bluuebunny/crossref_metadata_2025_split huggingface dataset:
960. Implementation and Evaluation of Alcohol Screening Tool in HIV Patients
Authors: Brickner Evan D , Mathew Trini , Johnson Paul 
Published: January 2021

Abstract

Background
In November 2018, the US Preventative Service Task Force (USPSTF) advised screening for Alcohol Use Disorder (AUD) in primary care settings for all adults. Given the consequences of AUD for immunocompromised patients, this recommendation was implemented using the Alcohol Use Disorders Identification Test (AUDIT) for patients with Human Immunodeficiency Virus (HIV) at Beaumont Hospital in Royal Oak, Michigan. This is a medical-student led, retrospective study to determine the impact of AUD in HIV patients that were screened using the AUDIT self-administered questionnaire.

Methods
All HIV patients undergoing outpatient care at the Beaumont Hospital HIV clinic were provided this self-administered AUDIT questionnaire as part of routine, check-in procedure by clinic staff starting on February 5, 2019. Scores were divided into “At Risk” or “Not At Risk” categories. Men (aged 18-60) screened positive for at-risk drinking if they scored 8 or higher. Men (older than 60) and women of all ages screened positive for at-risk drinking if they scored 4 or higher. This categorization of risk was determined using the criteria established by the National Institute on Alcohol Abuse and Alcoholism. Analysis between groups was made using T-Tests, Chi-Square tests, and odds ratios (OR), with corresponding 95% Confidence Intervals.

Results
A total of 121 HIV patients completed at least one AUDIT form. There were a total of 157 patient encounters. The mean age of “At Risk” drinkers was significantly higher than the mean age of “Not at Risk” drinkers, at initial visits and all visits, respectively (55.75 years vs. 46.25 years, p = 0.0117; 55.33 years vs. 46.29 years, p = 0.0075). These findings are depicted in Tables 1 and 2.
Table 1: Differences in Health Status between “At Risk” and “Not at Risk” Individuals (Initial Visit Only)

Table 2: Differences in Health Status between “At Risk” and “Not at Risk” Individuals (All Visits)

Conclusion
The preliminary results of this study demonstrate the importance of screening for AUD within the vulnerable HIV patient population. More specifically, it highlights the value of screening older individuals who may be at increased risk of hazardous drinking. In March 2020, the COVID-19 pandemic required transitioning to a telemedicine platform, thereby preventing completion of AUDIT paper forms. Thus, we will leverage technology by incorporating the AUDIT into electronic medical records, in effort to fortify this quality improvement initiative and ensure patient centered care.

Disclosures
All Authors: No reported disclosures
962. Linkage to Care Outcomes among Known HIV-Positive Patients at a High Prevalence Urban Hospital Emergency Department
Authors: Sudyn Alexander W , Paer Jeffrey M , Kodali Swetha , Maldonado Samuel , Nyaku Amesika , Swaminathan Shobha 
Published: January 2021

Abstract

Background
Retention in care of persons with HIV (PWH) is essential for achieving viral suppression and decreasing community transmission. CDC estimates that the 23% of known PWH not retained in care account for 43% of all new transmissions. This study seeks to describe the impact of an opt-out ED screening with navigator-assisted linkage to care (LTC) protocol for out of care PWH.

Methods
An IRB-approved retrospective chart review was conducted among PWH (prior positive) inadvertently retested in the ED between 2015 and 2018. Univariate and multivariate logistic regression was used to identify factors associated with LTC with patient navigator (PN) support. Factors with p ≤ 0.1 were included in the multivariate analysis as were age and sex at birth. Patients who died were excluded from statistical analyses.

Results
Among 464 patients who tested positive, 338 (73%) were known positive with 120 (35%) of those out of care at the time of screening. Mean age for this group was 47 (SD 11.9); 57% male, 81% non-Hispanic black, 10% Hispanic, and 6% non-Hispanic white. Fifty-five (46%) patients were successfully LTC, 54 (45%) referred to the state for linkage, and 11 (9%) died. A total of 109 patients were included in the analysis. Univariate analysis was performed for age (F(1, 107) = 0.98, p = 0.324) and female sex at birth (OR = 1.42 [95% CI 0.66, 3.05], p = 0.373) as well as Hispanic race (OR = 3.33 [95% CI 0.84, 13.04], p = 0.085), heterosexual HIV risk (OR = 2.76 [95% CI 1.27, 5.99], p = 0.011), IDU (OR = 0.49 [95% CI 0.21, 1.11], p = 0.088), and other SUD (OR = 0.42 [95% CI 0.19, 0.94], p = 0.035). Only heterosexual HIV risk (OR = 3.01 [95% CI 1.23, 7.32], p = 0.015) maintained significance in the final multivariate model.

