bluuebunny/crossref_metadata_2025_split huggingface dataset:
925. Adverse Events Due to Inappropriate Prescribing in Older Adults Living with HIV
Authors: Cinquegrani Mark , Cabanilla M Gabriela , Ryan Keenan L , Marzolini Catia , Jakeman Bernadette 
Published: January 2021

Abstract

Background
People living with HIV (PLWH) are aging and experience age-related comorbidities as well as physiological changes leading to a higher risk for polypharmacy, drug-drug interactions, inappropriate prescribing and related adverse events (AE). Prior studies have highlighted a growing concern for inappropriate prescribing in older PLWH. The objective of this study was to examine the prevalence of AEs resulting from inappropriate prescribing in PLWH &gt; 65 years of age.

Methods
This was a retrospective chart review. PLWH followed-up at the outpatient HIV clinic at the University Hospital in New Mexico between 01/01/2015 and 08/21/ 2018 were eligible if they were &gt; 65 years of age and had &gt;1 potentially inappropriate prescriptions (PIP). PIP were identified using the Beers and STOPP/START criteria for inappropriate mediations in elderly, as well as drugs incorrectly dosed, and potentially deleterious drug-drug interactions (DDI). The University of Liverpool’s HIV interaction checker and Lexicomp’s interaction checker were used to screen for DDI between HIV and non-HIV drugs, and between non-HIV drugs. AEs related to PIPs were collected and their severity was classified using the WHO scale for grading of AEs.

Results
A total of 104 PLWH &gt;65 years of age fulfilled the eligibility criteria. Most patients were male (88.5%) with an average age of 69 years. The majority of patients were virologically suppressed (89%), with an average CD4 cell count of 650 cells/µL. Polypharmacy (&gt;5 non-HIV medications) was identified in all 104 patients; average number of non-HIV medications was 9.4 + 4.8. 30 (28.8%) patients experienced &gt;1 AE, with a total of 53 AEs identified. Of those, 20 (67%) presented with a serious AE. 14 patients (47%) had to seek treatment at an emergency department and 2 patients (7%) had to be hospitalized. The most common AEs included falls (27/53 events; 51%), bleeds (7/53 events; 13%), fractures (4/53 events; 8%). Risk for an AE was significantly associated with increasing number of medications (OR 1.16; 95% CI 1.05-1.29).

Conclusion
PIP and related AEs are common in older PLWH. Interventions to prevent harm including medication reconciliation, medication review, and medication prioritization according to the risks/benefits of individual patients are warranted.

Disclosures
Keenan L. Ryan, PharmD, PhC, Theravance (Advisor or Review Panel member)
928. Barriers to Hepatitis C Elimination in an Urban Clinic Offering Integrated HIV/HCV Treatment
Authors: Correia Lauren A , Tseng Christopher C , Portilla Mario , Swaminathan Shobha 
Published: January 2021

Abstract

Background
Treatment of Hepatitis C virus (HCV) infection for persons with Human Immunodeficiency Virus (HIV) is dependent on consistent outpatient follow-up. We sought to identify factors that are associated with lower HCV treatment rates in HIV/HCV co-infected patients followed at Rutgers Infectious Diseases Practice (IDP), an integrated urban clinic.

Methods
Retrospective chart reviews were conducted for HIV/HCV co-infected patients treated at IDP in Newark, New Jersey between January 2017 and July 2018. We assessed factors associated with lack of HCV treatment in this practice. Data collected included demographics, HIV disease markers, liver function tests, HCV treatment history and response. Factors with p&lt; 0.05, age and race were included in the multivariate analysis.

Results
We included 317 HIV/HCV co-infected patients with at least one visit between January 2017 and July 2018. Fifty eight percent were male, 79% black, 10% hispanic, 6% white, and 5% other; 21% reported heterosexual and 79% drug use (injection and non-injection) as their HIV risk factor The median CD4 was 522 cells/cm3, and 74% of patients had HIV viral load (VL) &lt; 40 copies/ml. HCV treatment was started at IDP in 142 (45%) and of those 87% were cured. Data are awaited on 6%. Univariate analyses showed those not treated for HCV were more likely to be born female (57% vs 42%), have a CD4 count &lt; 200 cells/cm3 (9% vs 27%), HIV VL &gt;40 copies/ml (43% vs 17%), currently (58% vs 30%) or previously (89% vs 74%) used drugs, and have a higher APRI score (0.43 vs 1.6). Multivariate logistic regression showed that patients with untreated HCV were more likely to be female (OR 2.93, p&lt; 0.001), report current drug/alcohol use (OR 2.43, p=0.004), and have HIV VL ≥40 copies/ml (OR 2.11, p&lt; 0.001).
Table 1: Demographics/Risk Factors of Study Group

