bluuebunny/crossref_metadata_2025_split huggingface dataset:
349. Implementation of a Multidisciplinary HIV-Pulmonary Clinic
Authors: Sellers Subhashini A , Durr Amy , Sanghani Aarti , Pierce Jonah , Little Hannah D , Farel Claire E 
Published: October 2019

Abstract

Background
Among people with HIV (PWH), pulmonary comorbiditiees are a leading cause of morbidity and mortality. As PWH live a near-normal lifespan with ART, the focus has shifted from opportunistic infections to chronic disease. This includes chronic obstructive pulmonary disease (COPD) and lung cancer, for which PWH with and without concomitant tobacco use are at high risk. We sought to improve access to and quality of pulmonary care for PWH by instituting a pulmonary clinic co-located within a Ryan White-funded HIV clinic in the Southeastern United States.

Methods
A pulmonologist with expertise in lung disease in PWH began seeing patients one half-day twice monthly beginning in 2017. Longitudinal demographic, clinical, and appointment information was collected on each patient.

Results
Fifty patients were referred to the HIV-Pulmonary clinic. Of the 32 patients seen for an initial visit, the mean age was 55, 63% were male, and all were on ART. The majority were current (52%) or prior smokers (31%) with a mean pack-year history of 42. Over 40% of the patients had a COPD diagnosis and 25% had no prior pulmonary diagnosis. The majority of patients had not engaged in pulmonary care within the past year, as 63% had never seen a pulmonologist and another 28% did not follow-up with a prior provider. After the first visit, 69% either followed up or had a pending follow-up. Of the 17 current smokers, all were offered assistance with smoking cessation and 59% engaged. Of the 10 patients who were eligible for lung cancer screening (LCS) by current guidelines, all engaged in shared decision making and 40% pursued annual screening CT scans.

Conclusion
Chronic pulmonary diseases are increasing relevant comorbidity in PWH on ART. Our HIV-pulmonary clinic demonstrates the utility and feasibility of integration of sub-specialty consultative care in comprehensive care of PWH. By introducing a general pulmonary clinic within the existing infrastructure of the HIV clinic at our institution, we were able to engage PWH with and at risk for lung disease in longitudinal care to prevent, detect, and treat pulmonary disease. Future goals of this interdisciplinary design include increased compliance with current COPD treatment guidelines and LCS, improved rates of smoking cessation, and continued collaboration between the ID and pulmonary providers.

Disclosures
All authors: No reported disclosures.
355. Barriers for Hepatitis C Elimination in HIV/HCV Coinfected Patients
Authors: Espinoza Joe , Vigil Karen J , Barnett Ben 
Published: October 2019

Abstract

Background
Approximately 30% of people living with HIV are co-infected with Hepatitis C virus (HCV). HIV/HCV coinfected patients have faster progression to liver fibrosis, cirrhosis, and increased mortality, compared with monoinfected patients. Therefore, treatment in this population is a priority. The objective of this study was to develop an active program to reach HIV/HCV co-infected patients, with the goal to eliminate Hepatitis C in our local HIV clinic.

Methods
Beginning in December 2016, our clinic received State funds to support open access to treat HIV/HCV patients with direct-acting antivirals (DAA). From December 2016 to May 2018, the process was based on primarily on physician referrals to treat HIV/HCV patients at our clinic, without an active intervention, and 50 patients were treated. Our active intervention during the second part was based on the identification of all untreated HIV/HCV patients and contacting them directly, to link them to care.

Results
A total of 462 HIV/HCV co-infected patients were identified who qualified for the state-sponsored treatment program. From June 1, 2018 to July 31, 2018, only 7 patients were linked to care and started on DAA. The four main identified reasons for not getting DAA therapy were: no show up to the clinic appointments, poor adherence to their HIV antiretroviral treatment, use of drugs and not able to be reached (figure). Although drug use was listed as one of the main reasons for not receiving DAA therapy, it was not the defining reason for most patients. A majority of the patients had more than one obstacle preventing them from coming in to be treated.

