bluuebunny/crossref_metadata_2025_split huggingface dataset:
941. Incarcerated patients living with HIV: Atherosclerotic cardiovascular disease risk and management
Authors: Michienzi Sarah M , Chiampas Thomas D , Valkovec Amy , Arzuaga Siria , Patel Mahesh C , Borgetti Scott , Badowski Melissa E 
Published: January 2021

Abstract

Background
The 2018 American Heart Association and American College of Cardiology (AHA/ACC) 2018 Guideline on the Management of Blood Cholesterol included human immunodeficiency virus (HIV) as an atherosclerotic cardiovascular disease (ASCVD) risk enhancer for the first time. Our study investigates if patients living with HIV in the Illinois Department of Corrections (IDOC) were prescribed appropriate HMG-CoA reductase inhibitor (statin) therapy following release of these guidelines based on risk.

Methods
This was a retrospective study of patients with &gt; 1 visit in our multidisciplinary HIV IDOC Telemedicine Clinic from 1/1/19-6/1/19. Our prescriptive authority is limited to HIV and directly related conditions, and we provide recommendations to on-site providers for other comorbidities. Included patients were &gt; 18 years of age, HIV positive, and incarcerated within IDOC. Excluded patients had existing ASCVD. Data from the first visit in the study period were extracted from the electronic medical record and analyzed utilizing descriptive statistics. Primary objectives were to quantify ASCVD risk and appropriate statin use in our population.

Results
Of the 158 patients included, average age was 42 years. The majority were male (89%), Black (73%), overweight/obese (117/148, 79%), on an integrase single-tablet regimen (78%), with CD4 &gt;200 cells/µL (97%), and HIV RNA &lt; 20 copies/mL (85%). Of the 18 females, 8 were transgender. Within the prior year, 65% had a lipid panel. For the 50 patients meeting criteria for 10-year ASCVD estimation, median (range) risk was 6.6% (0.8% - 31.9%). Only 12 patients were on statins. Of these, all were indicated per AHA/ACC guidelines with 10 prescribed appropriate intensity. An additional 45 patients had indications for statins but were untreated. In total, 47 patients (30%) were not receiving appropriate statin therapy.

Conclusion
Results of our study suggest ASCVD risk management is an area of improvement for inmates living with HIV, especially as we look towards caring for an aging HIV population. Future directions include comparing these data to data from a later time point to evaluate time for guideline uptake.

Disclosures
Thomas D. Chiampas, PharmD, BCPS, AAHIVP, Gilead (Employee)
944. Pneumocystis-Tuberculosis Co-infection in the HIV Positive Host
Authors: Nair Sashi N , Brar Indira , K.P. Gireeshkumar 
Published: January 2021

Abstract

Background
Concurrent infection with Pneumocystis Jirovecii (PJP) and Tuberculosis (TB) has been described in HIV infected patients. Developed countries, where guidelines on the treatment of PJP have been created have dramatically lower rates of latent and active TB than developing countries. PJP may obscure the diagnosis or delay the treatment of TB. Furthermore, treatment of PJP with corticosteroids may be detrimental to the course of TB. The objective of this study was to examine the frequency and the clinical characteristics of the co-infection of PJP and TB in HIV.

Methods
The clinical details of all HIV patients being treated at Amrita Hospital in South India have been prospectively collected in an electronic database since 2006. We compiled the data from 2006 to 2018 and further examined the clinical and laboratory results from electronic charts of patients admitted with PJP. Statistical analysis of the data was performed with descriptive analysis.

Results
A total of 21 of the 576 HIV patients were had admissions for PJP. Of these, 43% were co-infected with PJP and TB. In all cases PJP was the opportunistic infection leading to a HIV diagnosis. When comparing the PJP and MTB group with the PJP only group, the dual infected group was younger (40 vs 45), however there was no difference in length of stay (16.5 days vs 11.8), ICU admission rate (33% vs 36%), or mortality (0 vs 3 patients died).
Demographic Data

Comparison of TB-PCP and PCP only groups

Conclusion
Our report highlights the need to increase awareness of occurrence of this dual infection in HIV infected patients, as both infections can mimic each other clinically and radiologically, and are potentially fatal if not recognized promptly. Furthermore tuberculosis has the risk of transmission to health care personnel and other patients. In addition we report a much higher rate of underlying TB in our patients with PJP than what has been generally reported in the literature and conclude that higher clinical suspicion for this entity is warranted, particularly in countries with a high prevalence of TB.
Immunology and Pathophysiology of HIV-PJP-TB triple infection

