bluuebunny/crossref_metadata_2025_split huggingface dataset:
1315. Food Insecurity and Viral Suppression in Human Immunodeficiency Virus Patients on Antiretroviral Treatment at an Urban Primary Care Practice
Authors: Doan Huynh Chi , Gutierrez Diana , Dakin Nicolette M , Valdivia Liza 
Published: October 2019

Abstract

Background
The U.S. Department of Agriculture (USDA) defines food insecurity as a lack of consistent access to enough food for an active and healthy life. A review of the literature indicates that there are only few studies on food insecurity and people living with human immunodeficiency virus (HIV) in the United States, despite it being one of the most basic physiological need. Here, we aimed to examine the association between food insecurity and viral load suppression in people with HIV on antiretroviral therapy (ART) at an HIV primary care practice.

Methods
This was a cross-sectional study conducted at an urban university hospital HIV primary care practice in Brooklyn, New York. It included patients seen during a six month period, from July 1 until December 31, 2018, that were found to have an unsuppressed viral load while reporting being on ART. We defined unsuppressed viral load as viral load >200 copies/milliliters. Food security was measured with the Household Food Insecurity Access Scale (HFIAS), a questionnaire by USAID’s Food and Nutrition Technical Assistance Program, which has demonstrated cross-cultured validity. It categorized patients into four groups: food secure and mildly, moderately or severely food insecure. Patient were contacted in clinic during their appointment or by telephone survey.

Results
A total of 145 patients were found to have an unsuppressed viral load while on ART, with 54 patients (37%) reporting food insecurity. Based on HFIAS’s classification, 44 patients (30%) reported mild or moderate food insecurity, and 10 patients (7%) reported severe food insecurity. The study population demographics was 86% African American or blacks, 12% Hispanics and 2% of other race. Seventy-three patients (50%) also reported receiving benefits from New York’s Supplemental Nutrition Assistance Program.

Conclusion
Food insecurity can be associated with unsuppressed viral load and was found in over one-third of our study population, with half relying on food assistance programs. It represents a complex problem fundamentally connected to issues such as poverty and unstable housing, which can negatively impact patient engagement and retention in care. Our findings highlight the importance of integrating food and social services into HIV programs, especially in lower-income populations.

Disclosures
All authors: No reported disclosures.
1329. Experiences and Emotional Challenges of Antiretroviral Treatment (ART)—Findings from the Positive Perspectives Study
Authors: De Los Rios Patricia , Young Benjamin , Marcotullio Simone , Punekar Yogesh , Koteff Justin , Ustianowski Andrew , Murungi Andrew 
Published: October 2019

Abstract

Background
While advances in treatment have dramatically improved the lives of people living with HIV (PLHIV), a number of important unmet needs remain. We conducted an international survey of PLHIV to explore their treatment experience and emotional challenges of ART.

Methods
Qualitative in-depth interviews were performed with PLHIV to identify key hypotheses. A steering group (led by community members) developed the survey tool which was fielded online from November 2016 to July 2017 in 8 high-income countries in North America (NA), Europe, and Australia. A mixed sampling/recruitment approach was used to ensure a broad cross-section of PLHIV. Respondents were screened for eligibility prior to receiving access to the online survey.

Results
1111 PLHIV were surveyed (74% male, 41% 35–49 years; 39% from NA). The majority (98%) were currently taking ARTs with 53% taking a single tablet regimen. Of those on treatment, 87% were satisfied with their current ART. Overall, results for NA respondents were similar to the global results. Many participants reported emotional challenges associated with their daily HIV treatment experience: 66% agreed taking ART every day was a reminder of their HIV status; 25% agreed being tied to a daily medication limited their day-to-day life; and 29% agreed they felt stressed and under pressure to take their HIV medication at the right time every day. Those not “open” about their HIV status were more likely to feel stressed by their medication and felt that it limited them. 37% of participants frequently or quite often hid their HIV medication to avoid revealing their HIV status, particularly amongst those who reported experiencing stigma or high emotional impact of HIV. 89% felt that advances in treatment will improve their quality of life. Reducing long-term adverse effects of ART and lowering dosing frequency were considered the most important areas for improvement; this was similar across demographics such as country, age, and gender.

