%) surgical site infections, and four (33%) skin and soft tissue infections. Six patients were cured or clinically cured for all sites of infection (50%), three patients died (25%), and one patient had two recurrences (Table 1).

Table 1. Patient demographics and outcomes of M. abscessus complex infection.

Conclusion

Most patients had multiple sites of infection, and treatment required combination antimicrobial therapy and appropriate surgical management. In this small cohort, tedizolid-containing regimens demonstrated a potential benefit in symptomatic and microbiologic improvement in SOT recipients with M. abscessus complex infection.

Disclosures

All Authors: No reported disclosures