Disclosures
Indira Brar, MD, Gilead (Speaker’s Bureau)janssen (Speaker’s Bureau)ViiV (Speaker’s Bureau)
945. Prevalence of HIV Associated Non-AIDS Conditions and Associated Risk Factors among Hospitalized HIV-infected Patients in India
Authors: Jereen Amyeo A , Kucera Celia , Pervin Saniya , Varma Muralidhar , Rajesh Radhakrishnan , Menezes Lynette , Lakshmi Seetha 
Published: January 2021

Abstract

Background
HIV-associated non-AIDS (HANA) conditions are becoming common as People Living with Human Immunodeficiency Virus (PLWHIV) age. However, data estimating the prevalence of HANA conditions and associated risk factors is lacking in developing countries. This study evaluates reasons for hospitalizations among PLWHIV in Udupi, India in the antiretroviral era, and describes associated risk factors.

Methods
Demographic and clinical data were extracted from medical charts of 1280 HIV-infected patients 18 years and older who were admitted to Kasturba Hospital, Manipal, India between January 1, 2013 and December 31, 2017, for a total of 2157 hospitalizations. Primary reasons for hospitalization were categorized into AIDS-defining vs Non-AIDS-defining and HANA vs Non-HANA conditions (Fig 1). Multivariate logistic regression analysis was performed to estimate demographic and clinical factors associated with hospitalizations due to AIDS-defining illness and HANA conditions.
Categorization of Reasons for Hospitalization

Results
Patients’ median age was 45 (18-80) years; 70% male. Median age of patients with AIDS-defining illness (45% of hospitalizations) was lower at 44 (18-75) years compared with HANA (15% of hospitalizations) at 48 (21-80) years.
Age (OR, 95% CI) (0.985, 0.974-0.995), admission CD4 (0.998, 0.997 - 0.998), history of hypertension (HTN) (0.59, 0.42-0.82), stroke (0.49, 0.24 - 0.93), diabetes (1.56, 1.10 - 2.19), and AIDS-defining cancers (1.74, 1.05 - 2.89) were associated with AIDS-defining hospitalizations (Fig 2).
Additionally, age (1.016, 1.001 - 1.031), history of HTN (1.70, 1.16 - 2.46), coronary artery disease (CAD) (4.02, 1.87- 9.02), chronic kidney disease (CKD) (2.30, 1.15 - 4.61), stroke (2.93, 1.46 - 5.96), Hepatitis B (3.32, 1.66- 6.72), Hepatitis C (16.1, 2.84 - 314), sexually transmitted disease (STD) (3.76, 1.38- 10.8), and HANA-associated cancer (2.44, 1.28- 6.42) were associated with HANA hospitalizations (Fig 3).
Patient Risk Factors for AIDS-related Hospitalization

Patient Risk Factors for HANA-related Hospitalization

Conclusion
Prevalence of HANA conditions was lower than AIDS-defining illnesses possibly because of a younger population. Patients with AIDS-defining illnesses were also likely to have HANA conditions. Early detection and effective treatment of both HIV and HANA conditions is essential to decrease hospitalizations in low-resource settings.

Disclosures
All Authors: No reported disclosures
946. Risk factors and Metabolic Implications of Integrase Inhibitor Associated Weight Gain
Authors: Asundi Archana , Olson Alex , Jiang Wenqing , Patel Swati , White Laura F , Sagar Manish , Lin Nina H 
Published: January 2021

Abstract

Background
Excessive weight gain associated with integrase strand transfer inhibitor (InSTI) antiretrovirals is an emerging issue in the current antiretroviral treatment (ART) era. Despite the known association between excess weight and impaired glucose tolerance in the general population, the metabolic implications of InSTI-associated weight gain have not been established. The objective of this study was to evaluate the presence of InSTI-associated weight gain amongst a diverse, urban population and to investigate potential risk factors and metabolic implications.

Methods
We obtained demographic, pharmacy and laboratory data from the hospital clinical data warehouse for ART-naïve adult HIV+ patients at Boston Medical Center between fiscal year (FY) 2007-2017. We compared patients who initiated on an InSTI to those with an alternate regimen (i.e. PI, NNRTI) who remained on their initial regimen for at least 18 months. Individuals with diabetes mellitus (DM) prescription or ICD 9/10 code prior to ART initiation were excluded. Our primary outcome was percent weight change in the first 24 months of ART estimated by linear mixed effects model fit by restricted maximum likelihood. Our secondary outcome was incident DM diagnosis in the 18 months after ART using progression-free survival (PFS). PFS rates were estimated by the Kaplan-Meier method and log-rank test, and Cox proportional-hazards model were determined, all using R v3.6.2.