Conclusion
In this international survey of PLHIV, despite overall satisfaction with current ART, significant emotional burden and daily impact of treatment persists. PLHIV consider the reduction of long-term adverse effects and dosing frequency important areas for improving ART.

Disclosures
All authors: No reported disclosures.
1336. Impact of Procalcitonin-Guided Antibiotic Management in Chronic Obstructive Pulmonary Disease Exacerbation and Community-Acquired Pneumonia
Authors: Triner Molly , Patel Sunita , Craft Rachael , Rajkumar Aarthi , Patel Tejas 
Published: October 2019

Abstract

Background
Chronic obstructive pulmonary disease (COPD) exacerbation and community-acquired pneumonia (CAP) are major drivers of antibiotic overuse, primarily due to challenges in pathogen identification. Procalcitonin is a serum biomarker that assists in distinguishing bacterial infection from other causes. The purpose of this study was to determine whether the use of a procalcitonin (PCT) guided algorithm in patients diagnosed with COPD exacerbation and/or CAP can reduce antibiotic exposure without negatively impacting clinical outcomes.

Methods
This was a quasi-experimental study conducted at Mercy Medical Center in Canton, Ohio. The patient data for the retrospective cohort (control group) was collected from the months of September 2017 through January 2018. The prospective phase (PCT group) took place during the months of September 2018 through January 2019. Physicians utilized a procalcitonin guided algorithm to determine appropriate initiation and duration of antibiotic use in patients admitted with a primary diagnosis of COPD exacerbation and/or CAP. The primary outcome was the duration of antibiotic therapy, measured in days. Secondary outcomes included all-cause hospital readmission within 30 days of discharge, respiratory-related hospital readmission within 30 days of discharge, 30-day mortality, hospital length of stay, and adverse events to antibiotics.

Results
A total of 76 patients were included in the study, 43 in the control group and 33 in the PCT group. Baseline characteristics were similar between groups. The use of a PCT algorithm significantly decreased duration of antibiotics by 2.7 days in comparison to the control group (2.6 [n = 33] vs. 5.3 [n = 43] days; P < 0.001; 95% CI). Secondary safety outcomes between the PCT and control group were similar, including all-cause hospital readmission within 30 days of discharge (30.3% vs. 25.6%; P = 0.648), respiratory-related hospital readmission within 30 days of discharge (80.0% [n = 10] vs. 81.8% [n = 11]; P = 0.731), and 30-day mortality (no incidence in either group).

Conclusion
The use of a PCT algorithm significantly reduced duration of antibiotics by 2.7 days without negatively impacting clinical outcomes in patients being treated for COPD exacerbation and/or CAP.

Disclosures
All authors: No reported disclosures.
1339. Impact of Implementing Procalcitonin Testing with Comprehensive Education on Procalcitonin Ordering Habits and Antibiotic Usage
Authors: Johnsrud Joyce , Dare Ryan K 
Published: October 2019

Abstract

Background
Procalcitonin (PCT) has emerged as a biomarker distinguishing bacterial from non-bacterial infections with FDA approval for acute respiratory infections and sepsis. Studies show that PCT use can reduce patient harm while decreasing antibiotic usage. Our objective was to evaluate PCT use at our hospital and assess the impact of a comprehensive education intervention.

Methods
In-house PCT testing was implemented at our institution April 2018 along with a rigorous education campaign. Interventions consisted of face-to-face didactics with 5 provider groups, distribution of evidence-based interpretation algorithms, development of EMR prompts to guide appropriate ordering, and creation of syndrome-specific interpretation displayed with PCT results. Retrospective analysis comparing pre-intervention (December 2017) to post-intervention (October 2018) was performed evaluating ordering habits and impact of PCT result on antibiotic management. Statistical analysis was performed using STATA 14.2.