Conclusion
Opt-out ED screening revealed &gt;30% of known positive PWH were out of care at the time of testing; of whom nearly 50% were LTC with PN support. It is possible that persons reporting heterosexual HIV risk may feel less stigmatized and therefore are more likely to LTC. Similarly, the association with SUD, albeit non-significant, may reflect underrepresentation of individuals with SUD in remission among patient navigators. Future opt-out ED screening protocols should build upon diverse care teams to further engage patients with SUD and those at risk for non-heterosexual HIV transmission.

Disclosures
All Authors: No reported disclosures
963. Non-Invasive Detection of Cardiovascular Risk in People Living with HIV in Miami
Authors: Salguero Douglas , Galo Jason , Rodriguez Jornan , Pester Mollie , Chedebau Alejandro , Lang Barbara , Parker Meela , Gonzales Alex , Alcaide Maria L , Hurwitz Barry , Schneiderman Neil , Martinez Claudia 
Published: January 2021

Abstract

Background
HIV is a risk factor for Cardiovascular Disease (CVD), and CVD is the leading cause of mortality among Hispanics (H). Hispanics in the US are disproportionately affected by HIV with higher rates of HIV related morbidity and mortality, as well as adverse CVD outcomes. This study sought to identify early markers of CVD risk among Hispanics living with HIV.

Methods
Interim analysis of 38 H and non-Hispanics (NH) people living with HIV (PLWH), stable on antiretroviral regimen, 30-50 years of age, without previously detected CVD. Demographics, CD4 T cells, HIV RNA viral load, traditional early markers of CVD risk were collected. CVD risk markers were obtained with non-invasive tools: epicardial adipose tissue (EAT) thickness was assessed by echocardiogram; arterial stiffness was assessed by applanation tonometry sequentially at the carotid, femoral and radial arteries (including central augmentation index - AI, peripheral AI, radial pulse wave velocity - PWV, and femoral PWV). The Framingham Coronary Event Risk Score (FCER) was calculated for each subject. Descriptive and linear regression analysis for predictors of FCER measures were age adjusted.

Results
Among the 38 participants enrolled the mean age was 42 years, 80% male, H 76%, NH 24%, Black 16%, with mean BMI of 26.7. 45% met clinical criteria for metabolic syndrome: high waist girth 24%, high blood pressure 18%, high Fasting Glucose 16%, high total cholesterol 21%, high triglycerides 26%, low HDL 45%, high LDL 18%, high TC/HDL ratio 68%. The mean EAT was 3.8 mm, mean central AI 20.2 %, mean peripheral AI 73%, mean femoral PWV 28.8 m/s, mean radial PWV 8.7 m/s. Older age was associated with greater central AI (r = 0.37, p =.01) and peripheral AI (r = 0.38, p =.01) but not with increased EAT. Regression analysis predicting FCER relationships showed radial PWV as an independent predictor of increased FCER (r = 0.36, p &lt; .05).

Conclusion
Risk factors leading to CVD are common among this group of PLWH and radial PWV is a moderate predictor of increased FCER. Although measures of arterial stiffness are available, they are not routinely used to assess CVD risk. Further studies should evaluate the use of noninvasive methods for diverse PLWH, to prevent the development of CVD.

Disclosures
All Authors: No reported disclosures
70. Impact of Fluoroquinolone Susceptibility Suppression on Discharge Prescribing for Acute Uncomplicated Cystitis
Authors: Hayden Dillon , White Bryan , Neely Stephen , Bennett Kiya 
Published: January 2021

Abstract

Background
Fluoroquinolones (FQ) are associated with multiple adverse effects and increasing resistance. Acute uncomplicated cystitis (AUC) treatment remains a frequent reason for FQ use. Previous data suggests that suppression of FQ susceptibility results can decrease inpatient use, but may not reduce prescribing at discharge. The purpose of this study was to investigate the impact of FQ susceptibility suppression on discharge prescribing for AUC.

Methods
This was a retrospective, quasi-experimental study in adult patients at a 350-bed academic medical center. The effect of suppression of FQ susceptibilities on pan-susceptible urine isolates for Klebsiella sp. and E. coli on FQ prescribing and appropriateness at discharge was compared one year before and after the intervention, starting in March 2018. Risk factors for FQ use were also examined. Exclusion criteria included pyelonephritis, urinary hardware, pregnancy, concomitant infections treated with FQ, and organisms not susceptible to FQ. Risk ratios of FQ use were calculated for pre-/post-groups and stratified by discharging team for adjusted rates (aRR) using a Cochran-Mantel-Haenszel approach. For secondary outcomes, Chi-Square statistics and generalized regression models were used to assess odds of FQ use among variables.

