bluuebunny/crossref_metadata_2025_split huggingface dataset:
1025. Integrating buprenorphine into an urban HIV primary care practice: Outcomes on viral load suppression and opioid use
Authors: Fabricant Scott , Nyaku Amesika , Dalla-Piazza Michelle L 
Published: January 2021

Abstract

Background
Opioid use disorder (OUD) is a correlate of poorer HIV outcomes among people with HIV (PWH). Research has shown promising results for buprenorphine (BUP), a medication for OUD, integrated into HIV primary care. In this study, we explored the effect of BUP on HIV outcomes in a cohort of PWH with OUD in Newark, New Jersey.

Methods
We performed a retrospective chart review of PWH on BUP attending the Rutgers NJMS Infectious Diseases Practice from January 2017 to June 2019 (n=91, median age 56, 59% male, 84% Black, median follow-up 1.5 years). Outcomes were suppressed HIV viral load measurements (VLS) or urine drug screening results (UDS). We analyzed data using descriptive statistics and multivariate logistic regression, which modeled associations of VLS or UDS with demographic, comorbid (substance use, chronic pain, HCV, psychiatric diagnosis), and social (insurance, employment, housing) factors. Results presented as odds ratio; 95% confidence interval.

Results
55% (n=46) of patients demonstrated BUP adherence (&gt; 50% positivity on serial UDS) and 61% (n=51) had ongoing opioid use. Patients with a UDS positive for opioids (primarily opiates) were more likely to have other substance co-positivity on UDS (5.4; 4.0-7.3, p &lt; 0.001), to be employed (5.4; 2.7-10.7, p=0.01), and enrolled in Medicaid (4.6; 2.5-8.5, p=0.01); and less likely to have BUP positive UDS (0.067; 0.050-0.088, p &lt; 0.001). Conversely, BUP positive UDS was negatively associated with the presence of other substances (0.55; 0.44-0.70, p=0.01) and history of alcohol use (0.56; 0.40-0.79, p=0.05), controlling for concurrent opioid positivity and baseline VLS. At baseline, 39% (n=32) of patients did not have VLS; at 1 year follow-up, one-third (n=11) achieved new-onset suppression. VLS during follow-up was positively associated with BUP adherence (2.9; 1.2-7.1, p=0.02) and VLS at baseline (17.0; 10.4-27.8, p &lt; 0.001), and negatively associated with housing insecurity (0.28; 0.15-0.52, p=0.04).

Conclusion
Integration of BUP for OUD into HIV primary care led to a decrease in opioid use and improved outcomes in HIV care. Multidisciplinary approaches addressing other substance use and social services may help achieve even greater progress in ending the dual epidemics of HIV and OUD.

Disclosures
All Authors: No reported disclosures
1026. Is Empiric Coverage Necessary? Incidence of Pseudomonas aeruginosa and Methicillin-Resistant Staphylococcus aureus in Foot Infections
Authors: Bird Scott G , Crum-Cianflone Nancy , Bagsic Samantha 
Published: January 2021

Abstract

Background
Empiric antibiotics for foot infections often include coverage of Pseudomonas aeruginosa (PA) and Methicillin-resistant Staphylococcus aureus (MRSA) due to their presumed frequency and ability to cause severe infection. The purpose of this study was to: 1) determine the incidence of PA and MRSA in foot infections; 2) identify variables associated with the presence of PA or MRSA; and 3) examine empiric antibiotic trends for foot infections to determine if empiric coverage of PA and MRSA is warranted.

Methods
Retrospective study of foot infections at five large urban hospitals in San Diego during 2018. Data were collected from the medical records including demographics, host factors, laboratory data, pathology and imaging data, culture results, and empiric antibiotics. Patients with a foot infection treated as an inpatient in our healthcare system who had a culture collected were included.

Results
310 patients with foot infections were included. Mean age was 61.6 years; 220 (71%) were male; 248 (80%) had diabetes; 40 (13%) had end-stage renal disease (ESRD), and 122 (39%) had peripheral arterial disease (PAD). PA was present in 28 (9%) cases. No patient had a positive blood culture for PA. MRSA was present in 55 (18%) cases. Only one patient had a positive blood culture for MRSA. On univariate analysis, wound location not in the forefoot (p=0.047) and presence of PAD (p=0.048) were associated with PA. These failed to remain significant in multivariate analysis (OR=0.42, p=0.074 and OR=2.54, p=0.0504, respectively). Factors associated with MRSA included shallower depth of wound (OR=0.36; p=0.043). 199/310 patients (64%) received empiric antibiotic coverage for PA while 262/310 patients (85%) received empiric MRSA coverage. Of those who received empiric anti-PA coverage, 174 were overtreated (87%). Of those who received empiric anti-MRSA coverage, 218 (83%) were overtreated.