Table 2: Laboratory Studies

Table 3: Logistic Regression of Significant HCV Treatment Factors

Conclusion
Our results show that despite the availability of integrated treatment programs, concerted efforts need to be made for patients at high risk for not receiving HCV treatment, and who therefore remain at high risk for complications from HCV. Provider perceptions may play a role in withholding treatment for those with high HIV VL and current drug or alcohol use; whereas the rationale for why women were less likely to be treated is less clear and may be related to trauma and other factors not captured by this project that may negatively impact their access to care.

Disclosures
All Authors: No reported disclosures
929. Characteristics Associated with Pain in Older People Living with HIV
Authors: Karris Maile , Mazonson Peter , Loo Theoren , Berko Jeff , Spinelli Frank , Zolopa Andrew 
Published: January 2021

Abstract

Background
Pain impacts up to 55% of people living with HIV (PLWH) and negatively impacts function. To date, limited data exist regarding factors that contribute to pain in older PLWH.

Methods
Data were utilized from the Aging with Dignity, Health, Optimism and Community (ADHOC) cohort, an observational study of older PLWH from ten clinics across the U.S. that collects patient-reported outcomes (PROs) on socioeconomic, psychosocial, and health factors. To measure pain, ADHOC participants were asked whether they had been diagnosed with back pain, hip pain, joint pain, or muscle pain, and were also instructed to report chronic pain conditions that were not listed. Bivariate analyses were performed to determine the associations between pain and PROs.

Results
Of 1,051 participants, 66% reported at least one type of pain. Factors associated with pain included multimorbidity, low income, anxiety, loneliness, depression, tobacco use, and older age (Table 1). Factors negatively associated with pain included employment, higher cognitive function, higher quality of life, greater resilience, higher social well-being, and alcohol use.
Table 1. Characteristics associated with pain among older people living with HIV. Pairwise correlations are reported above using correlation coefficient r.

Conclusion
Improving pain management is currently a priority in the US healthcare system. Some factors identified in this study, including systemic issues such as socioeconomic status and employment, are not easily modifiable. Other factors, such as anxiety, depression, and smoking, are modifiable and therefore represent targets for interventions focused on improving pain and its sequelae in older PLWH.

Disclosures
Maile Karris, MD, Gilead Sciences (Grant/Research Support)Viiv Healthcare (Grant/Research Support) 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) Frank Spinelli, MD, ViiV Healthcare (Employee) Andrew Zolopa, MD, ViiV Healthcare (Employee)
932. Creating a Statewide HCV Treatment Cascade for HIV/HCV Co-Infected Persons Using a Partnership with DPH
Authors: Wegener Maximilian D , Brooks Ralph P , Speers Suzanne , Villanueva Merceditas 
Published: January 2021

Abstract

Background
Treatment cascade models focused on persons with HCV mono-infection have been created based on estimates from multiple data sources. Approximately 25% of persons with HIV are coinfected with HCV; no comparable treatment cascade has been reliably generated due to inadequate HCV surveillance data. Using expanded surveillance capacity and validated HIV matching algorithms, we created an HCV treatment cascade for HIV/HCV coinfected persons in Connecticut.

Methods
Surveillance databases used: CTEDSS (CT Electronic Disease Surveillance System used for HCV) and eHARS (electronic HIV/AIDS Reporting System). eHARS data timeline includes all surveillance entries with labs from 1/1/2015-10/1/2019. Two CTEDSS timelines analyzed: One, all surveillance entries (1/1/1994-1/1/2020); Two, all surveillance entries with labs from 1/1/2016-1/1/2020. Matching CTEDSS and eHARS, coinfected lists were generated and patient HCV labs (AB & PCR) were assessed to determine HCV care status on the treatment cascade.
Inclusions and Exclusions for All HCV surveillance entries (1/1/1994 to 1/1/2020)

Inclusions and Exclusions for All HCV Surveillance Entries with Labs from 1/1/2016 to 1/1/2020

