bluuebunny/crossref_metadata_2025_split huggingface dataset:
321. Low Volumetric Bone Density at Proximal Femur in HIV-Infected Men and Its Risk Factors: Comparison with Community-Dwelling Non-Infected Men
Authors: Ho Kim Jung , Hong Namki , Ji Lee Woon , Seong Hye , young Ahn Jin , Jin Jeong Su , su Ku Nam , Chang Kim Hyeon , Yeom Joon-Sup , Rhee Yumie , yong Choi Jun 
Published: October 2019

Abstract

Background
Individuals with HIV infection is at increased risk of low area bone mineral density (BMD) and fracture. However, data regarding volumetric BMD (vBMD) of central bone determined by quantitative computed tomography (QCT) which can distinguish the cortical and trabecular bone component are limited.

Methods
From November 2017 to October 2018, we measured spine and hip vBMD in HIV-infected men aged 30 years or older at the tertiary center. QCT data were compared with 1:2 matched control by age- and body mass index (BMI) sampled from a community-based healthy individual cohort. HIV-specific risk factors for low total hip vBMD as a primary outcome were identified using multivariate linear regression models.

Results
A total of 83 HIV-infected men and 166 control were analyzed (mean age 47.4 vs. 47.0 year; BMI 23.3 vs. 23.7 kg/m2; P > 0.05). In HIV-infected men, vBMD of trochanter, intertrochanter and total hip was significantly lower than that of non-infected men. (198 ± 31 vs. 213 ± 32; 339 ± 50 vs. 356 ± 47; 280 ± 41 vs. 296 ± 41 mg/cc; all P < 0.05) Association between HIV infection and lower total hip vBMD remained robust (Adjusted β -14.4; P = 0.013) after adjustment for age, diabetes, smoking, and vitamin D status. In HIV cohort, low CD4 T-cell count at initial diagnosis (< 200 vs. ≥200 cells/μL; Adjusted β = −6.7, P = 0.015) and use of protease inhibitor (vs. integrase inhibitor; Adjusted β = −29.9, P = 0.029) were negatively associated with total hip vBMD, after adjustment for age, BMI, and duration of HIV infection, whereas tenofovir disoproxil fumarate use was not. (Adjusted β −12.1, P = 0.280) In HIV-infected men with low tertile total hip vBMD, the levels of β-crosslaps (0.42 ± 0.23 vs. 0.30 ± 0.16 ng/mL; P = 0.012) and osteocalcin (22.10 ± 8.65 vs. 16.57 ± 6.04 ng/mL; P = 0.001) were higher than those with middle-upper tertile total hip vBMD.

Conclusion
HIV-infected men had lower hip vBMD compared with age- and BMI-matched non-infected men. Low baseline CD4 T-cell count and protease inhibitor use were independent risk factors for lower total hip vBMD. High born turnover was attributable to the negative effect on born health of HIV-infected men.

Disclosures
All authors: No reported disclosures.
327. Barriers to Positive Health Outcomes in the HIV-Infected Cancer Clinic Population
Authors: Goldstein Alexa , Riedel David J 
Published: October 2019

Abstract

Background
Significant disparities in morbidity and mortality from cancer in HIV-infected persons exist compared with those with cancer in the general population. This study sought to identify psychological, social and economic factors impacting or impeding cancer care in the HIV-infected population.

Methods
A voluntary, anonymous one-time questionnaire was completed by patients diagnosed with cancer who are HIV-infected and HIV-uninfected at the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC). Andersen’s Behavioral Model of Health Services Use served as the theoretical framework for assessing psychological, social, and economic barriers to care. We used the chi-square test to evaluate the association between HIV status and barriers to accessing cancer care.

Results
A total of 25 HIV-infected and 100 HIV-uninfected cases were included. More HIV-infected patients with cancer experienced self-esteem and fear barriers to a greater degree than their HIV-uninfected counterparts (28% vs. 15% for self-esteem, and 40% vs. 21%). A significant proportion of HIV-infected individuals reported experiencing insufficient social support (32% vs. 10% in the HIV-uninfected population, P = 0.01). HIV-infected individuals reported that they did not feel looked down upon in the cancer clinic. They also described that their cancer and HIV diagnoses were delivered in a similar manner by the provider.

Conclusion
Given that HIV-infected persons are experiencing lower survival rates for most cancer subtypes when compared with their HIV-uninfected counterparts, there is a need to further investigate the feelings of fear, low self-esteem, and insufficient support reported in the HIV-infected sample. Cancer care may need to be tailored to reflect the differences in psychological barriers and enabling resources that continue to be disproportionately prevalent in HIV-infected patients.

