bluuebunny/crossref_metadata_2025_split huggingface dataset:
344. HIV and Diabetes in the Era of Antiretroviral Therapy
Authors: Sabbaj. Spieler Gabriel , Overton Edgar T , Willig Amanda , Burkholder Greer A , Varshney Mohit , Westfall Andrew O 
Published: October 2019

Abstract

Background
With advancements in ART, non-AIDS comorbidities are becoming more common among people living with HIV (PWH). In this analysis, we identified PWH followed at a single Ryan White HIV Clinic in Alabama and determined the overall prevalence of diabetes (DM). We then evaluated the cohort for risk factors associated with DM.

Methods
The records of all PWH who attended at least one routine care HIV primary provider visit from 2009 to 2018 at the UAB 1917 HIV Clinic in Birmingham, AL were abstracted. We defined DM as individuals having ≥1 of the following: (1) diagnosis of DM and receiving any diabetic medication, (2) Hgb A1c ≥ 6.5%, (3) any glucose >200 mg/dL. We evaluated the association of traditional, demographic, and HIV-specific risk factors with PWH with and without DM using Chi-square and Wilcoxon rank-sum testing. Univariate significance and amount of missing data were considered when constructing the multivariable logistic regression model to identify independent associations.

Results
Of the 5247 PWH assessed, 1178 were female (23%), 45 transgender persons (1%); 3235 (62%) black, 1834 (35%) white. At baseline, the median age was 37.5 years, median BMI 24.5 kg/m2, median CD4+ count 333 c/mm3. Overall, 1110 PWH developed DM (21%). By univariate analysis, numerous traditional, demographic and HIV-related risk factors were associated with diagnosis of DM (see Table 1). By multivariable analysis, the following factors were independently associated with DM: traditional (antihypertensive use, aspirin use, glucocorticoid use, statin use, comorbid CKD, comorbid liver disease), demographic (black race, female gender, older age), and HIV-related (nadir CD4) (P < 0.05 for all).

Conclusion
Over 20% of PWH had a diagnosis of DM. Both traditional and HIV-related factors were independently associated with DM. Notably, lower nadir CD4 and longer time to ART initiation were key HIV-related factors. Additionally, a majority of PWH with DM had multimorbidity (85%) and polypharmacy (90%). Despite the lower complexity of modern ART, the care of PWH remains challenging, partly because of cardiometabolic comorbidities, including DM. Effective diabetes prevention and treatment strategies for PWH should be prioritized.

Disclosures
All authors: No reported disclosures.
348. Kidney Function Decline Among HIV-infected Thai Adults: Is Low Vitamin D One of the Factors?
Authors: Hlaing Than Win , Putcharoen Opass , Avihingsanon Anchalee , Kerr Stephen 
Published: October 2019

Abstract

Background
The prevalence of both hypovitaminosis D and Chronic Kidney disease (CKD) are high among Thai HIV-infected adults. Therefore, we examined the association of hypovitaminosis D and kidney function decline among HIV-infected Thai adults.

Methods
Using data prospectively collected from the HIV-NAT long-term cohort, we selected patients who were on ART, and virologically suppressed for ≥6 months. Baseline was defined as when the patient had a serum 25 OHD measured, with estimated Glomerular filtration rate (eGFR) above 60 mL/minute. Participants with eGFR measured at least twice a year were analyzed in the study. The primary outcome was kidney function impairment assessed as eGFR decline. Generalised estimating equations (GEE) were used to assess associations between the outcome and patient comorbidities and disease-related characteristics, including age, sex, body mass index (BMI) hypertension, gout, diabetes mellitus, co-infections with Hepatitis B or C viruses HIV-viral load and co-variate interactions with vitamin D status defined as normal, insufficient or deficient.