Conclusion
The incidence of PA in foot infections was overall low, and none had positive blood cultures. MRSA was more often present, however, most patients did not have bacteremia or severe infections. In our study, the majority of empiric anti-PA, as well as anti-MRSA, antibiotic coverage for foot infections was unnecessary questioning the need for upfront, empiric coverage for these pathogens in foot infections.

Disclosures
All Authors: No reported disclosures
1030. Medicaid Expansion: How Does it Impact HIV Outcomes in One Non-urban Southeastern Ryan White HIV/AIDS Program Clinic?
Authors: McManus Kathleen A , Srikanth Karishma R , Powers Samuel D , Dillingham Rebecca , McQuade Elizabeth T Rogawski 
Published: January 2021

Abstract

Background
People living with HIV (PLWH) with Medicaid historically have lower viral suppression (VS) rates than those with other insurance. VS rates with Medicaid expansion (ME) are unknown. We examined HIV outcomes (engagement in care, VS) by insurance status for a non-urban Southeastern Ryan White HIV/AIDS Program (RWHAP) Clinic cohort for year after ME.

Methods
Participants were PLWH ages 18-63 who attended &gt; 1 HIV medical visit/year in 2018 and 2019. Log-binomial models were used to estimate the association of characteristics with Medicaid enrollment prevalence and one-year risks of engagement in care and VS in 2019.

Results
Among 577 patients, 241 (42%) were newly eligible for Medicaid due to ME and 79 (33%) enrolled (Figure 1a). For those without Medicare, Medicaid enrollment was higher for those with incomes &lt; 100% FPL (adjusted prevalence ratio [aPR] 1.67; 95% confidence interval [CI] 1.00-1.86) compared to those with incomes &gt; 101% FPL. Those enrolled in Medicaid due to ME had 87% engagement in care compared to 80-92% for other insurance plans (Figure 1b). Controlling for 2018 engagement, older age (adjusted risk ratio [aRR] for 10 years 1.03, 95% CI 1.00-1.05; Table 1) was associated with being engaged in 2019. Engagement was lower for those with employment-based insurance (aRR 0.91, 95% CI 0.83-0.99) and Medicare (aRR 0.87, 95% CI 0.78-0.96). Of those with viral loads in 2018 and 2019 (n=549), those who newly enrolled in Medicaid due to ME had 85% VS compared to 87-99% for other insurance plans (Figure 1c). In univariate analysis, age, income, and baseline viral load status were associated with viral suppression (Table 2), and those with Medicaid due to ME (aRR 0.90, 95% CI 0.81-1.00) were less likely to achieve VS compared with others.
Figure 1

Table 1

Table 2

Conclusion
The low uptake of ME was likely influenced by many PLWH already having Medicare. While the RWHAP supports high quality HIV care, Medicaid enrollment improves access to non-HIV care and should be supported by RWHAP. Given that engagement in care was high for PLWH who newly enrolled in Medicaid, the finding of lower VS is surprising. The discordance may be due to medication access gaps associated with changes in pharmacy logistics. Future studies with larger cohorts will need to examine how ME contributes to PLWH’s overall health and to ending the HIV epidemic.

Disclosures
Kathleen A. McManus, MD, MSCR, Gilead Sciences, Inc (Research Grant or Support, Shareholder) Rebecca Dillingham, MD, MPH, Gilead Sciences, Inc (Research Grant or Support)Warm Health Technologies, Inc (Consultant)
1031. Mobility and Structural Barriers Contribute to Loss to Follow up from HIV Care in Rural South Africa
Authors: Hannaford Alisse , Moll Anthony , Madondo Thuthukani , Khoza Bulelani , Shenoi Sheela 
Published: January 2021

Abstract

Background
Retention in care is critical to achieving and sustaining viral load suppression, and reducing HIV transmission, yet lost to follow-up (LTFU) in South Africa remains substantial. We sought to understand reasons for disengagement and return to care in neglected rural settings.