Results
218 PCT orders from 170 patients and 263 PCT orders from 170 patients were included in the pre- and post-intervention periods, respectively. All provider groups who received face-to-face education changed PCT ordering habits. Orders placed in ED and ICU locations increased (P < 0.01 and P = 0.01, respectively) while orders from floor locations decreased (P < 0.01). Serial PCT orders increased (20% vs. 33%; P < 0.01). PCT orders for FDA-approved indications improved (71% vs. 90%; P < 0.01) and following intervention, services who received in-person didactics were more likely to order PCT for FDA-approved indications than untrained groups (93% vs. 80%; P < 0.01). Clinicians were less likely to adjust therapy when PCT was low than when elevated in both periods (55% vs. 72%; P = 0.01; 61% vs. 77%; P = 0.01, respectively). Providers appropriately altered or continued therapy at similar rates during both periods (64% vs. 70%; P = 0.2).

Conclusion
Providing comprehensive PCT education significantly impacted PCT ordering habits. Testing improved to comply with FDA-approved indications, specifically in providers who received face-to-face education. Appropriate alteration of therapy based on PCT results were similar between groups suggesting repeat education is needed to avoid confirmation bias.

Disclosures
All authors: No reported disclosures.
1345. Randomized Control Trial to Evaluate the Clinical and Cytokine Response Profile to Oral Thalidomide in Leprosy Patients with Erythema Nodosum Leprosum
Authors: Chopra Ajay , Mitra Debdeep 
Published: October 2019

Abstract

Background
Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. Erythema Nodosum Leprosum is an acute inflammatory Type III hypersensitivity response during the chronic course of the disease process. This immune response manifests clinically as painful red nodules and systemic symptoms similar to sepsis with neutrophilic leukocytosis. Capsule Thalidomide is the drug of choice for treating this condition.

Methods
A randomized control study to study the immunological markers involved in the pathogenesis of erythema nododsum leprosum and its successful suppression by Thalidomide should provide newer insight into the pathogenesis of this disease process, provide better diagnostic and therapeutic options and better markers to predict prognosis. Based on the previous studies our aim was to find a correlation with tumor necrosis factor-a, interferon-gamma, and Cd-64 expression on activated circulating neutrophils during Type II lepra reaction and the successful response to capsule Thalidomide. Venous blood samples were collected from all the samples and after 7 days post thalidomide therapy, only in the treated population. All the patients with type II lepra reaction responded to Capsule Thalidomide clinically and all the skin lesions resolved in 7–14 days. Blood samples and skin biopsy was subjected to histopathology, immunofluorescence assay, immunohistochemical staining, quantitative RT–PCR (reverse transcriptase-polymerase chain reaction) and flow cytometry.

Results
Study found out that Interferon Γand Tumor necrosis factor-Α are sensitive markers in diagnosing erythema nodosum leprosum and Cd-64 expression on activated circulating neutrophils is both a specific and sensitive marker. Cd-64 expression also had a positive correlation with Thalidomide treatment and clinical response.

Conclusion
Cd-64 expression on circulating neutrophils is a potential early biophysical marker for diagnosing erythema nodosum leprosum and can be used as a tool to assess thalidomide response. InterferonΓ and Tumor necrosis factorΑ are sensitive markers to screen for lepra reactions and this study showed no significant correlation with Thalidomide therapy.

Disclosures
All authors: No reported disclosures.
1356. A Randomized Controlled Trial of Prednisolone vs. TNF-α inhibitor Infliximab in the Management of Type 1 Lepra Reaction in Leprosy Patients
Authors: Chopra Ajay , Mitra Debdeep 
Published: October 2019

Abstract

Background
Leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae. Type 1 lepra reactions (T1R) are an acute inflammatory response during the chronic course of the disease. If it is not treated promptly with immune suppression, it can lead to a permanent disability affecting hands, feet and eyes. tumor necrosis factor-alpha (TNF-a) which is produced mainly by inflammatory T cells is up-regulated in patients of Type I Lepra reaction. Conventionally oral corticosteroids steroids have been the mainstay in the management of Type 1 Lepra reactions. This novel biologic drug is a targeted therapy which blocks the offending interleukin molecule without any serious adverse effects. We report the results of this randomized control study wherein an immuno-modulator biologic molecule has been safely used to treat an inflammatory reaction in a chronic infectious disease. Outcomes were measured using recurrence rate, a clinical severity score, quality of life and adverse events.

