bluuebunny/crossref_metadata_2025_split huggingface dataset:
959. HIV-1 DNA Testing Identifies Drug Resistance in Viremic Patients with Pan-Sensitive Plasma Virus
Authors: Curanovic Dusica , Martens Sharon K , Rodriguez Milka A , Hammill Hunter A , Petropoulos Christos J , Walworth Charles M 
Published: January 2021

Abstract

Background
HIV-1 drug resistance mutations (DRMs) are lost from plasma virus in the absence of selective drug pressure. Therefore, viremic patients who present with pan-sensitive plasma HIV-1 may harbor archived drug resistance that hinders virologic suppression upon reinstatement of therapy. We sought to determine if testing HIV-1 DNA in peripheral blood mononuclear cells (PBMCs) can identify drug resistance in patients with pan-sensitive plasma virus.

Methods
Sixty-four patients were identified who had HIV-1 RNA and HIV-1 DNA drug resistance testing performed on the same day and demonstrated pan-sensitive virus on the HIV-1 RNA test. Antiretroviral (ARV) resistance and DRMs identified by each test were compared between 66 test pairs. Patients were stratified by viral load (VL) to assess its impact on resistance detection using t-test and correlation analyses.

Results
The mean patient age was 37; 92% were female. Most (94%) were infected with HIV-1 subtype B, with an average VL of 110,000 c/mL (150 - 1,470,000 c/mL) at the time of resistance testing. Resistance to at least one ARV was reported on 20% (13/66) of HIV-1 DNA tests, and was associated with nucleos(t)ide and non-nucleoside reverse transcriptase inhibitors (NRTIs and NNRTIs), protease inhibitors (PIs), and integrase inhibitors (INIs) on 4.5%, 9%, 4.5%, and 6% of HIV-1 DNA reports, respectively. Across all HIV-1 DNA tests, 74 DRMs were identified that were not found in the plasma virus, including 12 NRTI, 16 NNRTI, 39 PI, and 7 INI DRMs; M184V was identified on 4.5% (3/66) of HIV-1 DNA reports. The mean VL was not significantly different between HIV-1 DNA tests reporting resistance to at least one ARV (101,000 c/mL) and those reporting pan-sensitivity (110,000 c/mL). Viral load at time of testing did not correlate with the number of ARVs to which resistance was reported.

Conclusion
In viremic patients with pan-sensitive plasma virus, HIV-1 DNA testing can identify drug resistance regardless of VL level. Assessment of drug resistance in HIV-1 DNA may be useful in designing suppressive ARV regimens for patients whose plasma virus DRMs fail to be identified due to lack of adherence or continuity of care.

Disclosures
Dusica Curanovic, PhD, Monogram Biosciences (Employee) Sharon K. Martens, MN, Monogram Biosciences (Employee) Milka A. Rodriguez, PhD, Monogram Biosciences (Employee) Christos J. Petropoulos, PhD, Monogram Biosciences (Employee) Charles M. Walworth, MD, Monogram Biosciences (Employee)
964. Opt-Out HIV- Hepatitis C (HCV) Testing at a Primary Care Resident Clinic in Columbia, SC: Who Gets Tested and Who Opts Out of Testing?
Authors: Pinkney Jodian , Ahuja Divya , Derrick Caroline , Durkin Martin 
Published: January 2021

Abstract

Background
South Carolina (SC) remains one of the most heavily affected states for both HIV and HCV infections. Males account for the majority of cases. Implementation of universal opt-out testing has improved screening rates but not much has been published describing the characteristics of those who opt out of testing. This becomes important as 10-50% of patients have opted out in previous studies.

Methods
Between February and August 2019, we conducted a quality improvement (QI) project which implemented opt- out HIV-HCV testing at a single primary care resident clinic in SC with the primary aim of increasing screening rates for HIV-HCV by 50%. Secondary aims included describing the demographic characteristics of the opt-out population. Persons were considered eligible for testing if they were between the ages of 18-65 years for HIV and 18-74 years for HCV. This was prior to the USPSTF 2020 guidelines which recommend HCV screening for adults aged 18-79 years. A retrospective chart review was used to obtain screening rates, opt status and demographic data. Logistic regression and the firth model were used to determine linkages between categorical variables. We present 3-month data.

