bluuebunny/crossref_metadata_2025_split huggingface dataset:
942. Lung Cancer Screening in at-risk patients with HIV in a Midwestern Clinic
Authors: Lopez Wilfredo , Sayles Harlan R , Bares Sara H , Fadul Nada 
Published: January 2021

Abstract

Background
Patients with HIV (PWH) have an increased risk of lung cancer compared to the general population. In 2013, the U.S. Preventive Services Task Force (USPSTF) released their lung cancer screening (LCS) guidelines for the general population. The objective of this study is to evaluate the frequency of and factors associated with LCS using computed tomography in at-risk PWH.

Methods
A retrospective chart review of patients 55-80 years old seen at a Midwestern HIV Clinic between July 1, 2016 to June 30, 2018 was conducted. Demographic, clinical, laboratory, and referral for LCS information were collected. Descriptive statistics and logistic regression models were used for analysis.

Results
We reviewed 347 patients, out of whom 91 were excluded for the following reasons: never smoked (8), deceased (38), pack history unknown (39), and prior lung cancer diagnosis (6). Mean (sd, range) for age was 61 (5.0, 55-78). A total of 256 patients were included in the analysis, out of whom 104 (41%) met the USPSTF criteria. No effect was identified for demographic information including race, ethnicity, gender, or insurance status on LCS referral. LCS referral was made for 22 out of 256 patients (9%) (13% of patients who met the USPSTF criteria and 5% of those who did not). Patients who received tobacco cessation counseling (OR 7.83, P=0.047) and with hepatitis C infection (OR 4.32, P=0.002) were more likely to receive LCS referral. Out of those who received LCS referral, 12/22 (55%) completed the referral. Patients with hepatitis C infection were more likely to complete LCS referral (OR 8, P=0.038).

Conclusion
Only 13% of patients who met USPSTF criteria were referred for LCS. Patients who received tobacco cessation counseling were more likely to receive a referral. Patients with hepatitis C infection were more likely to receive and complete LCS referral. Quality improvement efforts to improve rates of LCS in PWH are needed. Future prospective studies should examine the factors associated with LCS in PWH.

Disclosures
Sara H. Bares, MD, Gilead Sciences (Grant/Research Support)
943. Older Gay Black Men Living with HIV Report Higher Quality of Life than Older Gay White Men, Despite Facing Additional Burdens
Authors: Mazonson Peter , Loo Theoren , Berko Jeff , Adeyemi Oluwatoyin , Oglesby Alan , Spinelli Frank , Zolopa Andrew 
Published: January 2021

Abstract

Background
Improving quality of life (QoL) is an important goal of care for people living with HIV (PLWH). This analysis uses data from the Aging with Dignity, Health, Optimism and Community (ADHOC) online registry to identify the different challenges faced by older white/Caucasian (“white”) and black/African American (“black”) gay or bisexual men living with HIV, and to assess differences in total QoL between the two groups.

Methods
QoL was measured using the PozQoL, a validated instrument for PLWH. The PozQoL assesses QoL across four domains: health concerns, psychological, social, and functional wellbeing. Total QoL was determined by combining domain scores for a total score. Student’s t-tests and chi-squared tests were used to identify disparities between black and white men. Factors with p&lt; 0.05 were used as control variables in a multivariable linear regression model where PozQoL total score was the dependent variable.

Results
In the ADHOC database, 91% (n=612) of respondents were white men (WM) and 9% (n=59) were black men (BM). Both BM and WM had a median age of 59 years, and had a similar number of comorbidities (7.9 vs 9.2 respectively, p=0.12). Compared to WM, BM were more likely to be single (74% vs 51%, p&lt; 0.001), less likely to have an income greater than $50,000 (25% vs 56%, p&lt; 0.001), less likely to have a college degree or more (42% vs 69%, p=0.034), and less likely to be virally suppressed (87% vs 96%, p=0.001). Even after controlling for these differences in the multivariable model, BM had significantly higher total QoL than WM (Table 1).

Conclusion
In this analysis, there were substantial differences between older BM and WM living with HIV. After controlling for sociodemographic and clinical challenges, BM still reported higher QoL than WM. Programs designed to improve QoL for older gay and bisexual BM and WM living with HIV should take into consideration the unique strengths and challenges faced by each group.