Disclosures
All authors: No reported disclosures.
334. Weight Change Associated with Antiretroviral Therapy Switch to Integrase Strand Transfer Inhibitor-Based Regimens
Authors: Saber Saghar , Bernstein Andrew B , Sparks Andrew D , Siegel Marc O 
Published: October 2019

Abstract

Background
An association between switching antiretroviral therapy (ART) to integrase strand transfer inhibitor (INSTI)-based ART and weight gain has been previously reported. However, insufficient data exists on risk factors associated with such weight gain.

Methods
We reviewed charts of 119 virally-suppressed HIV-positive patients switched from nonnucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI)-based ART to INSTI-based ART and compared their weight change over 17 months to 56 virally-suppressed patients who were maintained on NNRTI-based regimens over the same period.We looked at variables associated with weight gain including age, weight, body mass index (BMI), gender, CD4 count, starting ART, and final INSTI-based ART.

Results
The 119 patients switched to INSTI-based ART gained an average of 6.9 lbs compared with an average 1 lbs weight gain in the 56 patients who were maintained on NNRTI-based ART (P = 0.002). There was also a statistically significant difference in the percentage % weight change between the two groups (4.2% vs. 0.7%, P < 0.001).There was an average 1.2 lbs weight loss in 92 of the 119 patients with weights recorded 17 months before switching ART, compared with an average 6.7 lbs weight gain after the switch (P < 0.001).There was no association between gender, CD4 count at the time of switch, starting ART, or final INSTI-based ART with weight gain. However, patients weighing < 150 lbs at the time of switch had a greater % weight gain than patients weighing >200 lbs (6.9% vs. 2.7%, P = 0.02) and a trend to greater % weight gain than those weighing ≥150 to ≤ 200 lbs (6.9% vs. 3.8%, P = 0.06). There was marginal statistical significance when comparing those with BMIs < 25 to those with BMIs ≥25 to ≤ 30 (8.2 vs. 6.5 lbs, P = 0.069) and those with BMIs >30 (8.2 vs. 5.0 lbs, P = 0.057). There was an inverse correlation between age and weight gain, indicating that less weight was gained when switching to INSTI-based ART as the age of the patient increased (ρ = -0.211, P = 0.021).

Conclusion
Our study showed a statistically significant weight gain in patients switched from NNRTI- or PI- to INSTI-based ART compared with patients maintained on NNRTI-based ART.Baseline variables associated with greater weight gain included weight <150 lbs, BMI <25 and younger age.

Disclosures
All authors: No reported disclosures.
356. HIV-HCV Coinfection: An Investigation of CD4 T-Cell Reconstitution after HCV Direct-Acting Antiviral Treatment
Authors: Michienzi Sarah M , Cai Jiaqi , Harris Cydnee , Kim Sean , Patel Nimish , Badowski Melissa E , Chan Juliana , Martin Michelle T , Schriever Christopher A 
Published: October 2019

Abstract

Background
Both human immunodeficiency virus (HIV) and hepatitis C virus (HCV) can adversely affect CD4 cell count. Among patients with HIV-HCV coinfection, treatment with HCV direct-acting antivirals (DAAs) may be an opportunity to restore/reconstitute CD4 count. The primary objective of this study was to determine whether DAA treatment results in improved CD4 cell counts in HIV-HCV coinfected patients.

Methods
A retrospective multicenter cohort study was performed among 4 sites between 11/1/2013–4/12/2018. Patients were included if they were age ≥18 years, infected with both HIV and HCV, and received all-oral DAA therapy. Trained reviewers extracted demographics, comorbidities, receipt of antiretroviral therapy (ART), DAA treatment regimen/duration and HIV/HCV-related lab values, which included CD4, HIV RNA, and HCV RNA. Labs were restricted to the closest values before/after DAA treatment. The primary endpoint was changed in pre-DAA/post-DAA CD4 count. Descriptive statistic and Wilcoxan Signed Rank were used.