Results
Overall discharge FQ prescribing decreased from 41.1% to 21.1% after the intervention, corresponding to a 53% lower adjusted risk (aRR 0.47 [95% CI 0.28–0.81]). One-hundred percent of FQ use was inappropriate, largely due to organism susceptibility to a guideline-preferred agent (n = 33/38). After adjusting for the intervention and clustering of discharge team, the odds of outpatient FQ use was 3.46 times higher for uninsured vs. insured patients, and 13.4 times higher among those who received FQ while inpatient.
FQ Use at Discharge

Other Antibiotic Use

Risk Factors for FQ Use at Discharge

Conclusion
Suppression of FQ susceptibilities on pan-susceptible urine isolates for Klebsiella sp. and E. coli was associated with a decrease in FQ prescribing at discharge for AUC. Patients who received FQ while inpatient were 13.4 times more likely to be continued on FQ at discharge. Overall, prescribing of FQ for AUC was inappropriate, and stewardship programs should implement FQ suppression policies to improve FQ prescribing at discharge.

Disclosures
All Authors: No reported disclosures
966. Pregnancy Outcomes and Engagement in HIV Care for Pregnant Women Living with HIV in Rhode Island 2012-2019
Authors: Byrd Katrina M , Henebeng Esther , McCarthy Meghan L , Gillani Fizza S , Hardy Erica , Holland Sabina D 
Published: January 2021

Abstract

Background
Prevention of mother to child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) requires a comprehensive approach and understanding the cultural backgrounds of pregnant women living with HIV (PWLH). In Rhode Island (RI), 70% of women newly diagnosed with HIV are foreign-born (FB) despite only representing 14% of RI’s population. Understanding the similarities and differences of pregnancy characteristics and engagement in postpartum HIV care between United States born (USB) and FB women is needed to ensure PWLH remain engaged in care and that appropriate resources are provided to all women with HIV in our state to maintain successful PMTCT of HIV.

Methods
A retrospective review of pregnant women living with HIV and their HIV-exposed infants evaluated in our hospital system were analyzed from 2012-2019. Clinical data were derived from medical records. Association between country of origin and sociodemographic, clinical, or lab variables were evaluated using chi-square test.

Results
A total of 72 pregnancies in 64 PWLH were included. Median # of pregnancies were 9 per year, median age at delivery 33 years, 54% of PWLH Black or African American, 33% Hispanic; 67.1% FB, most (56%) from Sub-Saharan Africa. Sixty-one % (n=42) with detectable (&gt; 20 copies/mL) viral load (VL) during pregnancy, 23% (n=15) at delivery, only 1 VL &gt; 200 at delivery. Pregnancy complications seen in 51%; 60% delivered vaginally; most (74%) at term. Engagement in postpartum HIV care declined from 71% at 6 months to 37% at 24 months. There was also decline in engagement in HIV care for the HIV exposed infants- 89% presented to the initial visit their children, from 89% attending the initial visit to 69% attending their last. DCYF involvement was more likely to occur in USB women compared to FB (P &lt; 0.05). Other comparisons between FB & USB women including adherence to care were insignificant.

Conclusion
USB PWLH are at higher risk of DCYF involvement compared to FB women. Investigation into this disparity is warranted, given the cultural and language differences between groups. Additional research to determine barriers to long-term postpartum follow up for women and their infants is urgently needed.

Disclosures
All Authors: No reported disclosures
968. The Impact of Opt-Out HIV Screening and Patient Navigator-Assisted Linkage to Care of Newly Diagnosed Persons with HIV in a High-Prevalence Emergency Department
Authors: Kodali Swetha , Paer Jeffrey M , Sudyn Alexander W , Maldonado Samuel , Nyaku Amesika , Swaminathan Shobha 
Published: January 2021

Abstract

Background
Newark is the epicenter of the HIV epidemic in New Jersey. University Hospital, the state’s only public safety net hospital, plays a critical role in identifying and linking newly diagnosed persons with HIV (PWH) to care. We previously showed that the emergency department (ED) is the most common setting for missed testing opportunities. Therefore, in 2015 we implemented a routine opt-out HIV screening and patient navigator (PN)-assisted linkage to care (LTC) protocol in the ED, and this project examined the LTC rates for newly diagnosed PWH.