Results
1253 patients were seen between May 1, 2019- July 31, 2019 (See Table 1). 985 (78%) were eligible for HIV testing. 482 (49%) were tested for HIV as a result of our QI project and all tests were negative. 212 (22%) of eligible patients opted out of HIV testing. Males were 1.59 times more likely to opt out (p=0.008). (see Table 2,3)
Regarding HCV, 1136 (90.7%) were deemed eligible for testing. 503 (44%) were tested for HCV as a result of our QI project. 12 (2.4%) were HCV antibody positive with viremia. 11 (90%) of antibody positive with viremia cases were in the 1945-1965 birth cohort (see Table 4). 244 (21%) opted out of HCV testing. Males and persons without a genitourinary chief complaint were more likely to opt out (p=0.02).
Table 1: Demographic characteristics of the population seen at the internal medicine resident clinic between May- July 2019

Table 2: Relationship between demographic variables and the odds of being tested for HIV or HCV within the last 12 months. Logistic Model.

Table 3: Relationship between demographic variables and the odds of opting out of testing for HIV or HCV. Firth Model.

Conclusion
Although implementation of routine HIV-HCV opt-out testing led to increased screening rates for both HIV and HCV, roughly 1 in 5 eligible patients chose to opt out of testing. Males were more likely to opt out despite accounting for the majority of newly diagnosed HCV cases. Future studies investigating drivers for opting-out in the male population could improve testing and assist with early diagnosis.
Table 4: Characteristics of patients newly diagnosed with HCV positive with viremia.

Disclosures
All Authors: No reported disclosures
965. Partnering with State Health Departments: A Road Map for Collaboration Using Public Health Enhanced HIV/AIDS Reporting System (eHARS)
Authors: Bassler John R , Levitan Emily B , Ostrenga Lauren , Crear Danita C , Johnson Kendra L , Cooper Gabrielle , Kay Emma Sophia , Parman Mariel , Nassel Ariann F , Mugavero Michael J , Batey D Scott , Rana Aadia 
Published: January 2021

Abstract

Background
Academic and public health partnerships are a critical component of the Ending the HIV Epidemic: A Plan for America (EHE). The Enhanced HIV/AIDS Reporting System (eHARS) is a standardized document-based surveillance database used by state health departments to collect and manage case reports, lab reports, and other documentation on persons living with HIV. Innovative analysis of this data can inform targeted, evidence-based interventions to achieve EHE objectives. We describe the development of a distributed data network strategy at an academic institution in partnership with public health departments to identify geographic differences in time to HIV viral suppression after HIV diagnosis using eHARS data.
Figure 1. Distributed Data Network

Methods
This project was an outgrowth of work developed at the University of Alabama at Birmingham Center for AIDS Research (UAB CFAR) and existing relationships with the state health departments of Alabama, Louisiana, and Mississippi. At a project start-up meeting which included study investigators and state epidemiologists, core objectives and outcome measures were established, key eHARS variables were identified, and regulatory and confidentiality procedures were examined. The study methods were approved by the UAB Institutional Review Board (IRB) and all three state health department IRBs.

Results
A common data structure and data dictionary across the three states were developed. Detailed analysis protocols and statistical code were developed by investigators in collaboration with state health departments. Over the course of multiple in-person and virtual meetings, the program code was successfully piloted with one state health department. This generated initial summary statistics, including measures of central tendency, dispersion, and preliminary survival analysis.

Conclusion
We developed a successful academic and public health partnership creating a distributed data network that allows for innovative research using eHARS surveillance data while protecting sensitive health information. Next, state health departments will transmit summary statistics to UAB for combination using meta-analytic techniques. This approach can be adapted to inform delivery of targeted interventions at a regional and national level.

Disclosures
All Authors: No reported disclosures
970. Transmitted Antiretroviral Drug Resistance Over a Period of 11 years at a Single Center in Southeast, USA
Authors: Klibanov Olga M , Gillette Chris , Ekwonu Tagbo 
Published: January 2021

Abstract

Background
In the United States, the prevalence of TDRMs is approximately 20%. As newer agents have become available, INSTI-based therapies have become the standard first-line treatment. The objectives of this study were to: (1) examine the incidence of TDRMs during 2008-2019 at a single institution and, (2) examine the association between TDRM and year as well as type of therapy.