Results
Between FY 2007-2017, 139 patients were initiated on InSTIs and 1117 were initiated on alternative anchor regimens. Approximately, one third of the cohort was female and more than 75% were non-white. InSTI use in women was associated with increased weight gain in the first 24 months of ART compared to non-InSTIs (+9.57%, p = 0.002, Figure 1). InSTI use was associated with more incident DM diagnoses in the first 18 months of ART compared to non-InSTI regimens (HR = 3.27, p = 0.014).
Figure 1: Percentage weight change from baseline at ART initiation between InSTI and non-InSTI regimens

Conclusion
Females have higher InSTI-associated weight gain which suggests they may be more susceptible to adverse metabolic issues. InSTI use appears to be associated with an increased incidence of DM diagnoses following ART initiation. Further prospective and controlled studies will be necessary to describe the mechanism of this effect and refine HIV management strategies.

Disclosures
Archana Asundi, MD, Gilead (Scientific Research Study Investigator)Merck (Scientific Research Study Investigator)ViiV (Scientific Research Study Investigator) Nina H. Lin, MD, Gilead Sciences (Scientific Research Study Investigator)ViiV (Scientific Research Study Investigator)
947. Stroke demographics and risk factor profile in HIV infected individuals in Florida
Authors: Ayoade Folusakin , Jayaweera Dushyantha 
Published: January 2021

Abstract

Background
The risk of ischemic stroke (IS) is known to be higher in people living with HIV (PLWH) than uninfected controls. However, information about the demographics and risk factors for hemorrhagic stroke (HS) in PLWH is scant. Specifically, very little is known about the differences in the stroke risk factors between HS and IS in PLWH. The goal of this study was to determine the demographics and risk factor differences between HS and IS in PLWH.

Methods
We retrospectively analyzed the demographic and clinical data of PLWH in OneFlorida (1FL) Clinical Research Consortium from October 2015 to December 2018. 1FL is a large statewide clinical research network and database which contains health information of over 15 million patients, 1240 clinical practices, and 22 hospitals. We compared HS and IS based on documented ICD 9 and 10 diagnostic codes and extracted information about sociodemographic data, traditional stroke risk factors, Charlson comorbidity scores, habits, HIV factors, diagnostic modalities and medications. Statistical significance was determined using 2-sample T-test for continuous variables and adjusted Pearson chi square for categorical variables. Odds ratio (OR) and 95% confidence intervals (CI) between groups were compared.

Results
Overall, from 1FL sample of 13986 people living with HIV, 574 subjects had strokes during the study period. The rate of any stroke was 18.2/1000 person-years (PYRS). The rate of IS was 10.8/1000 PYRS while the rate of HS was 3.7/1000 PYRS, corresponding to 25.4% HS of all strokes in the study. Table 1 summarizes the pertinent demographic and risk factors for HS and IS in PLWH in the study.
Table 1: Summary of pertinent demographic and risk factors for hemorrhagic and ischemic strokes in people living with HIV from One Florida database

Conclusion
In this large Floridian health database, demographics and risk factor profile differs between HS and IS in PLWH. Younger age group is associated with HS than IS. However, hypertension, hyperlipidemia and coronary artery disease are more likely to contribute to IS than HS in PLWH. Further research is needed to better understand the interplay between known and yet unidentified risk factors that may be contributing to HS and IS in PLWH.

Disclosures
All Authors: No reported disclosures
948. The Changing Dynamics of Hospitalizations Among People Living with HIV Over Time
Authors: Gujaran Shruti , Stafford Kristen A , Riedel David J 
Published: January 2021

Abstract

Background
As antiretroviral therapy for HIV has become more successful, people living with HIV (PLWH) are aging. Nearly half (48%) of all PLWH in the U.S. are now ≥ 50 years old, and this proportion is expected to continue to grow. The aging population of PLWH offers new challenges to the healthcare system beyond HIV management, with increased risks for chronic comorbidities and other complications of aging. Few studies have examined the causes and outcomes of hospitalizations among PLWH or how these diagnoses have changed over time.