Results
A total of 435 participants were observed longitudinally through observations over the median follow-up of 24 (IOR 12–48) months. The median age of the participants was 46.6 (IOR 38.06–54.29) years. Median serum 25 OHD was 23.4 (IQR 18.5–29) ng/mL, and 209 (48%) and 126(29%) had insufficient and deficient 25 OH levels, respectively. Median baseline eGFR was 95 (IQR 82.70–104.93) mL/minute/l.73 m2. We found a significant interaction between BMI and vitamin D concentration (P = 0.02). In our multivariate model, the adjusted mean predictions of eGFR change at 24 months for patients with BMI ≥25 kg/m2 and deficient, insufficient and sufficient vitamin D were 89.8 (88.3–91.4), 91.2 (90.1–92.4) and 92.8 (91.3–94.4), respectively. In those with BMI <25 kg/m2 and deficient, insufficient and sufficient Vitamin D the adjusted mean predictions in eGFR change were 92.0 (91.1–93.0), 91.6 (90.9–92.3) and 92.3 (91.3–93.3), respectively.

Conclusion
HIV-infected Thai adults with high BMI (25 and above) but who are vitamin D deficient had a statistically significant eGFR decline. Further studies in larger populations with multi-ethnic groups are warranted.

Disclosures
All authors: No reported disclosures.
364. Association of Maternal ARV Use with Microcephaly in HIV-Exposed Uninfected Children
Authors: Williams Paige L , Yildirim Cenk , Chadwick Ellen G , Van Dyke Russell B , Smith Renee , Correia Katharine , DiPerna Alexandria , Seage George R , Hazra Rohan , Crowell Claudia S 
Published: October 2019

Abstract

Background
Perinatal HIV transmission has dramatically decreased with combination antiretroviral (ARV) regimens, but complications among HIV-exposed uninfected (HEU) children, such as microcephaly, warrant ongoing surveillance.

Methods
We evaluated HEU children enrolled in the Surveillance Monitoring for ART Toxicities (SMARTT) study, a prospective cohort study conducted by the PHACS network at 22 US sites. Microcephaly was defined using 2000 CDC Growth z-scores for head circumference (HC) measured at 6–36 months of age (z-score <−2) and using Nellhaus standards (<2nd percentile) after age 3 (“SMARTT” criteria), or using Nellhaus standards across all ages. Modified Poisson regression models were fit to obtain relative risks (RRs) for associations between in utero ARV exposure and microcephaly status, adjusted for potential confounders. Sensitivity analyses were conducted. Neurodevelopmental functioning was compared between HEU children with vs. without microcephaly.

Results
Among 3055 SMARTT participants enrolled as of April 2017 with a HC measurement over 5.1 years median follow-up (IQR = 3.0, 7.2), 159 (5.2%, 95% CI: 4.4–6.1%) had microcephaly identified by Nellhaus criteria and 70 (2.3%, 95% CI: 1.8–2.9%) by SMARTT criteria. In adjusted models, in utero exposure to efavirenz (4.7% exposed) was associated with increased risk of microcephaly by both Nellhaus standards (aRR=2.02, 95% CI: 1.16, 3.51) and SMARTT criteria (adjusted RR = 2.56, 95% CI: 1.22, 5.37). These associations were more pronounced among children exposed to combination regimens of efavirenz which included zidovudine+lamivudine than those including tenofovir+emtricitabine (Figure 1). Associations of microcephaly with efavirenz persisted in several sensitivity analyses (Figure 2). Protective associations were observed for darunavir exposure (aRR = 0.50; 95% CI: 0.24, 1.00). HEU children with microcephaly had lower mean scores on neurodevelopmental assessments at ages 1 and 5 years and higher prevalence of impairment than those without microcephaly.

Conclusion
Efavirenz exposure during pregnancy was associated with a higher risk of microcephaly in infancy and childhood. These findings may support identification of alternatives to efavirenz as part of first-line ARV therapy.