Methods
A retrospective chart review was conducted at a single center in the Southeast United States. Resistance was defined on the basis of the International AIDS Society 2019 definition and Stanford University’s HIV Drug Resistance Database. Relative risk and multivariable logistic regression were used to analyze data.

Results
Among 456 treatment-naïve patients who entered care 2008-2019 (80% male, 86% African American, mean CD4 count 359 cells/mm3), the cumulative incidence rate of &gt;1 TDRM was 19.3% (n=88). There has been a steady increase in annual cumulative incidence in TDRMs since 2008, with the highest incidences in 2018 (46,667/100,000) and 2019 (36,585/100,000). Over the 11-year study period NNRTI resistance was most common (67/88; 76%), followed by NRTI (9/88; 10%), PI (4/88; 5%), and INSTI (2/88; 2%). Dual class resistance was noted in 6 (7%) patients, one of whom had TDRMs in the INSTI and NNRTI classes. The relative risk (RR) for TDRMs was 1.76 (95% CI=1.42-2.17). According to the regression model, compared to patients whose initial treatment was NNRTI-based, patients who started treatment on PI-based therapies (OR=5.34, 95% CI=2.17-13.11) or INSTI-based therapies (OR=4.00, 95% CI=1.43-11.20) had significantly greater odds of TDRMs, controlling for age, gender, race, baseline CD4+ count, HIV RNA, hepatitis B status, hepatitis C status, and time period of testing. The time period was not significantly related to TDRM incidence in this model.
TDRM Incidence 2008-2019

Conclusion
The overall incidence of TDRMs in our clinic mirrors national surveillance data, with notably higher incidences in the last 2 years. Prescribing of the newly available INSTI-based regimens reflects the continued increase in the incidence of NNRTI TDRMs.

Disclosures
All Authors: No reported disclosures
971. Unmasking the Undetectable: Identifying and Troubleshooting a Series of Falsely Elevated HIV Viral Load Results in a Group of Patients in a Community Clinic in San Antonio, Texas
Authors: Pinilla Ruth Serrano , Hartzler Anthony 
Published: January 2021

Abstract

Background
Using effective antiretroviral therapy to consistently suppress plasma HIV RNA levels to &lt; 200 copies/mL is known to improve morbidity and mortality at all stages of HIV infection and prevent transmission to sexual partners. Logistical challenges such as transporting, processing, and storing samples may threaten the accuracy of the test results. Plasma Preparation tubes (PPT) or Ethylene Diamine Tetra Acetic Acid (EDTA) tubes can be used for this test. PPT tubes contain an inert gel that migrates during centrifugation, forming a barrier between the plasma and cellular elements. Adequate separation of cellular elements may not always occur, and this can result in falsely elevated HIV Viral load (VL) due to measurement of integrated intracellular virus. It is therefore routine practice to centrifuge samples twice when PPT tubes are used. This is not necessary with EDTA tubes. In addition, there are reports that HIV RNA levels may be higher with PPT tubes are used, compared to EDTA tubes.

Methods
This is a quality improvement project that reviews a series of falsely elevated HIV VL in a group of patients who reported adherence and had been previously virologically suppressed.

Results
A total of 20 unexpectedly elevated HIV VL were identified from January to March of 2020 after introduction of a new phlebotomist in our clinic. VL ranged from 200-2530 copies/ml. Most patients (18/20) had history of virologic suppression and reported adherence. We standardized our process by using only PPT tubes and centrifuging samples twice prior to processing. Our nurses reported visible residual cellular elements in some of the plasma specimens in the tubes even after appropriate centrifugation. We continued to see suspected erroneous results. We repeated the test in EDTA tubes. 16/19 had HIV VL &lt; 20, the remainder ranged from 27-41 copies/ml. We then implemented the use of EDTA tubes in all samples. No further cases of falsely elevated VL have been seen since the change.
Table 1

Conclusion
We describe potential steps that can interfere in the accuracy of HIV VL results. Detailed review of past history and patient’s adherence to treatment is essential to identify systemic problems that may lead to errors. Close communication with staff and laboratory provider will be key to overcome such challenges.