Methods
62 patients with new Type 1 Lepra reactions were randomized to receive Infliximab (a chimeric monoclonal antibody biologic drug that works against tumor necrosis factor-alpha (TNF-α) or Prednisolone for 20 weeks. TNF-α levels were correlated before and after the intervention.

Results
Recovery rates in skin signs were similar in both groups (91% vs. 86%). Improvements in nerve function both, new and old, sensory (68% vs. 49%) and motor (72% vs. 77%) loss were higher (but not significantly so) in the patients on Infliximab. Recurrences rates of lepra reaction (24%) were high in both groups, and recurrences occurred significantly earlier (8 weeks) in patients on Infliximab, who needed 10% more additional prednisolone. Serious major and minor adverse events rates were much lesser with Infliximab as compared with Prednisolone alone. Both groups had a significant improvement in their quality of life after the study, measured by the short-form survey SF-36.

Conclusion
This is the first double-blind randomized control trial assessing Infliximab, in the management of lepra reaction. It could be a safe alternative second-line drug for patients with leprosy reactions who are not improving with prednisolone or are experiencing adverse events related to prednisolone.

Disclosures
All authors: No reported disclosures.
1361. Knowledge, Attitude, and Practices on Drug-Resistant Tuberculosis Infection Control Among Healthcare Workers in Nepal: A Cross-Sectional Study
Authors: Kumar. Shrestha Sailesh , Bhattarai Ratna , Raj Joshi Lok , Kumar Shrestha Suvesh , Basnet Rajendra , Thapa Anil , Narsingh Kc Kedar 
Published: October 2019

Abstract

Background
Healthcare centers are important sites for tuberculosis transmission, particularly in low-income settings where the burden of tuberculosis is high and infection control practices are often inadequate. This study aims to assess the knowledge, attitude, and practices of drug-resistant tuberculosis infection control among the healthcare workers under the National Tuberculosis Control Program in Nepal.

Methods
In this descriptive cross-sectional survey, we studied the healthcare workers from all the functioning drug-resistant tuberculosis treatment centers across Nepal between March 1, 2018 and March 15, 2018. Nepal Health Research Council provided ethical clearance. Trained enumerators obtained informed consent and conducted face-to-face interviews with a pretested questionnaire to collect data on the basic characteristics of healthcare workers, their self-reported knowledge, attitude, and practice on tuberculosis infection control. We assigned a score of one to the correct response and zero to the incorrect or no response and calculated a composite score in each of the knowledge, attitude, and practice domains. We ascertained the healthcare workers as having good knowledge, appropriate attitude, and optimal practices when the composite score was at least 50%. We summarized the numerical variables with median and interquartile range (IQR) and the categorical variables with proportions.

Results
A total of 95 out of 102 healthcare workers from 11 drug-resistant tuberculosis treatment centers participated in the study. There were 46 male and 49 female respondents. The median age was 33 years (IQR 26–42). The majority of them (53, 56%) were mid-level paramedics. The median work experience in drug-resistant tuberculosis was 2 years (IQR 1–5). We found 91 (96%) respondents had a good knowledge of tuberculosis infection control with the median knowledge score of 14 (IQR 12–14), 49 (52%) respondents had an appropriate attitude with the median attitude score of 5 (IQR 4–6) and 35 (37%) respondents had optimal practices with the median practice score of 5 (IQR 4–7).

Conclusion
Healthcare workers at the drug-resistant tuberculosis treatment centers in Nepal had good knowledge of tuberculosis infection control but it did not translate into an appropriate attitude or optimal practices.

Disclosures
All authors: No reported disclosures.
1366. Prognostic Factors for Unfavorable Outcomes of Patients with Spinal Tuberculosis in a Country with an Intermediate Tuberculosis Burden: a Multi-Center Cohort Study
Authors: Ho Kim Jung , young Ahn Jin , Jin Jeong Su , su Ku Nam , yong Choi Jun , Keun Kim Young , Yeom Joon-Sup , Goo Song Young 
Published: October 2019

Abstract

Background
Spinal tuberculosis (TB) remains an important concern. Although spinal TB often has sequelae such as myelopathy after treatment, the predictive factors affecting such unfavorable outcomes are not yet known. Therefore, we investigated the clinical manifestations and predictors of unfavorable treatment outcomes in patients with spinal TB.