Disclosures
Peter Mazonson, MD, MBA, ViiV Healthcare (Grant/Research Support) Theoren Loo, MS, BS, ViiV Healthcare (Grant/Research Support) Jeff Berko, MPH, BS, ViiV Healthcare (Grant/Research Support) Oluwatoyin Adeyemi, MD, ViiV Healthcare (Grant/Research Support) Alan Oglesby, MPH, ViiV Healthcare (Employee) Frank Spinelli, MD, ViiV Healthcare (Employee) Andrew Zolopa, MD, ViiV Healthcare (Employee)
68. Impact of a Pharmacy-Driven Antimicrobial Time-out on Duration of Therapy in Community-Acquired Pneumonia
Authors: Patel Amolee R , Murrey Timothy F 
Published: January 2021

Abstract

Background
Community-Acquired Pneumonia (CAP) is associated with substantial antibiotic use and potential for overprescribing. Previous studies have demonstrated a reduction in antimicrobial exposure following implementation of provider-driven antimicrobial time-outs (ATOs). ATOs prompt assessment of appropriateness of therapy, clinical response, and duration of therapy. In January 2018, OSF Healthcare System implemented a 48-hour pharmacy-driven ATO in the electronic health record. The purpose of this study was to determine if the implementation of the ATO decreased the duration of antibiotic therapy for CAP at a community hospital.

Methods
This was a retrospective chart review of adults hospitalized with CAP at OSF Saint Anthony Medical Center between May 2016 - October 2017 (pre-implementation; PRE) and April 2018 - September 2019 (post-implementation; POST). The primary outcome was total duration of antibiotic therapy between hospitalization and discharge prescriptions. Secondary outcomes included hospital length of stay (LOS), duration of IV therapy, and rates of treatment failure, relapse, and antibiotic-associated adverse events.

Results
A total of 808 patient charts were reviewed with 155 patients meeting inclusion criteria in both study groups. The mean duration of antibiotic therapy was reduced by 2.14 days (PRE 10.51 days vs. POST 8.37 days; P&lt; 0.001). Duration of IV therapy (3.86% vs. 3.21%; P&lt; 0.001) and 30-day emergency department visit rate (16.13% vs. 3.23%; P&lt; 0.001) were also significantly reduced. Differences in LOS (4.60 days vs. 4.45 days; P=0.279) and 30-day readmission rate (9.03% vs. 4.52%; P=0.114) did not meet statistical significance. Antibiotic-associated diarrhea (28.39% vs. 17.42%; P=0.022) and acute kidney injury (17.42% vs. 6.45%; P=0.003) were significantly reduced while C. difficile infection (2.58% vs. 0.65%; P=0.371) and treatment failure (3.22% vs. 1.94%; P=0.723) only trended downward.

Conclusion
Implementation of the pharmacy-driven ATO was associated with reduced duration of antibiotic therapy in patients hospitalized with CAP, though total durations still exceeded evidence-based recommendations. The ATO maintained the efficacy of treatment and reduced treatment-associated adverse effects, such as diarrhea and AKI.

Disclosures
All Authors: No reported disclosures
950. Venous Thromboembolism in Persons Living with HIV (PLWH): A Single Center Retrospective Cohort Study
Authors: Chan Kok Hoe , Atallah Liana , Ahmed Eyad , Farouji Iyad , Crincoli Joanna , Patel Khamoshi , Shaaban Hamid S 
Published: January 2021

Abstract

Background
Data on risk of thromboembolism in PLWH is limited. HIV is often recognized as a chronic inflammatory disease and has been recognized as a prothrombotic condition. We aimed to analyze the incidence and demographic of venous thromboembolism such as pulmonary embolism and deep vein thrombosis in PLWH admitted to our hospital.

Methods
We conducted a retrospective hospital cohort study on PLWH ≥ 18 years old who were admitted to our hospital between 09/01/2018 and 09/01/2019. Study individuals were recruited if they had complete laboratory profile and well-defined clinical outcomes. Demographic, clinical and laboratory data were reviewed and retrieved. Descriptive analysis was employed to describe the demographic profile of PLWH with venous thromboembolism.

Results
Out of the 192 hospitalized PLWH during the study period, 15 (8%) patients had documented deep vein thrombosis (DVT) and/or pulmonary embolism (PE). History of DVT/PE was present in 5 (33%) patients while the rest had new onset of DVT/PE. Out of the 15 patients, 4 (27%) had DVT and PE, 4 (27%) had only DVT and 7 (46%) had only PE. The median age was 57 years, ranged from 40 to 74 years; 4 males and 11 females. As for ethnicities, 2 Caucasian, 12 were African American and 1 Hispanic.
The average D-dimer was 4491. The median CD4 count for PLWH with venous thromboembolism was 487 and a median viral load of 900. In contrary, the median CD4 count of PLWH without venous thromboembolism was 420 and median viral load of 140. Though not statistically significance, higher viral load seems to associate with risk of venous thromboembolism. Surprisingly, female gender is an independent risk factor for venous thromboembolism in PLWH (z-score 2.75, p=0.0059; odds ratio [OR], 4.67; 95% confidence interval [CI], 1.56-13.69).