Methods
We conducted an IRB-approved retrospective chart review of patients who tested positive for HIV in the ED between 2015 and 2018. Descriptive statistics were used to summarize demographic and clinical data. Univariate and multivariate regression were used to identify demographic and clinical factors associated with LTC for newly diagnosed PWH. Age, sex, and factors with p ≤ 0.10 in the univariate analysis were included in the final model.

Results
Of the 464 patients who screened positive, 123 (26.5%) were new diagnoses. The mean age was 41.0 years (SD = 13.8); 82 (67%) male; 74 (60%) black, 26 (21%) Hispanic, 7 (6%) white. The median CD4 count was 242 (IQR = 120 - 478) cells/µL, and 10 patients (8.1%) had acute HIV infection. Six patients (4.9%) died before LTC. Among the remaining 117 patients, PN outreach resulted in scheduled appointments at the Infectious Disease Practice for 102 (87.2%). In total, 79 (67.5%) were linked to care and 38 (32.5%) were referred to the state for linkage. Of the patients linked to care, 49 (62.0%) attended their first appointment and 30 (38.0%) required additional PN outreach. Men who have sex with men (MSM) (OR = 17.2, p = 0.002) and heterosexual contact (OR = 6.3, p &lt; 0.001) were predictive of LTC.

Conclusion
Our protocol resulted in LTC for the majority of newly diagnosed PWH. Among those linked to care, over a third required additional PN outreach after missing their first appointment, highlighting the importance of PN follow-up. MSM and heterosexual contact, the two highest risk factors for HIV in New Jersey, were predictive of LTC. Their successful LTC may be explained, in part, by the fact that PNs were demographically similar and lessened perceived stigma associated with entry into care.

Disclosures
All Authors: No reported disclosures
969. TNF-alpha inhibition in the setting of undiagnosed HIV infection: a call for enhanced screening guidelines
Authors: Claytor Jennifer , Viramontes Omar , Conner Stephanie , Wen Kwun Wah , Beck Kendall , Henrich Timothy J , Chin-Hong Peter , Chin-Hong Peter , Peluso Michael J 
Published: January 2021

Abstract

Background
Despite the risks of immunosuppression, recommendations regarding screening for HIV infection prior to initiation of biologic therapies targeting common autoimmune disorders, including inflammatory bowel disease (IBD) and inflammatory arthritides, are limited. Few cases of patients started on biologics while living with undiagnosed HIV have been reported.

Methods
We report 3 cases of patients initiated on biologics in the absence of recent or concurrent HIV screening who developed refractory disease or unanticipated complications and were later found to have undiagnosed chronic HIV infection.

Results
In Case 1, a 53-year-old man who has sex with men (MSM) with negative HIV testing 10 years prior presented with presumed rheumatoid arthritis. He did not respond to methotrexate (MTX), so adalimumab (ADA) was started. HIV testing to evaluate persistent symptoms was positive 9 months later; CD4 was 800 cells/uL. Antiretroviral therapy (ART) resulted in resolution of symptoms, which were attributed to HIV-associated arthropathy.
In Case 2, a 55-year-old woman with injection drug use in remission and no prior HIV testing presented with Hidradenitis Suppurativa (HS). She was initiated on infliximab (IFX) and MTX with good response. After she developed weight loss and lymphopenia, an HIV test was positive; CD4 was 334 cells/uL. Biologic HS therapy was discontinued, with subsequent poor HS control.
In Case 3, a 32-year-old MSM with no prior HIV testing presented with presumed IBD; IFX and steroids were started. Symptoms progressed despite IBD-directed therapy, and he was diagnosed with extensive Kaposi Sarcoma (KS) with visceral and cutaneous involvement likely exacerbated by immunosuppression. HIV testing was positive; CD4 was 250 cells/uL. KS initially worsened due to ART-associated immune reconstitution inflammatory syndrome. He is now improving with systemic chemotherapy and ART. HIV-associated KS is presumed to be hte underlying diagnosis.

Conclusion
All 3 patients had elevated risk for HIV infection, and 2 had final diagnoses attributed to chronic HIV infection, not warranting therapeutic immunosuppression. Screening for HIV infection prior to initiation of biologic therapy should be incorporated into clinical practice guidelines.

Disclosures
All Authors: No reported disclosures
972. Infection and Overdose Prevention for Persons with Injection Drug Use-Related Infections: Evaluation of an Inpatient Quality Improvement Program
Authors: Speight Carly C , Stoner Bobbi J , Guthrie George A , Brown Turkeisha S , Farel Claire E , Rivera M Patricia , Schranz Asher J 
Published: January 2021

Abstract

Background
Hospitalizations for injection drug use-related infections (IDU-I) are increasing in North Carolina and nationally. Many IDU-I, such as endocarditis, bone, joint, and spine infections, require long antimicrobial courses and extended inpatient stays. These hospitalizations are opportunities to engage patients in overdose and infection prevention.