Disclosures
All authors: No reported disclosures.
365. Neurocognitive Function Change after Switching from Efavirenz to Rilpivirine in HIV-Infected Adults: A Randomized Control Trial
Authors: Kaewpoowat Quanhathai , Thongton Wirongrong , Robertson Kevin , Chaiwarith Romanee , Robbins Nathaniel , Supparatpinyo Khuanchai 
Published: October 2019

Abstract

Background
HIV-associated neurocognitive disorders (HAND) remain problematic even in the antiretroviral therapy (ART) era. Efavirenz (EFV) is well known for neuropsychiatric side effects and has been associated with worsening neurocognitive performance (NC). We hypothesized that switching from an ART regimen with EFV to one with rilpivirine (RPV) would improve NC.

Methods
This single-center, open-label, superiority, randomized controlled trial was conducted at Maharaj Nakorn Chiang Mai Hospital June 2018 to March 2019. HIV- infected adults (≥18 years), virologically suppressed on an EFV-containing regimen for at least 12 months, who met Frascati’s criteria of asymptomatic neurocognitive impairment (ANI), were randomized to a switching arm (RPV-containing regimen) vs. a control arm (EFV-containing regimen). The primary objective was to compare the improvement of NC at month 6 (M6) after switching. Secondary outcomes were individual NC domains, tolerability, and safety after switching regimens.

Results
20 ANI participants (10 per group) completed the study. 11 participants showed NC improvement at M6: 6 in the switching arm and 5 in the control arm. Global neuro deficit scores (GDS), figure learning, and figure memory at M6 significantly improved in both arms (P < 0.05). Verbal memory and speed of information processing improved over time in the switching arm only (0.6 (0.1–1.0); P = 0.02, and 0.7 (0.1–1.2); P = 0.03, respectively). However, no significant differences between the two groups were observed. Male gender, age < 50 and initiation of ART within 5 years after diagnosis all trended toward an association with improved NC. No tolerability issues or clinical significant adverse events were reported.

Conclusion
Despite some positive trends, switching from an EFV-containing regimen did not significantly improve NC. This finding was consistent with previous reports. A larger study with longer follow-up may be warranted.

Disclosures
All authors: No reported disclosures.
371. Tuberculosis and HIV Co-infection at a Tertiary Care Hospital in Thailand
Authors: Nimitvilai Sireethorn , Jintanapramote Kavita 
Published: October 2019

Abstract

Background
TB is the most common opportunistic infections (OIs) among patients living with HIV and associated with morbidity and mortality. The objective of the study was to describe epidemiology and characteristics of TB in newly diagnosed HIV patients.

Methods
Retrospective study was conducted at Nakhonpathom hospital, a 722-bed tertiary care hospital in Thailand during October 2016 and September 2018. The data on demography and outcome were collected.

Results
There were 369 newly-HIV diagnosed patients. Of these, 182 patients (49.3%) presented with AIDS-defining illnesses. TB was the most common (80 patients), followed by PCP (49 patients), cryptococcal meningitis (13 patients) and invasive salmonellosis (6 patients). Medical records of 29 HIV-TB patients were incomplete and were excluded from the study. Out of 51 HIV-TB patients, the median age was 41 (range 18–63) years and 39 (76.5%) were male. The median CD4 counts was 62.5 (range 7–773) cells/µL. Twenty-six (51.0%) had only pulmonary TB, 13 (25.5%) had only extra-pulmonary TB, and 12 (23.5%) had disseminated TB. Among extra-pulmonary TB, TB lymphadenitis was seen in 13, followed by intraabdominal TB in 8, TB meningitis in 4, and TB pleura in 3 patients. The mortality rate of HIV-TB in our study was 11.8%.

Conclusion
TB is the most common OIs that occurs among patients with advanced HIV disease. The outcome was unfavorable, with death in 11.8%. Strategies to improve early diagnosis and treatment are warranted.