Conclusion
Our observation of PLWH with venous thromboembolism suggest that this population has an increased risk of venous thromboembolism as compared to general population. Female gender is an independent risk factor for venous thromboembolism in PLWH and higher HIV viral load seems to associate with higher risk. Larger prospective studies in this population are needed to dissect the interplay between HIV and venous thromboembolism.

Disclosures
All Authors: No reported disclosures
951. Weight Gain Associated With Antiretroviral Therapy
Authors: Patel Yesha , Okere Sheila , Lustberg Mark , Malvestutto Carlos 
Published: January 2021

Abstract

Background
Obesity is a global public health crisis with a growing prevalence in persons with human immunodeficiency virus (PWH) population. In this study, we aimed to investigate factors associated with weight gain in the PWH population.

Methods
This was a single-centered, retrospective cohort study of our clinic patient population from January 1, 2015 to January 1, 2019. Patients with human immunodeficiency virus (HIV) were identified from the electronic health record and a randomized sample of 300 patients who had at least two follow up appointments, were on antiretroviral therapy, and had viral loads less than 200 were evaluated. The primary outcome was weight change over follow up. Cox Proportional Hazards models were used, taking a weight gain &gt; 3 kg as the outcome, and the time on therapy between visits as the time to event. Robust linear regression was used to model mean changes in weight, accounting for influential observations. All analysis were performed in STATA 16.0.
Table 1

Results
At baseline, 87% were male, 63% were white, and 65% were overweight/obese. 30% were on a protease inhibitor, 46% were on non-nucleoside reverse transcriptase inhibitor, and 37% were on an integrase inhibitor. 64% were on Tenofovir disoproxil (TDF), 8% were on Tenofovir alafenamide (TAF), and 19% were on Abacavir. Mean weight change over follow up was significantly increased at 1.31 kg (95% CI = 0.58 – 2.04 kg, p= 0.0004). TAF use and male gender were significantly associated with risk of weight gain &gt; 3 kg in univariate analysis [respectively, OR = 2.53, 95% CI = 1.30 – 4.92, p = 0.006; OR = 2.60, 95% CI = 1.05 – 6.45, p = 0.04]. In multivariate analysis, TAF use was significantly associated with weight gain &gt; 3 kg, while male gender was of borderline significance [respectively, OR = 2.29, 95% CI = 1.17 – 4.47, p = 0.01; OR = 2.40, 95% CI = 0.96 – 5.97, p=0.060]. Significant factors associated with weight change are noted in Table 1.

Conclusion
As PWH are living longer on effective ARV therapy, monitoring for weight gain is required as obesity contributes to morbidity and mortality from cardiovascular disease and metabolic diseases. Key factors for weight gain in our clinic population include male gender, baseline diagnosis of hypertension, use of TAF, bictegravir use, and rilpivirine use.

Disclosures
Carlos Malvestutto, MD, Gilead Sciences (Advisor or Review Panel member)ViiV Healthcare (Advisor or Review Panel member)
952. Weight-Gain in Treatment Naive Newly Diagnosed HIV-Infected Persons After Initiation on Integrase Strand Inhibitor Based Treatment Regimens
Authors: Szep Zsofia , Cui Saishi , Conway Heather , Evans Alison 
Published: January 2021

Abstract

Background
We performed a retrospective cohort study of treatment-naive patients with newly diagnosed HIV-infection enrolled at an urban university specialty clinic to identify whether INSTI-based ART regimens were associated with greater weight gain compared to NNRTI and PI based regimens in the first 12-18 months of treatment. The secondary aim of this study was to determine differences in weight gain between males and females within each of the three ART classes

Methods
Differences in weight change and BMI change were compared across ART class using nonparametric tests, specifically the Wilcoxon rank sum test. Nonparametric tests were also used to compare differences in weight change and BMI change between males and females within each ART class. Data were analyzed using R Core Team, 2020