Conclusion
Wide availability of DAA and open access to treatment is not enough to eliminate HIV/HCV co-infection. Innovative outreach processes with the active participation of key stakeholders are needed in order to eliminate this viral infection.

Disclosures
All authors: No reported disclosures.
357. Hepatitis C (HCV) Testing and Diagnosis and Their Relationship to Sexually Transmitted Infection (STI) Screening and New Infections in an HIV+ Men Who Have Sex with Men (MSM) Outpatient Cohort
Authors: Cooper Joseph D , Beil Robert S , Zingman Barry S 
Published: October 2019

Abstract

Background
Assess HCV prevalence, screening, new infections and reinfections and their relationship to other STI screening and diagnosis in HIV+ MSM at an urban center.

Methods
Retrospective review of HCV and STI testing and diagnosis among HIV+ MSM with ≥1 visit January 1, 2016–October 31, 2018 at Montefiore’s Center for Positive Living and Medical Group outpatient sites. Demographics from local databases, clinical data from EPIC and chart review on select cases.

Results
876 HIV+ MSM, median age 42, 80% virally suppressed. 850 (98.2%) had known HCV status. 36/850 (4.2%) HCV Antibody (Ab)+ at any point: 23 (2.7%) at baseline (6 dual MSM/IDU), 13 (1.5%) newly Ab+ (0 dual risk). 4/36 (11.1%) HCV RNA+: 1 of baseline Ab+, 3 in newly Ab+’s. Among new Ab+’s, 7 asymptomatic, 6 symptomatic, most commonly high liver tests. 3/13 (15.4%) were persistently viremic requiring therapy. 614/827 (74.2%) HCV Ab-’s were retested ≥1, 260 (31.4%) >1x – average retesting interval 13 months. Among 36 HCV Ab+’s, 0 had reinfection. Testing and new STIs by HCV status is in Table 1. 2/13 (15.4%) with new HCV were not tested for gonorrhea or chlamydia (G/C) at any site. Acute syphilis was more common in new HCV+’s than HCV-’s (P =.002). HCV rescreening was higher in those tested for extragenital (EG) G/C vs. those not tested (Table 2), but up to 18.8% were not HCV retested despite EG testing done. 304/876 (34.7%) were ≤35 years of age. Testing and positive results for all four STIs were greater in those ≤35 (Table 3). Non-Hispanic (NH)-Black was the largest race/ethnicity and had the highest rate of new STI’s except pharyngeal chlamydia, rectal gonorrhea and acute syphilis (Table 4).

Conclusion
We found significant risk of HCV among HIV+ MSM in our cohort, with a prevalence of 2.7% and a 34-month incidence of 1.5%, with no reinfections. HIV+/HCV Ab- MSM were frequently retested for HCV but missed opportunities among sexually active individuals lead to delayed diagnoses of acute infection. Unexplained elevation of liver tests in sexually active HIV+ MSM should prompt immediate HCV testing, and more HCV Ab testing is indicated as part of STI screening in this group. Awareness should be raised about risk of acute HCV with new syphilis, and there is room to improve EG G/C testing.

Disclosures
All authors: No reported disclosures.
358. HIV Infection and the Risk of Hepatocellular Carcinoma in Patients with Hepatitis B Virus (HBV) Co-infection: a Propensity Score-matched Cohort Study
Authors: Lui Grace , Yip Terry , Yuen Becky , Sze Alex , Hui Yee-tak , Tse Yee-Kit , Wong Vincent , Wong Grace 
Published: October 2019

Abstract

Background
There is a paucity of data to show whether HIV infection would affect the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection.