Disclosures
All authors: No reported disclosures.
378. Seroprevalence of Helicobacter pylori among HIV-Infected Patients in a Tertiary Care Hospital in Busan, South Korea
Authors: Eun Lee Jeong , Hee Lee Sun , Lee Shinwon , Kim Kye-Hyung , Ok Lee Soon 
Published: October 2019

Abstract

Background
As human immunodeficiency virus (HIV) management has become more successful during the past years, the importance of non-AIDS-defining cancer such as gastric cancer has increased. Gastric cancer is the second most common cancer, and the third leading cause of cancer-related deaths in South Korea. Chronic inflammation of the gastric mucosa with Helicobacter pylori (H. pylori) is associated with gastric cancer, the highest incidence of which is observed in South Korea. The objective of this study was to evaluate the seroprevalence and risk factors of H. pylori infection in Korean HIV-infected patients.

Methods
In a hospital-based survey, HIV-infected patients attending Outpatient Department of Pusan National University Hospital were enrolled between October 2018 and January 2019. Socio-demographic information was evaluated using questionnaires, serological status of H. pylori infection was tested with commercial H. pylori serology kits (Helicobacter pylori IgG ELISA, IBL, Germany).

Results
A total of 302 patients were included in the study. Two hundred and Sixty-one patients (86.4%) were males and 41 (13.6%) were females. Their median age was 54 years (range, 23–81 years), median CD4+ count was 667 /μL (7–1,699 /μL). The overall seropositivity of H. pylori in HIV-infected patients was 30.1%. Age-specific seroprevalence was as follows: 20–29 years, 12.5%; 30–39 years, 15.6%; 40–49 years, 38.6%; 50–59 years, 36.2%; 60–69 years, 27.9%; and ≥70 years, 18.2%. A lower seroprevalence of H. pylori was observed among patients younger than 40 years; however, it was not significant (P = 0.063). The risk factors associated with H. pylori seropositivity were alcohol consumption [adjusted odds ratio (OR): 1.99, 95% confidence interval (CI): 1.17 to 3.39; P = 0.011] and CD4 cell count ≥350/μL (OR = 4.32; 95% CI 1.51–12.36; P = 0.006).

Conclusion
HIV-infected patients had a lower seroprevalence of H. pylori compared with general population (30.1% vs. 49.1%). Alcohol consumption and CD4 cell count ≥350/μL were significantly associated with H. pylori seropositivity.

Disclosures
All authors: No reported disclosures.
379. Clinical Management of HIV-associated Pneumocystis jirovecii Pneumonia in Rural Nigerian Communities: Public Health Interventions and Impact
Authors: Onokala Ozioma , Nwabueze Emmanuel , Ijezie Echey 
Published: October 2019

Abstract

Background
The prevalence of Pneumocystis jirovecii Pneumonia (PJP) is increasing among vulnerable Persons Living with HIV (PLWH) in rural communities. In such communities, optimum clinical management of PJP in PLWH, is often limited by sub-optimal coordination of healthcare programs and inadequate human resources. The study evaluated the impact of interventions implemented by public health programs, to improve the clinical management of PJP among PLWH in rural Nigerian communities.

Methods
The longitudinal study was done at 30 randomly selected rural communities in Nigeria. Program interventions included: decentralization of comprehensive Anti-Retroviral Therapy (ART) to primary healthcare facilities; and strategic private–public partnerships to ensure provision of free medications for ART and prophylaxis/treatment of PJP, (according to National Treatment Guidelines). Additional interventions included: training of indigenous healthcare workers on clinical management of PJP; task-shifting; routine monitoring and evaluation of PJP indicators to ensure program quality, among others. Real-time data from Patients’ Care Cards were utilized for pre- and post-intervention assessments in January 2014 and January 2019, respectively. Chi-square was applied as inferential statistics; P < 0.05 indicated statistical significance.