Disclosures
All Authors: No reported disclosures
974. The Effects of Changes in State-Level Policies Affecting Eligibility for the Supplemental Nutrition Assistance Program (SNAP) on Annual HIV Diagnoses in the United States
Authors: Richterman Aaron , Ivers Louise , Tsai Alexander , Block Jason 
Published: January 2021

Abstract

Background
The connection between food insecurity and HIV outcomes is well-established. The Supplementary Nutrition Assistance Program (SNAP), the primary program in the United States that addresses food insecurity, may have collateral impacts on HIV incidence, but the extent to which it does is unknown. “Broad-based categorical eligibility” for SNAP is a federal policy that provides a mechanism for states to increase the income or asset limits for SNAP eligibility. The Department of Agriculture under the Trump Administration has proposed eliminating this policy.

Methods
We estimated the association between the number of new HIV diagnoses from 2010 to 2014 for each state and (1) state income limits for SNAP eligibility as a percentage of the federal poverty level and (2) state asset limits for SNAP eligibility (increased/eliminated vs. unchanged). We fitted multivariable negative binomial regression models with annual incidence of HIV diagnoses specified as the outcome; SNAP policies as the primary explanatory variable of interest; state and year fixed effects; and time-varying covariates related to the costs of food, health care, housing, employment, SNAP outreach, and total spending on Temporary Assistance for Needy Families (TANF) programs.

Results
From 2010 to 2014, 204,034 new HIV diagnoses occurred in the United States. HIV diagnoses within states had a statistically significant inverse association with state income limits for SNAP eligibility (IRR 0.94 per increase in the income limit by 35% of federal poverty level, 95% CI 0.91-0.98), but no statistically significant association with state asset limits (increased asset limit vs. no change, IRR 1.02, 95% CI 0.94-1.10; eliminated asset limit vs. no change, IRR 1.04, 95% CI 0.99-1.10) (Table).
Table

Conclusion
State income limits for SNAP eligibility were inversely associated with the number of new HIV diagnoses for states between 2010-2014. Proposals to eliminate the use of broad-based categorical eligibility to increase the income limit for SNAP may undercut efforts to end the HIV epidemic in the United States.

Disclosures
All Authors: No reported disclosures
976. A Descriptive Retrospective Data Analysis of Maternal Sociodemographic Factors and Access of Healthcare Resources within the African Cohort Study, an Integrated Multicountry Preventative Mother to Child Transmission Program
Authors: Traver Jeanette , Esber Allahna L , Dear Nicole , Polston Elizabeth , Iroezindu Michael , Bahemana Emmanuel , Kibuuka Hannah , Owuoth John , Maswai Jonah , Crowell Trevor A , Polyak Christina , Ake Julie A , Kunz Anjali 
Published: January 2021

Abstract

Background
Global reduction in new infant HIV infections is largely due to the expansion of prevention of mother-to-child transmission (PMTCT) programs. Identification of gaps in healthcare services is paramount in targeting interventions that identify high-risk populations and healthcare barriers that could lead to increased risk of mother to child transmission (MTCT) of HIV.

Methods
HIV infected women from 5 regions of Africa enrolled in the African Cohort Study (AFRICOS) were followed prospectively with assessments performed every 6 months. Sociodemographic factors, pregnancy outcomes, and access of PMTCT resources were reviewed for retrospectively reported pregnancies and those followed prospectively from study enrollment. Statistical analysis compared the impact of clinical factors on infant mortality and preterm delivery.

Results
The study reported 5591 pregnancies from January 2013 to June 2019 of which 5363 were retrospectively reported prior to study enrollment and 228 occurred after enrollment. Pregnancies followed prospectively had higher rates of linkage to PMTCT services prenatally (92.5% vs 6.8%, P&lt; 0.001), intrapartum (64.5% vs 3.5%, P&lt; 0.001), and post-partum (64.5% vs 2.9%, P&lt; 0.001). This group had higher rates of delivery by a skilled birth attendant (93.4% vs 66.7%, P&lt; 0.001) and antiretroviral therapy (ART) prescribed antepartum (96.1% vs 5.5%, P&lt; 0.001) and post-partum (74.6% vs 3.6%, P&lt; 0.001). Both groups had similar rates of prescriptions for intrapartum ART (98.7% vs 97.9%). The majority of women reported ART adherence (96.5%, P&lt; 0.001) which was associated with a decrease in both preterm delivery and infant mortality (adjusted OR 0.24, 95% CI 0.15-0.39). A significant proportion of women followed prospectively reported their infants received ART with good adherence (51.8% vs 0.3% and 93.4% vs 6.3%, respectively P&lt; 0.001).