Results
All surveillance entries (1/1/1994 to 1/1/2020): The coinfected list had 3,689 entries; 1,938 had positive HCV screenings (AB+ and/or PCR+) and were eligible for further analysis based on lab dispositions: 567 HCV AB+ only; 721 HCV AB+ and PCR+; 149 PCR+ only; 453 AB+ then PCR+ then PCR-; 48 PCR+ then PCR-. Of 1,371 with evidence for chronic HCV, 501 had presumed sustained virologic response (SVR) (36.5%). All surveillance entries with HCV labs from 1/1/2016 to 1/1/2020: The coinfected list had 912 entries; 665 met inclusion criteria for positive HCV screenings with lab dispositions: 17 HCV AB+ only; 197 HCV AB+ and PCR+; 6 PCR+ only; 407 AB+ then PCR+ then PCR-; 38 PCR+ then PCR-. Of the 648 chronically infected, 445 had presumed SVR (68.6%).
Treatment cascade for all surveillance entries (1/1/1994 to 1/1/2020)

Treatment cascade for all surveillance entries with labs from 1/1/2016 to 1/1/2020

Conclusion
It is feasible to create statewide treatment cascades for HIV/HCV coinfected individuals. SVR rates improved from 36.5% to 68.6% with the use a of more recent HCV surveillance timeline. Contributing factors include: 2016 HCV case definition change (increased HCV PCR testing); electronic lab interface with CTEDSS being able to record negative PCRs in 2018; enhanced DAA availability and implementation. Future studies should adopt this approach which more accurately represents the HCV care status of the current co-infected population.

Disclosures
All Authors: No reported disclosures
933. Cured vs. Not Yet Treated: Population Differences for HIV/HCV Co-infected Patients Navigating the HCV Care Cascade in 11 Connecticut Clinics
Authors: Brooks Ralph P , Wegener Maximilian D , Speers Suzanne , Sideleau Robert J , Nichols Lisa G , Villanueva Merceditas 
Published: January 2021

Abstract

Background
Hepatitis C (HCV) care cascades for persons with HIV/HCV co-infection are hampered by incomplete HCV surveillance data, lack of standardized matching algorithms, and incomplete ability to determine HCV treatment status from surveillance alone. However, client-level data from individual clinics can be combined into multi-site cascades to assess progress toward micro-elimination goals. To achieve these goals, characterization of treatment gaps is crucial. Looking at trends in 11 HIV clinics, we examine correlates of not entering/initiating HCV therapy.

Methods
We established a partnership with CT Dept. of Public Health and 11 HIV clinics through a HRSA SPNS grant (047). Lists of HIV/HCV co-infected individuals obtaining care from these clinics from 1/2009-9/2018 were created using data from HIV (eHARS) and HCV (CTEDSS) surveillance, individual clinic rosters and a validated matching algorithm. Clinic personnel reviewed these lists to determine who were treatment eligible (TE) and their current HCV treatment status (e.g. treatment initiated, SVR documented, untreated but in clinical care). Clinic lists were updated regularly to reflect changes in overall patient status (e.g. deceased, relocated, transferred care). We performed bivariate analysis to identify correlates of treatment initiation including odds ratios with 95% confidence intervals.

Results
Of 7265 patients receiving HIV-related services, 2117 matched to HCV surveillance, representing 1496 unique patients. As of 6/1/2020, 821 patients were TE, 727 (89% of TE) were in active care, 630 (77%) initiated treatment, 620 (76%) completed treatment, 584 (71%) achieved SVR. Of the TE group, 77 (9%) had not yet initiated treatment. Compared to initiators of HCV therapy, patients not yet initiating treatment are more likely to be women (OR 1.7 95% CI 1.1-2.8), and black (OR 1.9 95% CI 1.1-3.1), with unsupressed HIV viral loads (OR 2.5, 95% CI 1.5-4.0).

Conclusion
This work capitalizes on the feasibility of creating a care cascade for HIV/HCV by Data to Care methods. Patients in partner clinics who had not yet initiated treatment were more likely to be women, black, and have poorly controlled HIV. Further efforts are needed to determine the barriers to treatment initiation among these groups.

Disclosures
All Authors: No reported disclosures
67. Impact of a Pharmacist-Driven Collaborative Initiative on Staphylococcus aureus Bacteremia Management
Authors: Kufel Wesley D , Mastro Keri A , Wang Dongliang , Steele Jeffrey , Riddell Scott W , Paolino Kristopher M , Thomas Stephen J 
Published: January 2021

Abstract

Background
Infectious diseases (ID) consultation has been associated with improved outcomes for Staphylococcus aureus bacteremia (SAB) largely by providing guidance to follow widely accepted standards. However, ID consultation may be delayed due to numerous factors. ID pharmacists may be able to facilitate timely and optimal management of SAB in collaboration with ID providers and microbiology. The primary outcome of this study was to evaluate the impact of a pharmacist-driven collaborative initiative for SAB.