Results
There were 88 patients included. Most (78.4%) identified as male. Mean ± standard deviation (SD) age was 57.1 ± 9.6 years. The proportion of patients with undetectable pretreatment HIV RNA was 78.4%. Among the 97.7% of patients on ART, regimens included the following classes of ART: integrase strand transfer inhibitor (75.6%), non-nucleoside reverse transcriptase inhibitors (23.3%) and protease inhibitors (19.8%). Of the 87 patients who completed DAA therapy and had post-DAA labs drawn, sustained virologic response (SVR) was achieved in 96.6%. The median (interquartile range, IQR) CD4 counts before/after DAA treatment did not significantly differ [515 (349–704) vs. 554 (374–693), P = 0.80]. In the subset of patients with pre-DAA CD4 counts < 350 cells/mm3 (n = 23), CD4 count significantly improved before/after DAA treatment [235 (202–311) vs. 309 (189–392), P = 0.01].

Conclusion
The use of DAA therapy in HIV-HCV co-infected patients resulted in a significant increase in CD4 count in patients with pre-DAA CD4 < 350 cells/mm3. This may represent a high priority population for DAA treatment.

Disclosures
All authors: No reported disclosures.
402. Clinical Characteristics and Outcome of Staphylococcus lugdunensis Prosthetic Joint Infections
Authors: Masood Komal , Duggan Joan , Redfern Roberta , Georgiadis Gregory , Suleyman Geehan 
Published: October 2019

Abstract

Background
Although Staphylococcus lugdunensis is a coagulase-negative staphylococcus, it shares similar characteristics with S. aureus and is increasingly recognized as the cause of serious infections, including prosthetic joint infections (PJIs). The aim of this study was to determine the clinical characteristics and outcome of S. lugdunensis PJIs.

Methods
This was a retrospective multicenter study conducted from January 2007 through December 2017 involving consecutive adult patients with S. lugdunensis PJIs in northwest Ohio. Clinical and microbiologic characteristics, treatment modalities and outcome were evaluated.

Results
A total of 695 patients were evaluated and 29 (4%) patients met inclusion criteria (Table 1). All patients were Caucasian and 52% were female with a median age 68.8. Comorbidities included Diabetes Mellitus (34%), CAD (41%), CHF (20%), COPD (20%) and cancer (14%). The most common clinical presentations were pain (28/29, 97%), decreased range of motion (27/29, 93%) and joint swelling (21/29, 72%). Two patients had concomitant bacteremia. Knee was the most commonly affected joint (69%), followed by hip (24%). All isolates, except one, were susceptible to oxacillin. Thirteen (45%) patients had a two-stage revision, nine (31%) debridement with/without revision, six (21%) no surgical intervention and one (3%) a 1-stage revision. The majority of patients (71%) received ≥4 weeks of antibiotics (abx). Two patients with no surgical intervention and one with debridement received no abx. Another was discharged to hospice without intervention. Relapse was observed in two (15%) patients who had a 2-stage revision, four (44%) who had debridement, 6 (100%) who had no surgical intervention or 1-stage revision. Overall, there was a statistically significant difference in cure rates in patients who underwent 2-stage revision compared with other treatment modalities (P = 0.003) regardless of abx treatment regimen, including prolonged IV abx therapy. However, IV abx were superior to oral (P = 0.009).

Conclusion
Appropriate management of S. lugdunensis PJIs includes both aggressive surgical management with a prolonged course of abx with excellent clinical responses. Relapse is high in patients treated without two-stage revision irrespective of route or duration of abx therapy.

Disclosures
All authors: No reported disclosures.
416. Improvement in Syphilis and HIV Screening Rates at a Community-Based Emergency Department in Columbus, Ohio: Six Month Post-Intervention Analysis
Authors: Buffomante Ashley , Goldstein Philip , Hussain Cory , Malvestutto Carlos , Bazan Jose A , Sobhanie Mohammad Mahdee , Pollak Brandon , Koletar Susan , Nandam Kushal , Petke Carol , Combs Julie , Dick Michael , Lindsey Sommer 
Published: October 2019

Abstract

Background
Sexually transmitted infections (STIs) disproportionally affect individuals living in underserved areas and Emergency Departments (ED) can play a major role in STI screening. Given the overlapping risk factors for STIs, patients screened for gonorrhea and chlamydia should also be screened for syphilis and HIV. Rates of syphilis/HIV screening in the ED are very low and barriers include lack of knowledge about the risk/prevalence, difficulty with results interpretation, and concerns about follow-up.

Methods
The main study objective was to improve rates of syphilis/HIV screening in a community-based ED in Columbus, OH. A team of clinical providers, case managers, and social workers was formed to address barriers to screening. Using root cause analysis and data feedback, a multistep intervention that included provider education along with expert review of syphilis/HIV results was implemented to ensure proper screening, treatment and rapid linkage to care. Syphilis/HIV screening rates in the ED were compared between two periods: 2012–2017 (pre-intervention) and November 2018–April 2019 (post-intervention).