Methods
Using U.S. hospitalization data from 1993 to 2014 from the National Inpatient Sample, we compared the primary diagnosis at admission among PLWH to HIV-negative hospitalizations and how this changed over time. We also compared the mean age at admission, hospital length of stay, total charges, and hospital disposition.

Results
There were 654,783,064 hospitalizations recorded from 1993 - 2014, with 5,370,749 among PLWH (0.8%) and 649,412,315 among HIV-negative patients (99.2%). The mean age of PLWH on admission increased from 37.4 years in 1993 to 48.1 years in 2014 and was lower than HIV-negative patients every year (Figure 1). There was a significant decrease in the proportion of admissions with HIV as the primary diagnosis for PLWH between 1993 - 2014 (53.1% to 24.2%) with a corresponding increase in non-HIV diagnoses over that time (Figure 2). The proportions of primary admission diagnoses for HIV-Negative patients were largely unchanged over the period. Although mean hospital lengths of stay for PLWH decreased over time, they were consistently longer than HIV-negative patients (Figure 3). Similarly, mean total charges for PLWH increased over time but were consistently higher than those for HIV-negative patients (Figure 3). The proportion of PLWH who died during hospitalization declined from a peak of 8.8% in 1993 to 2.4% in 2014 while inpatient mortality among HIV-negative patients declined from 3.2% to 2.2% over the same time.
Figure 1. Trends of Mean Age for PLWH and HIV-Negative Admissions from 1993 – 2014

Figure 2. Trends of HIV vs. non-HIV as the Primary Admission Diagnoses for PLWH from 1993 – 2014

Figure 3. Trends of Length of Hospital Admission and Total Charges for PLWH and HIV-Negative Patients from 1993 – 2014

Conclusion
The primary admission diagnoses for PLWH has shifted from HIV to non-communicable causes as PLWH are living longer. PLWH are typically younger on admission and have longer and more expensive hospitalizations than HIV-negative patients.

Disclosures
All Authors: No reported disclosures
949. Use of Optical Coherence Tomography Angiography to Assess Microvascular Health Among Persons with HIV: Employing the Retina as a Convenient Window
Authors: Collins Lauren F , Shantha Jessica G , Nesper Peter L , Sheth Anandi N , Fawzi Amani A , Yeh Steven , Ofotokun Ighovwhera 
Published: January 2021

Abstract

Background
Mechanisms underlying the rising burden of non-AIDS comorbidities (NACM) among persons with HIV (PWH) remain unclear. Microvasculopathy may link HIV-related chronic inflammation and premature multimorbidity, similar to diabetes and other conditions characterized by inflammatory end-organ damage. We used a novel retinovascular imaging tool, optical coherence tomography angiography (OCTA), to evaluate the retina as a convenient assessment of microvascular health among PWH.

Methods
Data from 4 PWH who underwent OCTA (Zeiss CIRRUSTM HD-OCT 5000) at the Emory Eye Center from 2018-2020 were analyzed. Demographics, HIV-specific indices and NACM were summarized at the time of OCTA. Images were reviewed qualitatively and metrics of microvascular health – the foveal avascular zone (FAZ) area and vessel density (VD) from the superficial capillary plexus (SCP) – were calculated by ImageJ.

Results
The median age was 39 years, 100% were male, 100% were black, 25% had ever smoked, and median body mass index was 25.4 kg/m2. Median time since HIV diagnosis was 19 years, all patients had a history of clinical AIDS, including 2 with prior cytomegalovirus retinitis. Median current CD4 count was 84 cells/mm3, 100% were prescribed antiretroviral therapy and 50% had HIV viral suppression. Prevalent NACM included (each n=1): hypertension, dyslipidemia, diabetes, chronic kidney disease and asthma.
Qualitatively, all 7 of the eyes evaluated by OCTA had evidence of microvascular pathology: 2 eyes demonstrated diffuse capillary nonperfusion, while the remaining 5 eyes had focal areas of nonperfusion around the FAZ. Mean FAZ area was 0.31 (SD±0.10) mm2 and mean VD of the SCP was 43.9% (SD±10.9%). Retinovascular pathology identified by fundoscopy and OCTA is shown in the figure.
Figure. Retinal imaging of a PWH with bilateral retinal vasculitis. Fundus photos of the right (A) and left (C) eyes show retinal vasculitis highlighted by the red arrows. OCTA of the right (B) and left (D) maculae (3X3 scan Zeiss AngioplexTM) show the FAZ areas outlined in yellow, both of irregular contour. OCTA of the left macula demonstrates areas of significant flow voids marked by the asterisks and the FAZ area is enlarged.