Methods
This was a single-center, quasi-experimental study of patients with SAB before (8/1/16–7/31/17) and after (8/1/18-7/31/19) implementation of pharmacist-driven collaborative initiative for SAB management. After direct notification of SAB and penicillin-binding protein assay results from microbiology personnel, the ID pharmacist promptly contacted the primary team to facilitate ID consultation and identified opportunities to optimize treatment or diagnosis prior to consult. Recommendations were also collaboratively discussed with the ID consult service. Included patients were ≥18 years old with SAB. Excluded patients were &lt; 18 years old, under palliative care or expired prior to S. aureus speciation, refused care against medical advice, pregnant, incarcerated, or had polymicrobial bacteremia.

Results
Ninety and 111 patients were included in the pre- and post-intervention cohort, respectively. Demographic data were similar between cohorts. Most SAB cases were community-acquired (72% vs 81%, p=0.137), complicated (83% vs 71%, p=0.059), and methicillin-susceptible (57% vs 65%, p=0.236). The most common sources were catheter (23%) and skin and soft tissue (30%) in pre- and post-intervention cohorts, respectively. Table 1 displays compliance with evidence-based SAB measures and clinical outcomes. Compliance with the SAB bundle was significantly higher in the post-intervention cohort (91% vs 50%, p&lt; 0.001).
Table 1. Compliance with Evidence-Based Staphylococcus aureus Bacteremia Management Bundle Elements and Clinical Outcomes

Conclusion
Increased compliance with evidence-based SAB recommendations decreased SAB duration, time to targeted antibiotics, and infection-related hospital length of stay after implementation of a pharmacist-driven collaborative initiative for SAB.

Disclosures
Wesley D. Kufel, PharmD, Melinta (Research Grant or Support)Merck (Research Grant or Support)Theratechnologies, Inc. (Advisor or Review Panel member) Jeffrey Steele, PharMD, Paratek Pharmaceuticals (Advisor or Review Panel member)
935. Effect of Tesamorelin in People with HIV with and without Dorsocervical Fat: Post Hoc Analysis of Phase III Double Blind Placebo Control Trial
Authors: Rahman Farah , de Chantal Marilyn , Mesquita Pedro , Aberg Judith A 
Published: January 2021

Abstract

Background
Lipohypertrophy is defined as excess fat deposition in abdominal defined as visceral adipose tissue (VAT) as well as in the dorsocervical region, breasts, trunk, and along with possible fat deposition in liver, muscle, myocardium and epicardium. Multiple factors have been described as contributing to lipohypertrophy in people living with HIV (PLWH), including patient characteristics, antiretroviral therapy (ART) and also impaired growth hormone (GH) secretion. Tesamorelin, a synthetic form of growth-hormone-releasing hormone (GHRH), is indicated for reduction of excess abdominal fat in PLWH with lipodystrophy

Methods
Post-hoc analysis was done on phase 3 randomized, double-blind, multicenter trials. Patients were eligible if between 18 and 65 years of age, had confirmed HIV infection, had evidence of excess abdominal fat accumulation and on stable ART regimen for 8 weeks or more. Participants were randomized to receive tesamorelin 2 mg daily or placebo daily for 26 weeks. Only tesamorelin responders, defined as patients with at least 8% decrease in VAT and who were adherent to the medication, were used for this analysis. Results are reported for patients with and without dorsocervical (DC) fat deposition.

Results
Demographic characteristics of responders at week 26 are shown according to presence or absence of DC fat (Table 1). At week 26, on average, the patients with DC fat deposition had higher BMI and waist circumference (WC) than the group without DC fat. Most patients in both groups had lipoatrophy. Metabolic and anthropometric parameters were measured at week 26 in patients with and without DC fat (Table 2). There was a decrease in VAT and also an improvement in their WC at week 26 in both groups.
Table 1: Baseline Characteristics of Tesamorelin Responder Subjects at Week 26, by Dorsocervical Status

Table 2: Change in Abdominal Adiposity, Insulin-Like Growth Factor-1 Levels, and Metabolic Parameters Between Baseline and Week 26 Among Tesamorelin Responders

Conclusion
This data demonstrates that tesamorelin is effective at reducing VAT in both patients with and without DC fat. The medication was well tolerated without significant changes to metabolic based measurements. Treatment of excessive VAT with tesamorelin has seemingly positive results in fat reduction in patients with or without DC fat deposition and our study contributes to the growing literature.