Results
Between 2012 and 2017, there were 24,427 ED encounters where any STI test was ordered. There were 23,652 (97%) tests for chlamydia, 23,637 (97%) for gonorrhea, 254 (1%) for syphilis, and 466 (2%) for HIV. Twenty-four (0.1%) encounters had screening that included all four tests. Six months after starting the intervention, there were 1,590 encounters where any STI test was ordered. There were 1,444 (91%) tests for chlamydia, 1,446 (91%) for gonorrhea, 493 (31%) for syphilis and 591 (37%) for HIV. Four hundred thirty-eight (28%) of encounters had screening that included all four tests.

Conclusion
Collaborative and practical interventions aimed at improving syphilis/HIV testing have resulted in dramatic increases in syphilis, HIV, and comprehensive STI screening (31-, 19-, 280-fold, respectively) over a relatively short post-intervention period. Additional steps are planned with the goal to further increase screening rates and improve linkage to prevention and treatment programs.

Disclosures
All authors: No reported disclosures.
439. Iclaprim Use for Acute Bacterial Skin and Skin Structure Infection (ABSSSI) is Not Associated with Hyperkalemia: Phase 3 REVIVE Studies
Authors: Huang David B , Noviello Stephanie S , Lodise Thomas , McKinnell James , Dwyer Jamie P 
Published: October 2019

Abstract

Background
Trimethoprim inhibits sodium channels in the distal portion of the renal tubule, thereby impairing renal potassium excretion. Trimethoprim has been associated with a greater risk of hyperkalemia compared with other antibiotics (amoxicillin, nitrofurantoin, cefalexin, ciprofloxacin). An analysis of Phase 3 studies was conducted to determine whether iclaprim, under development for ABSSSI and also a selective bacterial dihydrofolate reductase inhibitor like trimethoprim, is associated with hyperkalemia, relative to vancomycin, an antibiotic not associated with hyperkalemia.

Methods
A post-hoc safety analysis was conducted on pooled results of two Phase 3, double-blind, randomized (1:1), active-controlled trials (REVIVE-1/-2) in patients with ABSSSI. These trials compared iclaprim 80 mg fixed doses with vancomycin 15 mg/kg; both administered intravenously every 12 hours for 5–14 days. Hyperkalemia was defined as serum potassium (K) ≥5.5 mmol/L, if normal at baseline, while on study drug. Hyperkalemia was compared between treatment groups and stratified subgroup comparisons were performed.

Results
Demographics and baseline disease characteristics were similar between the pooled iclaprim and vancomycin groups (table). Hyperkalemia occurred during treatment in 1.5% (9/592) and 2.5% (15/599) of patients treated with iclaprim and vancomycin, respectively. Of the patients with hyperkalemia, one patient in each treatment group had moderate to severe renal impairment (creatinine clearance [CrCl] 15–59 mL/minute). Among patients with moderate to severe renal impairment on any RAS, KSD or K supplements, hyperkalemia occurred in 1/16 and 0/16 patients in the iclaprim and vancomycin groups, respectively, and in 2/83 and 0/46 patients with mild to no renal impairment. No patients with hyperkalemia experienced adverse events of palpitations, chest pain, myalgia, muscular weakness or fatigue.

Conclusion
No differences in hyperkalemia were seen between the iclaprim and vancomycin groups in the Phase 3 REVIVE studies. In general, few cases of hyperkalemia occurred among patients with renal impairment treated with concomitant angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers treated with iclaprim.

Disclosures
All authors: No reported disclosures.
465. Comparative Efficacy of Double vs. Single Antibiotic Regimens for the Empiric Treatment of MRSA-Induced Acute Bacterial Skin and Skin Structure Infection
Authors: Alhifany Abdullah A , Bifari Nisrin , Alatawi Yasser , Ullah Malik Saad , Almangour Thamer 
Published: October 2019

Abstract

Background
The initial management of Acute bacterial skin and skin structure infection (ABSSSI) is burdensome. It requires empirical antibiotic therapy that covers both gram-positive and gram-negative bacteria. Vancomycin plus aztreonam are the most commonly used antibiotic combination, nonetheless, they have many limitations which limits their use. Hence, many new single agents with MRSA and gram-negative coverage, oral options, and/or good safety profile have been developed to be a potential alternative such as: ceftaroline, ceftobiprole, tigecycline and the recent FDA approved antibiotic (delafloxacin). In the absence of head-to-head trials comparing these agents, we decided to conduct a network meta-analysis for these therapeutic regimens.