Methods
We performed a multi-center retrospective cohort study of patients with spinal TB. The clinical features, comorbidities, laboratory data, imaging findings and treatment outcomes of the patients were analyzed. The unfavorable outcome was defined according to previous studies. The prognostic factors for unfavorable outcomes as the primary outcome were determined using multivariate logistic regression analysis and a linear mixed model were used to compare time course of inflammatory markers during treatment.

Results
A total of 185 patients (85 males and 100 females) were included. The mean age of the patients was 57.2 years. Of them, 115 underwent surgery during treatment, with a median treatment duration of 12 months. Fifty-nine patients had unfavorable outcomes. In multivariate regression analysis, the factors associated with unfavorable outcome were old age (odds ratio [OR], 2.51; P = 0.034), acid-fast bacilli (AFB) smear positivity in specimens obtained through biopsy (OR, 3.05; P = 0.039), and elevated erythrocyte sedimentation rate (ESR) at the end of treatment (OR, 3.85; P = 0.002). Patients with unfavorable outcomes had a significant trend toward higher ESR during treatment compared with patients with favorable outcome (P = 0.009). Duration of anti-TB and surgical treatment did not affect prognosis.

Conclusion
Elevated ESR at the end of treatment could be used as a marker to identify spinal TB patients with a poor prognosis. Patients whose ESR are not normalized during treatment, as well as those with old age and AFB smear positivity, should be aware of unfavorable outcomes.

Disclosures
All authors: No reported disclosures.
1386. Reduction in Expected Survival Associated with Nontuberculous Mycobacterial Pulmonary Infection
Authors: Mourad Ahmad , Baker Arthur W , Stout Jason E 
Published: October 2019

Abstract

Background
Nontuberculous mycobacteria (NTM) are emerging agents of pulmonary disease, estimated to affect >80,000 people in the United States. While the spectrum of pulmonary NTM severity is broad, some published series report 5-year mortality of up to 40%.

Methods
We conducted a retrospective cohort study to examine mortality of patients with positive respiratory cultures for NTM in the Duke Health System from January 1, 1996 to June 30, 2015, compared with the expected mortality in the US population among a cohort with the same demographic composition. We included patients with ≥2 positive NTM respiratory cultures, or 1 positive culture plus an associated ICD diagnosis. Patients with disseminated NTM, HIV, cystic fibrosis, and solid-organ or hematopoietic cell transplants were excluded, as were isolates of Mycobacterium gordonae. Five specific comorbidities (cancer, chronic obstructive pulmonary disease, stroke, chronic renal failure, myocardial infarction) were assessed with ICD codes. Survival was measured from the date of first positive NTM culture and censored as of 6/30/2015.

Results
We identified 653 patients who met the case definition. 451 (69%) were female; 548 (84%) were Caucasian, and the median age was 69 years (IQR 59–76). 544 (83.3%) patients had only Mycobacterium avium complex (MAC) isolates in cultures; 39 (6%) had only M. abscessus; 33 (5%) had both MAC and M. abscessus; 37 (5.7%) had other NTM isolates. Most patients (n = 410, 62.8%) had none of the evaluated comorbidities prior to NTM diagnosis. Median follow-up time was 1252 days (IQR 449–2688). Median survival in our cohort among persons with and without comorbidities was 1973 days (95% CI 1487–2995) and 3952 days (95% CI 3496–5186), respectively. Median expected survival in the demographically-matched population cohort was significantly longer at 5479 days (P<.0001). Mortality at 5 years was 47.9% (39.7–55.0) and 27.2% (95% CI 22.1–32.0) among NTM patients with and without comorbidities, respectively, vs. expected mortality of 5.7% in the general population.

Conclusion
NTM pulmonary infection in our cohort was associated with significantly lower survival than expected in the general population. The impact of NTM infection itself vs. other comorbidities on survival requires further study.

Disclosures
All authors: No reported disclosures.