Methods
A territory-wide cohort study was performed to determine the risk of HCC in patients with HBV with and without HIV co-infection. All patients with HBV/HIV co-infection and HBV mono-infection treated with antiviral therapy in public hospitals in Hong Kong from 2000 to 2017 were identified from an electronic database. Patients with hepatitis C virus (HCV) infection, HCC diagnosed within six months, or follow-up less than 6 months were excluded. The primary outcome was HCC. A propensity score (PS) for each patient was defined as the conditional probability of having HIV infection given the baseline characteristics (including age, sex, cirrhosis, bilirubin, alanine transaminase/ALT, platelet, albumin, and prothrombin time). HBV/HIV-co-infected and HBV-monoinfected patients were matched in a 1:5 ratio by PS matching. Weighted Fine-Gray subdistribution hazards model was estimated, where the variables included were HIV status and ALT as the other important co-variates were well matched.

Results
A total of 822 HBV/HIV-coinfected and 53,974 HBV-monoinfected patients were identified, and 692 and 38,102 were included for PS matching (Figure 1). Six hundred and three HBV/HIV-coinfected and 2,380 HBV-monoinfected patients were included in the final analysis. Among this cohort, 85% were male, mean (± standard deviation) age was 42 ± 12 years, and 4.5% had cirrhosis at baseline. At a median follow-up of 5.8 (interquartile range 2.6–9.6) years, 7 (1.2%) and 75 (3.2%) HBV/HIV-coinfected and HBV-monoinfected patients developed HCC, respectively. Weighted Fine-Gray model showed that HIV infection was associated with a lower risk of HCC (subdistribution hazard ratio 0.39, 95% confidence interval 0.16–0.94, P = 0.036) (Figure 2).

Conclusion
HIV/HBV co-infected patients had lower risk of HCC compared with antiviral therapy-treated HBV-monoinfected patients. This observation can be explained by a lower threshold, in terms of severity of liver disease, to start antiviral treatment in HBV/HIV-coinfected compared with HBV-monoinfected patients.

Disclosures
All authors: No reported disclosures.
361. Residual Lamivudine-Resistant Hepatitis B Virus Detected on Next-Generation Sequencing of Treatment-Experienced HIV Patients Failing Antiretrovirals
Authors: Schwem Brian , Francisco Christian , Dungca Nina Theresa , Arevalo Geraldine , Penalosa-Ramos Christine , Lim Jodor , Salvana Edsel Maurice T 
Published: October 2019

Abstract

Background
Hepatitis B is highly prevalent in the Philippines, with 17% of the population infected. With the fastest-growing HIV epidemic in the Asia-Pacific, 12% of HIV patients are HBsAg reactive. With the use of lamivudine and tenofovir-based antiretrovirals (ARVs), hepatitis B virus (HBV) treatment in co-infected HIV patients is not usually an issue. However, there is a potential to develop HBV resistance when patients are switched off tenofovir when antiretroviral resistance develops. With high rates of acquired K65R tenofovir resistance, the potential for inadvertently causing re-emergence of lamivudine-resistant HBV is present. We report two HIV patients with residual whole-genome HBV with lamivudine and telbivudine resistance mutations.

Methods
As part of a surveillance study on acquired drug resistance in the Philippines, samples with an HIV viral load >1,000 copies underwent Sanger sequencing of RT and PR for genotyping and HIV drug-resistance testing. Near-whole-genome next-generation sequencing (NGS) for HIV using Illumina HiSeq was also performed on these samples.

Results
Two patients had coincidental whole-genome amplification of HBV on NGS (Table 1). HBV serology for both showed reactive anti-HBsAg and non-reactive HBsAg and Anti-HBc. The two HBV samples were genotype A and were resistant to lamivudine and telbivudine, with intermediate resistance to entecavir.

Conclusion
Residual HBV may be present in patients on ARVs. Antibody responses for HBV serology may not be very reliable in highly immunosuppressed patients. The potential of lamivudine-resistant HBV to emerge when HIV patients are shifted off tenofovir due to resistance in patients should be considered when deciding on second-line ARVs.