Results
Among the 348 individuals included in the study, 73% were African American and 79% were male and the median age was 32 years. There were 155 individuals initiating therapy on NNRTI based regimens (44%), 58 were on PI based regimens (17%) and 135 were on INSTI regimens (39%). The median weight at baseline was 170.5 lbs. and the median body mass index was 25.4 kg/m2. Median weight increased across all 3 ART regimens within the first 12-18 months of treatment. Median weight gain among the PI group was the greatest, at 6.8 lbs. (p= 0.04). Median weight gain among the NNRTI group was the lowest, .88 lbs (p=&lt; .01). Median weight gain among those on INSTI based regimens was 4.8 lbs. (p= 0.11). Among those on INSTI-based regimens, women had a greater median increase in weight compared to men, 10.1 lbs. compared to 3.2 lbs., (p=0.046).

Conclusion
Overall, among individuals initiating HIV treatment those initiating PI based regimens experienced the most weight gain and individuals initiating INSTI based regimens did not experience a significant weight gain. Women on INSTI based regimens did experience a significant weight gain in comparison to men.. More research is needed to elucidate specific ART regimens’ causal role in weight gain and to identify risk factors for ART-associated weight gain.

Disclosures
All Authors: No reported disclosures
953. Frailty Among People Living with HIV In Miami, A Cross Sectional Pilot Study
Authors: Salguero Douglas , Rodriguez Jornan , Raccamarich Patricia , Abbamonte John , Pallikkuth Suresh , Rodriguez Allan , Pahwa Savita , Alcaide Maria L 
Published: January 2021

Abstract

Background
Frailty, a status of high vulnerability, is a clinical syndrome associated with adverse health outcomes and characterized by a constellation of various health deficits. Although age is a major contributor of being frail, HIV infection is associated with accelerated aging, and likely contributes to frailty. This association has seldom been evaluated. This study evaluated factors associated with frailty among PWH in Miami.

Methods
Cross-sectional study. Adults (&gt; 18 years), HIV infected (HIV+) and uninfected (HIV-), virologically suppressed for at least 1 year (&lt; 50 copies/ml). Sociodemographic factors and the self reported FRAIL scale was administered (Fatigue, Resistance or ability to climb a single flight of stairs, Ambulation or ability to walk one block, Illnesses or non-HIV associated comorbidities, and more than 5% weight Loss in the previous year). Groups were categorized base on the FRAIL scale scoring as Non-Frail (0), Pre-Frail (1-2), and Frail (3 or more). The association by Frail categories were analyze using descriptive statistics and ordinal logistical regression.

Results
N (40), median age was 43 years (SD 20.6); 35% White; 20% Hispanic; 52% females; 25 (62.5%) HIV +/ 15 (37.5%) HIV -. A small number of participants reported use of tobacco 2 (5%) and alcohol 7 (18%). More than half of the participants were frail or pre- frail (18 or 45% Non-Frail, 18 or 45% Pre-Frail, and 4 or 10% Frail, and HIV+ were more likely to be pre-frail or frail than HIV-, 72% vs 26%, p = 0.019). Frail scale symptoms were common among all participants but HIV+ reported higher fatigue than HIV- (85% vs 14%, p= 0.01). On Regression analysis, both HIV status and age were significant predictors of frailty status (HIV χ2 (1) = 4.36, p = .037 and age χ2 (1) = 13.48, p &lt; .001). When controlling for age, being HIV - on average reduced frailty by an odds of 2.16 (b = -2.164, SE = 1.04, p = .037, 95% CI [-4.2 -0.13]). When controlling for HIV status, for every one year of increase in age, the ordered log odds of being frail increased by 0.07 (b = 0.07, SE = 0.02, p &lt; .001, 95% CI [0.03 0.1]).

Conclusion
Using the FRAIL scale, a simple tool to screen for frailty, we identified high prevalence of frailty among PWH. Further studies are needed to identify the best tools to assess frailty and prevent poor health outcomes among this vulnerable population.

Disclosures
All Authors: No reported disclosures
957. Efficacy of Using Disease Intervention Specialists (DIS) to Re-engage Out of Care HIV/HCV Co-Infected Persons into HCV Treatment
Authors: Wegener Maximilian D , Brooks Ralph P , Speers Suzanne , Gosselin Deborah , Villanueva Merceditas 
Published: January 2021

Abstract

Background
Published treatment cascades for HIV/HCV co-infection show WHO goals for HCV micro-elimination are not being met. Barriers include entry to care, access to DAA, treatment adherence, and out of care (OOC) patients. A Data to Care approach used to define persons with HIV (PWH) who are OOC, together with DPH-employed DIS to promote re-engagement has been successful for re-engaging OOC PWH. We modified this approach to re-engage OOC HIV/HCV coinfected persons.