Results
The number of PLWH on ART, who received primary PJP prophylaxis with Trimethoprim-Sulfamethoxazole (TMP-SMX), increased from 2,280 (pre-intervention) to 14,461 (post-intervention). PLWH (55 females; 40 males), exhibited TMP-SMX intolerance and were offered Dapsone for primary PJP prophylaxis. PJP diagnosis and treatment for female PLWH increased from 5% (pre-intervention), to 82% (post-intervention). PJP diagnosis and treatment for male PLWH increased from 3% (pre-intervention), to 79% (post-intervention). Incidences of PJP increased with age, viral load, ART interruption, and late presentation to HIV care. Secondary PJP prophylaxis for PLWH (after the completion of pneumonia treatment) increased from 2% (pre-intervention) to 90% (post-intervention).

Conclusion
The interventions significantly improved the clinical management of PJP in PLWH. They are recommended for implementation by health programs in rural communities.

Disclosures
All authors: No reported disclosures.
380. Characterizing Host Factors, Treatment Strategy, and Clinical Outcomes of Group A Streptococcus Orthopedic Infections
Authors: Nadeem Naiha , Saraiya Nidhi , Nori Priya , Szymczak Wendy , Boland-Reardon Carmel 
Published: October 2019

Abstract

Background
The annual incidence of invasive β-hemolytic group A streptococcus (GAS) infections in the United States is approximately 3.8 cases per 100,000 patients with 10–30% mortality. But data in GAS orthopedic infections is limited. We sought to characterize patient factors, medical and surgical management, and clinical outcomes from GAS orthopedic infections at our medical center.

Methods
A total of 12 patients with GAS orthopedic infections (necrotizing fasciitis, osteomyelitis, prosthetic joint infection, septic arthritis, or tenosynovitis) from July 2017 and March 2019 were included. Medical records were reviewed for site of positive GAS culture (blood, wound, joint fluid, or tissue cultures), demographics, comorbidities, surgical management, and antibiotic regimen and duration. The primary outcome was cure at 90 days defined as clinical improvement without recurrent or new infection, or further surgical or medical management at 90 days after treatment completion. The secondary outcome was erythrocyte sedimentation rates (ESR) before and after treatment.

Results
The median age of the 12 patients was 56 years (range 3–75); 58% were female and 58% had a body mass index ≥30 kg/m2. The median Charlson comorbidity index score was 3 (range 0–7) with 58% having diabetes mellitus. Two patients had either rheumatoid arthritis or monoclonal gammopathy (Table 1). Most patients had severe infections; 33% with necrotizing fasciitis and 25% with orthopedic implants. All patients had an elevated initial ESR, including 75% with ESR >40 mm/h. 92% required surgery, including 42% amputations and 17% prosthesis removals. Patients were mostly treated with β-lactams and vancomycin (92%); only 50% received clindamycin or linezolid. Most patients (75%) required at least 2 weeks of antibiotics. Five patients (42%) were not cured at 90 days, and 1 died of infectious complications (Table 2).

Conclusion
Severe GAS orthopedic infections necessitate both surgical management and prolonged antibiotics. 42% of our patients were not cured at 90 days and most eventually required amputation. Toxin mediators, clindamycin and linezolid, were underutilized. Chronic suppressive antibiotics should be considered for patients with orthopedic implants, especially those with durable immune suppression.

Disclosures
All authors: No reported disclosures.
388. Spinal Implant Infections Treated with Debridement and Hardware Retention
Authors: Rivero Cynthia , Martinez Santiago , Pardo Orlando , Jahan Cintia , Fuego Segundo , Ignacio Dapas juan , Vila Andrea 
Published: October 2019

Abstract

Background
Surgical site infections following spinal surgery affect 0. 3 to 20% of patients. The longer the infection, the greater the chance of antibiotic treatment failure due to the establishment of mature microbial biofilm on the hardware, requiring its removal for infection eradication.