Disclosures
All authors: No reported disclosures.
362. Hepatitis C Virus (HCV) Co-Infection in Women Living with Human Immunodeficiency Virus (HIV) in Northwest Louisiana
Authors: Mohammed Ethar , Nambiar Puja 
Published: October 2019

Abstract

Background
HIV and HCV infection are emerging global public health problems. People living with untreated HIV infection have higher HCV viral loads and more rapid HCV disease progression with twice the rates of perinatal HCV transmission. Data are lacking in HCV coinfected women living with HIV. Our study reviewed underrepresented minority group of women living with HIV/HCV in Northwestern Louisiana to better understand epidemiology, risk factors and access to care among this cohort.

Methods
Women with HIV/HCV coinfection aged 18–70 years who presented to an academic medical center between November 2011 and November 2018 were included for analysis. A retrospective chart review was conducted. Data were collected and analyzed on demographics (age, race), risk factors (sexual history, drug use), HIV (viral load, CD4 count, antiretroviral treatment (ART)), and HCV (viral load level and antibody, genotype, alanine transaminase, liver fibrosis, liver cirrhosis, referral, and treatment).

Results
A total of 41 patients met our inclusion criteria. The mean age was 52 years. Of these HIV/ HCV coinfected women, 27 (66%) were African American and 14 (34%) Caucasian. 18 (44%) had history of Injection drug use. Thirty-nine out of 41 (95%) were linked to HIV care and on antiretroviral therapy with 36 (88%) with CD4 count >200. Twenty-three out of 41 (56%) was referred for HCV treatment but only 11 (26%) co-infected patients received treatment for HCV.

Conclusion
In this cohort of HCV/HIV coinfected women, only 26% of the women received HCV treatment. Some of the barriers include access to providers, linkage to care and behavioral and socioeconomic factors. The lack of timely appropriate HCV care in this underserved high-risk population is alarming especially in the current era of highly effective direct-acting antiviral therapy for HCV. Despite improved HIV care, further work needs to focus on optimizing HCV screening, linkage and treatment uptake in order to overcome multiple barriers to HCV elimination in this patient population.

Disclosures
All authors: No reported disclosures.
366. Severe Neurologic Impairment Persists Despite Potent ART in HIV Encephalopathy
Authors: Cutler Riley , Trentman Sarah , Jandarov Roman , Brown Jennifer , Robertson Kevin , Fichtenbaum Carl 
Published: October 2019

Abstract

Background
Approximately 4–8% of the 1.1 million HIV patients in the United States have or will be diagnosed with HIV encephalopathy or HIV associated dementia (HAD). There are no published studies of the long-term outcomes of HAD treated with potent antiretroviral therapy (ART). We hypothesize that more than 60% of individuals diagnosed with HAD will have persistent neurocognitive impairment despite the successful use of potent ART and fewer than 20% will be employed.

Methods
This is a cross-sectional prospective and retrospective study of outcomes in individuals previously diagnosed with HAD. We identified all individuals with the diagnosis of dementia and HIV at the UC Infectious Diseases Center (IDC). For those who matched the 1993 CDC HAD definition, we collected medical, neurocognitive, and functional information. We attempted to contact all individuals alive and still in the IDC practice (N = 26) to perform a validated battery of neuropsychological tests. We excluded individuals with HIV-associated neurocognitive disease that developed after treatment with ART.

Results
We confirmed 39 diagnoses of HAD out of 137 records reviewed. The median CD4 count at the time of diagnosis of HAD was 47 cells/mm3 with a median viral load of 211,475 copies/mL. The median length of follow-up after diagnosis of HAD was 72 months (range 1–166 months). Potent ART was prescribed to all individuals, with 67.5% reaching consistent undetectable viral loads (< 200 copies/mL, occasional blips allowed). Persistent neurologic deficits were noted in 32.5%, while 60% had persistent cognitive deficits. Psychiatric disturbances were present in 72.5%. Only 2.5% reported any employment. To date, 28% have died. Ten participants have undergone formal neurocognitive testing to date (N = 26 available). The median overall summary score (total Z score) was -1.17 (range 0.08, -1.95) and median global deficit (GDS) score was 1.48 (range 0, 2.92).