Methods
Surveillance databases used: CTEDSS (CT Electronic Disease Surveillance System used for HCV) and eHARS (electronic HIV/AIDS Reporting System). Two OOC cohorts studied: HIV OOC for 12 months (no HIV lab 10/2018-10/2019) and 18 months (no HIV lab 12/2017-6/2019). Lists generated for the 2 cohorts matched to CTEDSS to determine the coinfected OOC. DIS supervisor performed pre-work/case conferencing on lists to assess DIS intervention eligibility. DIS success was defined as those who reengaged (made/kept appointment) out of those successfully contacted. Analysis: tests of homogeneity performed between those OOC and not OOC; evaluation of cases at each level of the intervention; measures of dispersion/central tendency performed illustrating reengagement workload.
Project Flow Chart

Results
12-month OOC: Non-baby boomers (p-value 0.05) and those with detectable HIV VLs (0.04) were more likely to be OOC; 53.7% were DIS-eligible; DIS initiation to client contact, 7 days average (range 4-11); 75 calls and 31 field visits for those successfully contacted; reengagement success rate, 39%. 18-month OOC: Non-baby boomers (0.017), Hispanic and Black race/ethnicity (0.043), and those with detectable HIV viral loads (0.002) were more likely to be OOC; 44% were DIS-eligible; DIS initiation to client contact, 12 days average (range 8-18); 74 calls and 36 field visits for those successfully contacted; reengagement success rate, 43%.
Results for the Two Cohorts

Out of Care and Workload Results

Conclusion
A data-to-care approach successfully identified, characterized, connected OOC HIV/HCV coinfected patients. DIS provided patient education, facilitating reengagement to care. DIS Success rates are encouraging but small; efforts were labor intensive. Additional strategies focused on preventing non-baby boomers, persons of color, and those with detectable HIV VLs from becoming OOC should be studied.

Disclosures
All Authors: No reported disclosures
958. Feasibility and Acceptability of HIV Self-Test Kit Distribution Through PrEP Clients’ Friendship and Sexual Networks
Authors: Balan Shuba , Klose Katie , King Katherine , Kanamori Mariano , Michniewicz Mara , Spencer Emma , Doblecki-Lewis Susanne 
Published: January 2021

Abstract

Background
Personal networks can influence behaviors, beliefs, attitudes, and values through contact and communication. The University of Miami Mobile PrEP Program offers low-barrier pre-exposure prophylaxis (PrEP)/HIV prevention services through a mobile clinic in five highly impacted neighborhoods in Miami-Dade, the county with the highest HIV incidence in the US. The highest rates are among black and Latino men who have sex with men (MSM). The goal of this study is to understand the acceptability and feasibility of expanding the reach of testing through our clients’ friendship and sexual networks.

Methods
This study was implemented in five locations across Miami from December 2019 to February 2020. During scheduled PrEP quarterly follow-up clinic visits, participants were offered Ora-Quick oral fluid self test (ST) kits, free of cost for distribution to up to four sexual partners and/or friends. In addition to the information available in the testing kit, brief training regarding the test and resources for post-test engagement were provided. A survey evaluated participants’ distribution plan, comfort level and concerns in offering the test kits to friends/sexual partners. Descriptive statistics included frequencies for categorical variables, and means and ranges for continuous variables.

Results
A total of 84 participants were offered the ST kits, of which 49 (58%) accepted. Of those accepting kits, 40 (81.63%) of 49 were Latino MSM. Participants requested an average of 3 (mean=2.9, range 1-4) kits, for a total of 144 kits. Overall, 41(84%) felt very comfortable and 47(96%) indicated they felt very comfortable offering this test to their friends/sexual partners. Also, 29(59.2%) planned to distribute kits only to friends, 2(4%) only to sexual partners, 11(22.4%) to both sexual partners and friends and 7(14.2%) to either family or self-test to provide ‘moral support’ to those taking the test. None of the participants expressed any concerns about offering kits to friends or sexual partners.

Conclusion
Distribution of home based self-test HIV kits through current Mobile PrEP clients’ friendship and sexual networks is acceptable and feasible. Similar social network strategies may be considered to expand reach of HIV testing and PrEP engagement to those with barriers to care.

Disclosures
All Authors: No reported disclosures