Conclusion
Participation in AFRICOS increased linkage to PMTCT programs which resulted in increased likelihood of skilled delivery and appropriate ART use for women and their infants. It highlights that linkage to care continues to be a crucial factor in limiting MTCT of HIV especially in resource-limited settings. Limitations in this study exist due to the low number of prospectively followed pregnancies.

Disclosures
All Authors: No reported disclosures
978. Barriers to Recruitment of Latino Men who Have Sex with Men and Transgender Women to Behavioral HIV Seroprevalence Studies
Authors: Flores John M , Jaramillo Natalie , Pagan-Parillo Patricia , Alvarez Carina , Hodge David , Khosla Shaveta , Brito Maximo O 
Published: January 2021

Abstract

Background
Chicago’s HIV epidemic disproportionally affects people of color. Almost a quarter (23%) of these infections occur in Hispanics. It is important to understand sexual behaviors and HIV risk in Latino MSM and transgender women (TGW) to create targeted culturally sensitive harm reduction interventions. However, participation of minority MSM and TGW in survey-based studies is low. The main objective of the study was to understand the sexual health and of Latino MSM and TGW residing in Chicago, Illinois, United States. We herein report subject’s attitudes towards participating in the study and qualitative observations about perceived barriers to enrollment of this population.

Methods
This study was a cross sectional analysis of a behavioral/HIV seroprevalence survey administered during 2017-2020 to presumed HIV negative, Latino identifying, MSM and TGW individuals. The survey included questions on sexual risk, HIV knowledge and depression scores. We categorized recurrent themes of the most common reasons participants provided for declining to participate in the study. We generated descriptive statistics.

Results
A total of 48 community organizations assisted with recruitment. Of 149 participants screened, only 18 (12%) agreed to complete the survey. Among those who declined to complete the survey (n=131), the most common reasons given were: participants were uncomfortable answering some questions (n=59, 45.0%), participant’s did not have the time to initiate or complete the survey (n=41, 31.3%) and survey was deemed long (n=16, 12.2%).
We categorized barriers to successful recruitment into the following general themes: 1) Participants were unwilling to discuss their sexual history; 2) Participant’s felt uncomfortable taking a rapid oral HIV test; 3) Participant’s lacked transportation; and 3) Participants didn’t have time to complete the survey or thought it was too long.

Conclusion
Despite extensive community networking, we found barriers to recruitment of high-risk Latino MSM and TGW into an HIV seroprevalence study. Further research is needed to better understand and address these barriers, and thus, increase representation of this key population in prevention studies.

Disclosures
All Authors: No reported disclosures
980. Drexel Medicine Resident Knowledge, Practices and Attitudes Regarding Pre-exposure prophylaxis (PrEP)
Authors: Mainville Jen E , Gracely Ed , Szep Zsofia 
Published: January 2021

Abstract

Background
Pre-exposure prophylaxis (PrEP) is a highly effective daily oral antiretroviral medication that was approved by the FDA in 2012 and has been shown to reduce the risk of HIV by 95% in real-world studies. Despite this, many healthcare providers are not offering PrEP to their patients who are at risk for HIV.

Methods
We performed a cross-sectional study among Drexel Internal Medicine, Family Medicine, and Obstetrics and Gynecology residents. The survey included questions about experience, knowledge, attitudes toward and barriers to using PrEP. The survey was adapted from previous studies regarding medical providers’ attitudes and knowledge about PrEP (Petroll, 2016; Seifman, 2016; Blumenthal, 2105). A Likert 5-point scale was used for attitude and barriers questions.

Results
Among 143 participants, 80% specialized in Internal Medicine. 43% of participants were in their first year of training and the mean age (+ SD) was 28.8 + 2. 76% reported never initiating a conversation about PrEP with a patient and only 18% reported ever prescribing PrEP to their patients. 92% reported being very or extremely willing to prescribe PrEP to a male with a current male partner known to be HIV positive. Only 43% of residents reported being moderately likely to prescribe PrEP to a patient coming in for a STI exposure. 68% of residents reported their knowledge about PrEP was a major barrier to prescribing PrEP.

Conclusion
We found that most residents have minimal experience with prescribing PrEP, and knowledge was identified as the largest barrier. Additional education and a better understanding of PrEP indications is necessary to ensure eligible PrEP patients have access to this highly effective HIV prevention method.

Disclosures
All Authors: No reported disclosures