Conclusion
HIV-associated dementia results in substantial morbidity and mortality despite potent antiretroviral therapy. Prospective neurocognitive assessment documents significant impairments in most individuals. HIV-associated dementia will require additional strategies to mitigate the profound impact on the quality of life and longevity.

Disclosures
All authors: No reported disclosures.
376. Effect of Parasitic Infections on Gut Epithelial Barrier and Immune Activation among Foreign-Born HIV-infected Patients
Authors: Reimer-McAtee Melissa , Somasunderam Anoma , Huan Xu Teena , Arduino Roberto , Serpa Jose , Mejia Rojelio , Utay Netanya S 
Published: October 2019

Abstract

Background
Strongyloides stercoralis often causes an asymptomatic infection despite continuous autoinfection for the lifetime of the host. Both HIV and recurrent enteric parasitic infections cause gut damage and increased microbial translocation, but little is known about the effects of co-infection. We aimed to evaluate changes in immune activation, mucosal damage, and microbial translocation in people with HIV-1 (PWH) and parasite co-infection.

Methods
In this pilot prospective cohort study, we enrolled foreign-born PWH on suppressive antiretroviral therapy (ART) in an ambulatory clinic in Houston, Texas. We evaluated serum Strongyloides IgG using ELISA with an S. stercoralis-specific recombinant protein. Intestinal fatty acid-binding protein (I-FABP), soluble CD14 (sCD14), sCD163, IL-6, and sTNFRII were analyzed as markers of enterocyte turnover, inflammation, and immune activation. Non-parametric tests were used for analysis.

Results
52 participants born in 14 countries were enrolled February–March 2019. Median CD4 count was 464/uL [95% CI 315–598]. Fourteen (27%) were positive for Strongyloides IgG. Strongyloides IgG levels correlated positively with sCD14 levels [r=0.36; P = 0.008]. Strongyloides+ participants had significantly higher sCD14 levels compared with Strongyloides− participants [1.67 vs. 1.48 μg/mL, P = 0.031]. Among the Strongyloides+ participants, Strongyloides IgG levels correlated with sCD163 levels [r=0.65, P = 0.026]. There were no difference in the other biomarkers. Logistical regression analysis showed that predictors of Strongyloides+ include absolute eosinophil count (AEC) (OR 1.45 for every 100 increase of AEC [95% CI: 1.02, 2.15; P = 0.047]). CD4 count, number of years living in the United States, country of origin, and years from HIV diagnosis were not associated with test positivity.

Conclusion
Strongyloides co-infection is common among foreign-born PWH and may contribute to chronic monocyte/macrophage activation, a predictor of morbidity and mortality in PWH. Future directions include stool PCR confirmation of these infections, continued enrollment, and follow-up assays 6 months after treatment of Strongyloides to determine the impact on inflammation and risk of co-morbidities.

Disclosures
All authors: No reported disclosures.
377. Diagnostic Yield of Bone Marrow Aspiration and Biopsy in Human Immunodeficiency Virus Patients with Fever and/or Cytopenia
Authors: Egge Stephanie , Malus Mathew , Osorio Ariel , Mansour Richard , Master Samip , Stevenson Joel Chandranesan Andrew 
Published: October 2019

Abstract

Background
Human Immunodeficiency Virus (HIV) patients are at increased risk of opportunistic infections and malignancies. Evaluation for the etiology of fever and/or cytopenia with conventional means such as cultures and serology can remain negative. Bone marrow aspiration or biopsy (BMAB) has the advantage of diagnosing disseminated infections, hematological abnormalities and oncological malignancies in HIV patients.

Methods
We performed a retrospective descriptive study of HIV patients with fever and/ or cytopenia who underwent Bone marrow aspiration or biopsy (BMAB). Patients with a diagnosis of HIV, 18 years and older who underwent BMAB in University Health (UH) Hospital or in UH clinics from January 2012 to February 2018 were included.