Conclusion
Among patients with longstanding HIV, OCTA identified microvascular abnormalities in all retinae examined. Retinovascular evaluation by OCTA is a feasible, non-invasive technique for assessing microvascular health and findings support additional study in a larger, more diverse group of PWH. Screening tools targeting microvasculopathy among PWH may aid in earlier detection of those at greatest risk of NACM and allow for aggressive risk-modification strategies.

Disclosures
All Authors: No reported disclosures
69. Impact of antimicrobial stewardship interventions on post-elective caesarean antibiotic prophylaxis and surgical site infections
Authors: Seah Xue Fen Valerie 
Published: January 2021

Abstract

Background
Antimicrobial stewardship programs (ASP) aim to improve appropriate antimicrobial use. This study aims to evaluate the impact of ASP interventions on post-elective caesarean (eLSCS) oral antibiotic prophylaxis use. In a subgroup of those without surgical site infection (SSI) risk factors, 30-day SSI rates was compared in those who received post-eLSCS oral antibiotics vs. those without.

Methods
This pre-post quasi-experimental study was conducted over 9 months (2 months pre- and 7 months post-intervention) in all women admitted for eLSCS in our institution. Interventions included eLSCS surgical prophylaxis guideline dissemination, where a single antibiotic dose within 60 minutes before skin incision was recommended. Post-eLSCS oral antibiotics was discouraged in those without SSI risk factors (e.g. obesity). This was followed by ASP intervention notes (phase 1) for 3 months, and an additional phone call to the ward team for the next 4 months (phase 2).

Results
A total of 894 women were reviewed. There were 244 women in the pre-intervention phase, 274 in post-intervention phase 1 and 376 in phase 2. Pre-intervention post-eLSCS antibiotic prescribing rates was 82% (200), compared to 54% (148) in phase 1 and 49% (180) in phase 2 (p&lt; 0.001). There were 560 women without SSI risk factors. Of these, only 4 of 301 (1.3%) who received oral antibiotics, and 3 of 259 (1.2%) without oral antibiotics developed post-op SSI (p=1.000).

Conclusion
ASP can reduce post-eLSCS antibiotic prophylaxis. In those without SSI risk factors, use of post-eLSCS oral antibiotics did not impact SSI rates.

Disclosures
All Authors: No reported disclosures
954. Missed opportunities for HIV Screening in the Emergency Department
Authors: Hirsch Amanda , Carpenter Christopher F 
Published: January 2021

Abstract

Background
There are 1.14 million people infected with human immunodeficiency virus (HIV) in the United States, and only about 86% are diagnosed. HIV diagnosis is the first step to care and expanded testing is essential to reduce transmission. Individuals with undiagnosed HIV have a transmission rate 3.5 times higher than those aware of their infection. Individuals seeking testing and treatment for sexually transmitted infections (STIs) represent a higher risk population for HIV infection. Despite revised Centers for Disease Control and Prevention (CDC) recommendations to expand HIV testing in healthcare settings, testing remains low. A significant obstacle to expanded testing, especially in emergency departments (EDs), is concern about ensuring appropriate HIV test tracking and follow-up.

Methods
We performed a retrospective chart review of patients presenting with symptoms of an STI between January 1, 2015 and July 8, 2019 at eight Beaumont Health EDs in Southeast Michigan. De-identified data was collected from the electronic health record (EHR) for patients aged 10 and older who had testing for one or more STIs including gonorrhea, syphilis, and chlamydia. Patients were evaluated for concurrent HIV testing during the encounter, and patients known to be HIV infected were excluded.

Results
Of 32,640 encounters during which patients not known to be HIV infected were tested for STIs, only 68 (0.21%) included HIV antibody/antigen screening. Of those tested, only one (1.47%) returned reactive. The remaining 67 screenings returned non-reactive. Applying only 10% of this diagnosis rate to the total number of STI encounters suggests an opportunity to diagnose 47 additional individuals; applying 50% of this rate and the corresponding value is 239 individuals.

Conclusion
These results highlight the need for expanded HIV screening in EDs. Systematic HIV test tracking and follow-up removes this burden from ED providers and enables expanded HIV testing in these settings.

Disclosures
All Authors: No reported disclosures