Disclosures
Marilyn de Chantal, PhD, Theratechnologies Inc (Employee) Pedro Mesquita, PhD, Theratechnologies, Inc. (Employee) Judith A. Aberg, MD, Theratechnology (Consultant)
936. Evaluating the Impact of Polypharmacy on Virologic Success in People with HIV
Authors: Jimenez Humberto R , Boachie Naana , Park Sangwon , Suh Jin 
Published: January 2021

Abstract

Background
As people with HIV (PWH) have experienced reductions in antiretroviral pill burden, there has been an increase in medications to manage non-AIDS-related co-morbidities. Previous studies have linked virologic failure to an increased pill burden. This study assessed whether polypharmacy and other variables affect success of HIV management in our population.

Methods
A retrospective, cross-sectional analysis of PWH receiving care at a Ryan White-funded clinic in New Jersey was performed. Eligible patients were ≥18 years old, had ≥2 visits in 2019 and were receiving antiretroviral therapy (ART). The primary endpoints were to determine the effect polypharmacy (defined as 5 or more non-ART pills per day) on virologic response rates (HIV RNA &lt; 200 copies/mL). Secondary endpoints accounted for the impact of age, gender, race/ethnicity, HIV transmission risk factor, and AIDS diagnosis on virologic response. A descriptive analysis of comorbidities and medication classes was also completed. Logistic regression, chi square and student’s t test were used for statistical analysis.

Results
964 patients were included in the analysis, with 355 (37%) meeting the criteria for polypharmacy. Most patients were male (60%) and the mean age was 49 years of age. The racial/ethnic breakdown was 46% Hispanic, 45% Black and 8% White. Polypharmacy was associated with higher rates of virologic success compared to those with a lower pill burden: 94% vs 86% had an HIV RNA &lt; 200 copies/mL (P=0.0003), respectively. ART pill burden was statistically, but not clinically higher among those with polypharmacy (1.34 vs 1.45, P=0.025). Virologic response was found to be higher among Hispanics and Whites in comparison to Black patients (OR 2.2, CI 1.4-3.5 and 3.0, CI 1.1-8.2). Patients with an AIDS diagnosis were less likely to achieve virologic response (OR 0.64, CI 0.42-0.99).

Conclusion
Patients with polypharmacy were more likely to achieve virologic success than paitents with a low pill burden in our population.

Disclosures
Humberto R. Jimenez, PharmD, BCPS, AAHIVP, Gilead (Speaker’s Bureau)
939. Immunity to Hepatitis A and/or Hepatitis B Viruses Among Inmates Living with HIV
Authors: Poondi Nivedha , Hou Jysheng , Michienzi Sarah M , Patel Mahesh C , Badowski Melissa E 
Published: January 2021

Abstract

Background
Hepatitis A (HAV) and B viruses (HBV) are vaccine-preventable diseases where screening upon entry into prison provides an ideal public health opportunity to assess vaccination status and administer vaccination while incarcerated.

Methods
A retrospective, electronic medical record review evaluated incarcerated adults receiving human immunodeficiency virus (HIV) telemedicine care in 26 prisons in Illinois, USA, from 01/01/19 through 12/31/19. Included subjects were living with HIV, incarcerated in the Illinois Department of Corrections (IDOC), and had available data for HAV/HBV serologies, viral load, and CD4 count during incarceration. The primary objective was to assess rates of HAV and/or HBV immunity in individuals with HIV. The secondary objective was to assess factors associated with vaccination status. Statistical analysis included Chi-squared testing and descriptive statistics.

Results
Among the 524 patients analyzed, the majority were Black men (75%) with an average age of 44 years. 429 patients had existing data for HAV vaccination where 79% had documented immunity. 397 patients had existing data for HBV vaccination where 5% had HBV infection, 1.4% had an equivocal HBV surface antibody and negative HBV surface antigen, and 70% had documented immunity. In total, 387 patients had existing data for HAV and HBV vaccination status where 213 (55%) were immune to both HAV and HBV while (7%) had no immunity to both HAV and HBV. Immunity did not vary based on CD4 count, age, gender, or race (p &gt; 0.05).

Conclusion
Assessing serologies and providing Hepatitis A and B vaccinations while incarcerated, where indicated, can increase immunity to these vaccine-preventable viruses and thereby reduce transmission of HAV and HBV. This is of particular importance for patients living with HIV as this is an indication for vaccination. Based on these findings, the telemedicine study team has been able to assess serologies and advocate for vaccination for inmates living with HIV entering the IDOC. Over time, we expect our interventions to result in further improvements in rates of immunity.

Disclosures
All Authors: No reported disclosures