Methods
Retrospective cohort of patients with microbiologically confirmed SII following spinal surgery treated with debridement and retention. SII was defined as the presence of clinical signs of deep surgical site infection with 2 or more positive culture results of tissue surrounding the implant taken during surgical debridement; or from CT guided biopsy. Inclusion criteria: adults with a 1º episode of microbiological confirmed SII diagnosed from 2008 to 2017 with >2 years of follow-up, treated with implant retention. Definitions Early-onset infection (EOI): infection < 1 month following implant placement. Late onset infection (LOI): between 30 days and 1 year after implant placement. Delayed onset infection (DOI): >1 year of implant placement. Statistical analysis made in Graph Pad Prism 5. 0.

Results
We analyzed 19 patients with SII treated with hardware retention. Mean age was 54 (21–70) years, 63% were female. Comorbidities, clinical manifestations and motive for surgery are in Table 1 and Figure 1. Hardware material used was titanium 15(79%) and steel 4(21%). In addition to the hardware,11 patients (57. 9%) underwent bone grafting, 4 experienced treatment failure (4/11 = 36. 4%); 2 patients had nonmetallic material inserted (carbon polymer), the 2 patients experienced failure. 16 patients (84. 2%) had EOI, 2 (10. 5%) LOI, 1 (5. 3%) DOI. Failure requiring implant removal was observed in 26. 3% (n = 5), 2 of the cases were EOI, 2 LOI and 1 DOI. Bacterial characteristics of patients are shown in Table 2. 47,4% of patients required more than one debridement (Figure 2). In the lineal regression model, treatment failure was associated with bone grafting (P = 0. 04) and the use of carbon polymer materials (P = 0. 007).

Conclusion
Treatment of SII with debridement plus antimicrobials treatment is acceptable, with a rate failure of 26%. In LOI and DOI spinal implant retention is more prone to fail. Bone grafting and the presence of polymers seem to be associated with treatment failure of conservative strategies.

Disclosures
All authors: No reported disclosures.
408. Single-cell Sequencing Identifies Variability in Host Response Among Different Genera of Influenza Viruses
Authors: Thielen Beth Kristine , Christensen Jaime , K. Strain Anna , Shen Steven , Langlois Ryan 
Published: October 2019

Abstract

Background
Seroprevalence and surveillance studies indicate that influenza C virus (ICV) infection is common among humans, and initial exposure occurs early in life. ICV often causes milder disease than influenza A and B viruses, but the mechanisms underlying differences in pathogenicity remain poorly understood.

Methods
To compare early events of infection in natural target sites, we cultured primary human tracheal/bronchial epithelial cells under air-liquid interface conditions to allow differentiation. We-infected these cells with human strains of influenza A, B or C virus. Cells were infected at low MOI (0.1) to ensure populations of directly infected cells and uninfected neighboring cells. To compare the early immune response and cell tropism among these viruses, we performed single-cell RNA sequencing of mock- and influenza-infected cells. In parallel, we infected cells pretreated with interferon to mimic later rounds of infection after an early immune response is initiated.

Results
Infection of primary cells by all three viruses was confirmed by RT-qPCR of bulk cell lysates. As expected, prior exposure to interferon β results resulted in reduced levels of viral transcripts. At the single-cell level, we identified expression of genes associated with specific cell types, including basal, ciliated and secretory cells. We also identified expression of interferon stimulated genes, but these genes were not homogeneously expressed among all cell subpopulations and varied among cultures infected with different influenza viruses. We also found different patterns in gene expression in cells previously exposed to interferon, suggesting that host environment varies over subsequent rounds of infection.

Conclusion
Single-cell sequencing is an important tool for studying the host response to influenza infection in complex cellular environments such as the respiratory tract, in which cells vary in their susceptibility to infection and antiviral response. Further analysis will characterize differences among directly infected vs. neighboring cells and correlate responses with pathogenicity.

Disclosures
All authors: No reported disclosures.