Methods
A Bayesian network meta-analysis of randomized clinical trials identified in PubMed/Medline and Embase databases was conducted. We performed both fixed and random effect models for clinical cure as the primary outcome of interest. Additionally, rankograms were generated using the surface under the cumulative ranking curve (SUCRA) to obtain the treatment ranking probabilities in relation to their relative effect.

Results
We identified 10 eligible studies involving 4,914 patients. The indirect comparison demonstrated that delafloxacin showed no difference in terms of clinical cure compared with ceftaroline (OR, 0.82, 95% Cr.I 0.39–1.8), ceftobiprole (OR, 0.79, 95% Cr.I 0.32–1.9), SOC (OR, 1.2, 95% Cr.I 0.62–2.4) and tigecycline (OR, 1.0, 95% Cr.I 0.45–2.2) in the fixed effect analysis, nor in the random-effect analysis (OR, 0.8, 95% Cr.I 0.26–2.2; OR, 0.78, 95% Cr.I 0.2–3.0; OR, 1.2, 95% Cr.I 0.51–3.1; and OR, 0.96, 95% Cr.I 0.30–3.0), respectively. Furthermore, the ranking probabilities in the fixed-effect and random-effect analysis showed that ceftaroline was ranked the first in terms of clinical cure (SUCRA, 40.02%) followed by ceftobiprole (SUCRA, 22.80%), delafloxacin (SUCRA, 16.60%), SOC (SUCRA, 13.80%), and then tigecycline (SUCRA, 6.70%).

Conclusion
Ceftaroline, ceftbiprole, delafoxacin, SOC and tigecycline are similarly effective. However, delafloxacin provides better convenience. Further comparative studies regarding their safety are needed.

Disclosures
All authors: No reported disclosures.
483. Case–control Study Evaluating the Risk of Stenotrophomonas maltophilia Pneumonia in Patients with Previous Exposure to Meropenem
Authors: Saraiya Nidhi , Chacko Jasmine , Goriacko Pavel 
Published: October 2019

Abstract

Background
Stenotrophomonas maltophilia (SM) is a growing cause of opportunistic nosocomial infections with a mortality rate of 23–77%. Previous studies have identified the use of broad-spectrum antibiotics, specifically carbapenems, as a risk factor for SM infection, but these findings were limited to secondary endpoints. Meropenem’s overall broad-spectrum activity but limited SM activity may favor SM colonization and infection.

Methods
Adult patients admitted between January 2016 and July 2018 with available culture data were identified using data mining software. Cases were defined by a positive SM respiratory culture between days 2 and 60 of admission and receipt of antibiotic treatment. Controls were defined by a respiratory culture negative for SM during the same period. The primary endpoint was to evaluate the exposure to at least 48 hours of meropenem between cases and controls, with exposure defined as at least 48 hours of meropenem treatment with the last dose given within 15 days of respiratory culture. Secondary endpoints were to evaluate exposure to at least 7 days of meropenem or other antipseudomonal antibiotics.

Results
A total of 225 patients were included, 106 as cases and 119 as controls. Baseline demographics and age-adjusted Charlson comorbidity index score were similar between groups. Twenty-one cases (19.8%) and 5 controls (4.2%) were exposed to at least 48 hours of meropenem before developing SM pneumonia. The odds of meropenem exposure was 5 times greater in cases than controls (OR = 5.6, P < 0.001). After adjusting for a longer length of stay before culture collection as a potential confounding variable, meropenem use was still associated with SM pneumonia (adjusted OR = 4.6, 95% CI 1.7–14.7). Significant associations were also found with exposure to at least 7 days of meropenem (OR = 4.7, 95% CI 1.52–14.77, P = 0.004) or other antipseudomonal antibiotics (OR = 3.0, 95% CI 1.59–5.71, P < 0.001).

Conclusion
This is the first study to evaluate meropenem as a risk factor for developing SM pneumonia. Even as little as 48 hours of meropenem exposure increases the risk of developing SM pneumonia. As one of the few modifiable risk factors for SM infection, judicious use of meropenem may reduce the incidence of SM infection and associated mortality.

Disclosures
All authors: No reported disclosures.