Methods
Using convenience sampling, surveys were completed by 102 PLWH who disengaged from ART (minimum 90 days) and subsequently resumed care. A subset (n=60) completed individual in-depth interviews. Questions assessed HIV knowledge, stigma, barriers to health care, and reasons for both disengaging and returning to care.

Results
Among 102 participants (53% female), median duration of ART discontinuation was 9 months (IQR 4-22). Participants had HIV knowledge gaps regarding HIV transmission and increased risk of tuberculosis. Two thirds were unaware that ART prevents transmission to other sexual partners. The major contributors to LTFU were mobility and structural barriers. PLWH traveled for an urgent family need or employment and were not able to collect ART while away. Structural barriers included inability to access care, due to lack of financial resources to reach distant clinics, HIV stigma, dissatisfaction with being treated at an HIV specific clinic, pill fatigue and lack of social support. Illness was the major precipitant of returning to care.

Conclusion
Among those returning to HIV care, patient motivation to continue ART was high, but mobility and structural barriers impede longitudinal HIV care in rural South Africa, threatening the gains made from expanded ART access. To achieve 90-90-90, future interventions to improve retention must address barriers relevant to rural settings including emphasis on patient-centered care such as multi-month ART prescriptions, expanding medication distribution sites, including community-based dispensing sites, integrating ART into primary care, and facilitating linkage to remote facilities when away from their home clinic. Healthcare workers should be capacitated to identify patients’ barriers to chronic care and intervene on those at high risk of LTFU.

Disclosures
All Authors: No reported disclosures
1032. More Similar than You May Think: A Comparison of Perinatally vs. Behaviorally Infected Young Adults Living with HIV
Authors: Ng Maria , Wallach Frances , Schwartz Rebecca , Rasul Rehana 
Published: January 2021

Abstract

Background
Many perinatally infected people living with HIV (PLWH) have reached adulthood. It is important to understand differences in key outcomes between this group and those who were behaviorally infected with HIV. We sought to determine if there were differences in HIV-RNA viral load, antiretroviral therapy (ART) adherence, substance use, comorbidities, and healthcare engagement between the two groups.

Methods
This retrospective study was performed at Northwell’s Center for AIDS Research and Treatment in Manhasset, NY from November 1, 2016 to December 31, 2018. The sample size included 38 perinatally infected PLWH and 51 behaviorally infected PLWH. Data were extracted from the electronic medical record. The primary endpoint was HIV-RNA viral load. Secondary endpoints included ART adherence, comorbidities, CD4 counts, number of missed HIV care appointments, self-reported sexual activity, and substance use. Comparisons of the two groups were conducted using the Wilcoxon rank sum test and Fisher’s exact test.

Results
Perinatally infected PLWH were more likely to have unsuppressed viral loads, lower CD4 counts, and lower patient reported ART adherence, but these differences were not statistically significant. Perinatally infected PLWH were also more likely to be female and unemployed, and to report consistent condom use. Sexually transmitted diseases were only detected in the behaviorally infected group. Perinatally infected PLWH were also less likely to report alcohol use. However, smoking and illicit drug use were similar between the two groups. There was no difference in racial composition. Asthma and hypertension were the most commonly recorded comorbidities and did not differ in prevalence between the groups (Table 1).The pattern of change in CD4 counts over time was similar between the two groups and both groups maintained average CD4 counts above 200 cells throughout the study (Table 2) (Figure 1). The number and percent of missed appointments were similar between the groups.
Patient Characteristics Compared by Perinatally Infected vs. Behaviorally Infected HIV Status

A Comparison of Outcomes Over Time Between Perinatally Infected PLWH vs. Behaviorally Infected PLWH

Observed Changes in CD4 Count Over Time, Compared by Mode (Perinatally Infected PLWH vs. Behaviorally Infected PLWH)

Conclusion
Despite differences in reported ART adherence, perinatally and behaviorally infected PLWH had similar rates of HIV viral load suppression and comparable absolute values and trends in CD4 count.