Methods
A quality improvement (QI) program was piloted for inpatients with IDU-I. Eligible patients admitted to the inpatient pulmonary or infectious disease teams from 11/2019 to 01/2020 were referred to the QI team if they reported or were suspected to have injected drugs over the past year, or felt to benefit from drug-related infection prevention and overdose services. A checklist of recommendations to the care teams included: (1) screening for HIV, Hepatitis B (HBV) and C (HCV), (2) immunization for Hepatitis A (HAV), HBV, and tetanus, (3) prescription of naloxone at discharge, and (4) information on a syringe services program in or near their county. After review of the medical record, the QI team made recommendations on the appropriate taks from the checklist. The number of QI checklist tasks performed on the two inpatient teams during a 9-week pilot period (the above period excepting a two-week break) was reviewed. Baseline comparison data was not incorporated, owing to the challenges in retrospective identification of IDU-I.

Results
20 patients were included in the intervention. The median age was 32 years (IQR 27-38) and 70% were female. The most common diagnosis was endocarditis (40%) and the median length of stay was 11 days (IQR 5-42). HIV and HCV tests were each conducted in 95% of patients (Table). Screenings for HAV and HBV immunity were done in 90% of patients. HAV, HBV, and Tdap immunizations were given to 20%, 35%, and 50%, respectively. Naloxone was provided to 60% of patients at discharge and half of patients were referred to syringe programs. HCV was detected in 8 patients and HBV in 2 patients. No patients were diagnosed with HIV.
Percentage of infection and overdose prevention services provided to eligible IDU-I patients during hospitalization.

Conclusion
In a setting without comprehensive addiction consultation, a simple intervention provided guideline-concordant infection and overdose prevention services for persons hospitalized for IDU-I.

Disclosures
All Authors: No reported disclosures
975. Why Sex Make a Difference in HIV Clinical Course? Bioinformatics Analysis of Differential Expressed Gene in Females and Males with HIV Disease
Authors: Suwanwongse Kulachanya , Shabarek Nehad 
Published: January 2021

Abstract

Background
Human immunodeficiency virus (HIV) disease progression are different among genders, in which women usually progress to acquired immunodeficiency syndrome (AIDS) faster than men. The mechanisms resulting in the gender biases of HIV progression are unclear. We conducted a bioinformatics analysis of differentially expressed genes (DEGs) in women and men with HIV disease to understand the sex-based differences in HIV pathogenesis.

Methods
We obtained microarray data from the Gene Expression Omnibus (GEO) database using our pre-defined search strategy and analyzed data using the GEO2R platform. The t-test was done to compare DEGs between females and males with HIV diseases. The Database for Annotation, Visualization, and Integrated Discovery (DAVID) was implemented to systematically extract biological features and processes of retrieving DEGs via gene ontology (GO) analysis. A Systemic search was performed to evaluate each DEG function and its possible association with HIV.

Results
One gene expression profiling data were retrieved: GSE 140713, composed of 40 males and 10 females with HIV1 infected samples. A GEO2R analysis yielded 19 DEGs (Table 1). The GO analysis result was demonstrated in Tables 2 and 3. Following a systemic search, we found two DEGs, which have previous studies reported an association with HIV: DDX3X (20 studies) and PDS5 (1 study). We proposed DDX3X (t 5.3, p 0.0037) is responsible for gender inequalities of HIV progression because of: 1. DDX3X is needed in the HIV1 life cycle. 2. Several studies confirmed a positive correlation between DDX3X expression and HIV1 replication. 3. Our study found an up-regulated DDX3X expression in women corresponded to the fact that women progress to AIDS faster than men. 4. Our GO analysis showed female up-regulated genes were enriched in positive regulation of the gene expression pathway, which can be explained by DDX3X and its underlying mechanism.
Table 1: DEGs in women and men with HIV1 disease

Table 2: GO functional enrichment pathway analyses of overall retrieving DEGs

Table 3: GO functional enrichment pathway analyses of down- and up-regulated clusters of DEGs

Conclusion
Aberrant DDX3X expression may contribute to sex-based differences in HIV disease. Drugs modifying DDX3X gene expression will be beneficial in the treatment of HIV especially resolving the HIV drug resistance problem because current anti-HIV drugs target viral components posed the risk of viral mutation.

Disclosures
All Authors: No reported disclosures