Results
There were a total of 42 patients who underwent Bone Marrow Aspiration or Biopsy. The median age was 41.5 years. Twenty-eight patients were Male and 14 were female. Preexisting Hematological malignancy was present in 10 patients at the time of BMAB. Average CD4 count at the time of BMAB was 92. 8 patients were compliant with ART and 12 patients were compliant with clinic appointments. White Blood Cell (WBC) count below 4.4 cells / L was present in 30 patients at the time of BMAB. Disseminated Mycobacterium Avium Complex infection (2 patients),Disseminated Histoplasmosis (2 patients), Disseminated Cryptococcus (1 patient) and Parvovirus B19 (based on Immunohistochemistry, 1 patient) were diagnosed from BMAB. CD4 count of these 6 patients range from 0 to 12 at the time of BMAB. All 6 patients presented to the hospital with fever for evaluation. Average WBC count, Hemoglobin and platelet count in these patients are 4.1 cells / liter, 8.7 g/dL and 74.8 k/micro liter, respectively. All 6 patients were non compliant to HIV medications and clinic appointments.

Conclusion
Since the advent of Anti Retroviral drugs with excellent efficacy and early diagnosis of HIV patients, incidence of disseminated fungal and mycobacterial infections have decreased in the United States. But patients with low CD4 count and cytopenias warrant a Bone Marrow aspiration or Biopsy to make a clear and early diagnosis.

Disclosures
All authors: No reported disclosures.
383. Rheumatic Disease Patients Have More Culture Negative Prosthetic Joint Infections: Are There Clinical Differences?
Authors: Kapadia Milan , Miller Andy O , Nocon Allina , Sculco Peter , Goodman Susan M 
Published: October 2019

Abstract

Background
Rheumatic disease (RD) patients are at increased risk for prosthetic joint infections (PJI), however, diagnosis is challenging because active RD may mimic joint infection. We aimed to assess the incidence of culture-negative (CN) PJI in a population of RD and osteoarthritic (OA) PJI using an institutional PJI registry. Baseline clinical differences between CN-RD and culture-positive (CP)-RD as well as the relationship of culture negativity to survivorship of the prosthesis were also evaluated.

Methods
A retrospective cohort of hip and knee PJIs, from 2009 to 2016, were identified by ICD codes, and confirmed by chart review. RD cases were identified by ICD code and use of RD-specific medications. CN cases were defined as PJIs with no evidence of microbial growth in intraoperative cultures. Demographics, medications, microbiology, surgical therapy and outcome were abstracted. Baseline characteristics were evaluated using Fisher’s exact and Chi-Square tests. Kaplan–Meier estimates were used to calculate survivorship.

Results
803 PJI cases were identified including 36 RD (33 rheumatoid arthritis and 3 systemic lupus erythematosus) and 771 OA. A higher proportion of RD PJI were CN (N = 10, 27%) vs. OA PJI (N = 109, 14%, P = 0.02). Fewer CN-RD cases met PJI histopathology criteria compared with CN-OA, (P = 0.08). On average, RD-CN were younger than OA-CN (59 vs 69, P = 0.01), but no different than RD-CP cases. One year survivorship of CN-OA and CN-RD were 87% and 66%, respectively and 47% for CP-RD. Comparing CN-RD vs. CP-RD, no difference was observed in age, smoking, diabetes, or Charlson comorbidities, but a trend toward higher prevalence of prior PJI in the CN-RD group. Clinically, no differences were found in surgical treatment (P = 0.92) or use of biologics and DMARDs (P = 0.12) between CN and CP RD patients.

Conclusion
RD PJIs are more likely to be culture-negative than OA PJIs. Prior PJI, histopathology and better outcomes suggest biologic differences that should be explored further.

Disclosures
All authors: No reported disclosures.