Disclosures
All Authors: No reported disclosures
1033. One year of Bictegravir in Mexico City: Differences in the Neuropsychiatric Adverse Events vs. Efavirenz
Authors: Rodriguez Victor 
Published: January 2021

Abstract

Background
In Mexico, Efavirenz (EFV) was considered as first-line regimen for several years. However, the Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) had a history neuropsychiatric effects such as depression, suicidal thoughts, insomnia, hypersomnia, impairment cognition, impairment in quality of life, these adverse events cause poor adherence and abandon EFV regimens. Since June 2019, bictegravir (BIC) in a single tablet regimen was introduced in Mexico as a first-line treatment. Therefore, the objective of the study was to compare the presence of depressive and cognitive symptoms, suicidality, sleep disturbances, quality of life between BIC and EFV regimens.

Methods
Prospective cross-sectional study, non-probability sample, both groups BIC and EFV were matched according to age. Patients were recruited from June 2019 to May 2020 in Condesa Specialized Clinic in Mexico City. All the patients had 1 to 4 months from starting treatment. The evaluation test used were Medical Outcomes Study Short Form-36 (SF-36), Beck Depression Inventory (IDB-IA), Center for Epidemiologic Studies-Depression Suicidal Ideation subscale (CES-D IS), State Impulsivity Scale (SIS) and Pittsburgh Sleep Quality Index (PSQI).

Results
One thousand six hundred patients, 800 in BIC group and 800 in EFV group. The mean age 37 years. Non-statistical difference was found in sociodemographic and HIV-related variables. Statistically significant differences were found between BIC and EFV groups (t = 1.91 - 15.28, p &lt; 0.03). The largest differences were seen in cognitive symptoms such as impulsivity, quality of life mental score and suicidal ideation (t &gt; 10.61). No differences were found in physical role and sleep disorders.
BIC & EFV groups comparison

Conclusion
In this study we found BIC group have fewer neuropsychiatric events than EFV group. The principal differences were in cognitive symptoms, suicidality, functionality associated with central nervous system symptoms. We suggest having a long-term follow-up of the sleep quality variables, to observe patient’s adaptation to treatment for a period over to 12 months.

Disclosures
All Authors: No reported disclosures
1042. The Attitude of Patients With HIV about Telehealth for Their HIV Care
Authors: Dandachi Dima , Dang Bich , Giordano Thomas Giordano 
Published: January 2021

Abstract

Background
The world is facing a pandemic of SARS-CoV-2 that disrupted our healthcare system and the way we deliver healthcare. For people with HIV (PWH), the ability to be retained in care plays a critical role in improving health outcomes and in preventing HIV transmission. Several definitions exist for retention in care, but they are centered around outpatient clinic visits. It is now more important than ever to understand PWH’s attitudes about using telemedicine for HIV care instead of face-to face clinic visits.

Methods
We administered a one-time survey to PWH presenting to an outpatient HIV center in Houston, Texas, from February–June 2018. The survey items were used to assess PWH’s attitudes towards and concerns for telehealth and explanatory variables.

Results
371 participants completed the survey; median age was 51, 36% were female, and 63% African-American. Overall, 57% of respondents were more likely to use telehealth for their HIV care if available, as compared to one-on-one in-person care, and 37% would use telehealth frequently or always as an alternative to clinic visits.
Participants reported many benefits including ability to fit better their schedule, decreasing travel time, and privacy but expressed concerns about the ability to effective communication and examination and the safety of personal information. Factors associated with likelihood of using telehealth include personal factors (US-born, men who have sex with men, higher educational attainment, higher HIV-related stigma perception), HIV-related factors (long standing HIV), and structural factors (having difficulty attending clinic visits, not knowing about or not having the necessary technology). There was no association between participants with uncontrolled HIV, medication adherence, and likelihood of using telehealth.
Survey items and response distribution

Conclusion
Telehealth programs for PWH can improve retention in care. A modification of the definition for retention in care, incorporating telehealth, should be considered. Availability and confidence using various telehealth technologies need to be addressed to increase acceptability and usage of telehealth among PWH.

Disclosures
All Authors: No reported disclosures
1047. Weight change associated with switching to bictegravir/emtricitabine/tenofovir alafenamide in virally suppressed people with HIV
Authors: Vo Daniel , Goss Charles W , Lian Qinghua , O’Halloran Jane A 
Published: January 2021

Abstract

Background
Integrase strand transfer inhibitor (INSTI) associated weight gain has been observed in a number of recent studies but with limited data on bictegravir. Here we examine weight change associated with the switch to co-formulated bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF).

Methods
We performed a retrospective analysis of consecutive PWH attending an academic outpatient clinic who received a prescription for B/F/TAF from 02/07/2018-02/07/2019 and had a baseline HIV RNA &lt; 200 copies/mL prior to starting B/F/TAF. Baseline demographics and clinical parameters were obtained from chart review. Parameters of interest were collected for one year (at a minimum) before and one year after starting B/F/TAF. Linear mixed model analyses were conducted for PWH before/ after switch. Separate analyses were performed examining factors associated with ≥ 10% BMI increase versus &lt; 10% increase.

Results
156 PWH switching to B/F/TAF were identified, of whom 107 (69%) identified as men, 105 (67%) were African American. Median age was 49 years (IQR 35-57), weight 184 lb (IQR 153-208), and BMI 27.5 (IQR 23-32.3). At time of switch, 3% were underweight, 31% normal weight, 24% overweight, and 41% obese. 74% switched from INSTI-based regimen, 17% from NNRTI- and 16% from PI-based regimens. Of the INSTI, elvitegravir (54.3%) or dolutegravir (41.7%) were most frequently used. 50% were on TAF pre-switch with 28% on tenofovir disoproxil. The mixed model analysis indicated that there was not a significant shift in the mean BMI (P=0.2017) or BMI rate of change over time (P=0.792) after participants switched. 19.2% had ≥ 10% increase in BMI; and when compared to those with &lt; 10% increase, younger age (42.8±13.8 vs. 48.9±13.2 years, P=0.036), switch from a non-PI based regimen (P=0.004), and switch from a TDF containing regimen (36.4% vs. 12.6%, P &lt; 0.001) were associated with greater weight gain.

Conclusion
Overall, there were no significant changes in BMI between pre and post switch to B/F/TAF time periods; however the majority of PWH switched from an INSTI-based regimen. Analysis of PWH who experienced ≥ 10% increase compared to &lt; 10% BMI increase, indicated that factors including younger age, switch from a non-PI containing regimen and switch from TDF were associated with greater weight gain.

Disclosures
All Authors: No reported disclosures
1049. Weight Gain in Persons Living with HIV (PLWH) Treated with Bictegravir Compared to Other Integrase Strand Transfer Inhibitors
Authors: Fang Michelle , Ma Ariel , Johns Scott T , Lacro Jonathan 
Published: January 2021

Abstract

Background
Recent studies have given rise to the concern that some integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy may lead to weight gain in PLWH. The objectives of this study were to compare the incidence of weight gain following initiation of bictegravir (BIC) compared to other INSTIs, and to assess whether any differences were associated with changes in metabolic indices.

Methods
Patients from the VA San Diego Healthcare System (VASDHS) were included in this retrospective cohort study if they were at least 18 years old and being treated for HIV with an INSTI that was started exclusively with FTC/TAF for at least 6 months. INSTI-containing regimens were excluded if initiated with non-FTC/TAF antiretroviral agents or if the patient was pregnant, using prescription weight loss drugs, or did not have weights recorded after the start of the studied regimen. The primary outcome was weight gain at 12 and 18 months after the start of the studied regimen. Secondary outcomes included changes in parameters used to define metabolic syndrome. Statistical analysis was performed using Mann-Whitney U, Chi-square, and Spearman’s Rho tests.

Results
560 patients with 809 instances of new INSTI prescriptions from VASDHS during November 2015 to October 2019 were reviewed for inclusion. Raltegravir-based regimens were excluded from analysis due to the limited number of eligible regimens. Study groups included group 1 (BIC, n=265), group 2 (elvitegravir/cobicistat, n=123), and group 3 (dolutegravir, n=35). There were no significant differences in baseline weight between groups. Median weight change at 12 months was 2.8 lbs. in group 1, 4.4 lbs. in group 2 (p=0.328 vs. group 1), and 5.3 lbs. in group 3 (p=0.133 vs. group 1). At 18 months, median weight change was 4.5 lbs. in group 1, 3.4 lbs. in group 2 (p=0.597 vs. group 1), and 7.7 lbs. in group 3 (p=0.585 vs. group 1). Within group 1, there was a significant increase in weight at 3, 6, 12, and 18 months compared to index date.

Conclusion
These results support the growing body of evidence associating INSTI use with weight gain, which was persistent over 18 months in all groups and in the context of a consistent FTC/TAF backbone in this study. No significant differences in magnitude of weight gain were observed between INSTIs.

Disclosures
All Authors: No reported disclosures