bluuebunny/crossref_metadata_2025_split huggingface dataset:
2496. Qualitative Thematic Analysis of Social Media Data to Assess Perceptions of Daily Oral and Long-Acting Injectable Antiretroviral Treatment among People Living with HIV
Authors: Matza Louis S , Paulus Trena , Garris Cindy , Van de Velde Nicolas , Chounta Vasiliki , Deger Kristen A 
Published: October 2019

Abstract

Background
Current HIV treatment options consist of daily oral antiretroviral therapies (ART). A long-acting injectable HIV treatment is in development for monthly or every other month administration. Patient preferences for ART are important to understand and can impact retention in care, adherence and outcomes. The purpose of this study was to obtain and analyze patient perceptions of oral and injectable ART using a novel approach.

Methods
Qualitative thematic analysis was conducted to examine online discussion threads posted by people living with HIV (PLHIV) in POZ Community Forums from 2013 to 2018. Perceptions of ART were analyzed using keywords (e.g., dose, pill, daily, long-acting, injection, monthly, cabotegravir). Relevant threads were extracted, reviewed and coded using qualitative data analysis software (ATLAS.ti.8).

Results
Analyses identified 684 relevant discussion threads including 2,629 coded quotations posted by 568 PLHIV. Oral ART (2,517 quotations) was discussed more frequently than injectable ART (112). Positive statements on oral ART commonly mentioned the small number of pills (278), dose frequency (248), ease of scheduling (154), and ease-of-use (146). PLHIV also noted disadvantages of oral ART including negative emotional impact (179), difficulty with medication access (137), scheduling (131), and treatment adherence (128). Among the PLHIV discussing injectable ART, common positive comments focused on less frequent administration (34), emotional benefits of not taking a daily pill (7), potential benefits for adherence (6), overall convenience (6), and benefits for traveling (6). Some quotations (10) perceived the frequency of injections negatively, and others had negative perceptions of needles (8) or appointments required to receive injections (8).

Conclusion
ART was frequently discussed among PLHIV on this online forum. This innovative approach for obtaining and analyzing unsolicited comments revealed that while many PLHIV expressed positive views about their daily oral regimen, others perceived inconveniences and challenges. Among PLHIV who were aware of a possible long-acting injectable treatment, many viewed this potential new option as a convenient alternative with the potential to improve adherence.

Disclosures
All authors: No reported disclosures.
2505. Incidence of Transmitted Drug Resistance and Its Clinical Implications Between 1999 and 2018 in a Regional HIV Population
Authors: Lang Raynell , Krentz Hartmut B , Vu Quang , John Gill M 
Published: October 2019

Abstract

Background
Baseline genotype antiretroviral resistance testing (GART) were introduced to allow better selection of antiretroviral therapy (ART), minimizing the use of less effective drugs and risk for ongoing transmission of drug-resistant virus. However, the value of baseline GART has recently been questioned due to declining incidence of TDR in the setting of improved drug tolerability profiles and effectiveness. We aimed to evaluate the long-term clinical and economic impact of TDR using a well characterized, geographically defined cohort between 1999–2018.

Methods
In the Southern Alberta Cohort (SAC) database we identified all (ART naïve) HIV patients, ≥16 years of age, with a baseline GART. They were classified by presence or absence of TDR. Clinical and sociodemographic data were obtained from database and chart review. All statistical analysis was performed with Stata.

Results
During the study 745 GART tests were done on ART naïve patients. Baseline ART resistance was documented in 78 /745 patients. TDR was to the NNRTI class in 59 (75.6%), to NRTI in 12 (15.4%) and to the PI class in 7 (8.9%) patients. Two patients had two class resistance and none had INSTI resistance. There was a significant difference in cost per year of therapy comparing the TDR and control ($17,152/year vs. $15,362/year, P ≤ 0.001). Patients with TDR had greater pill burden with 20% being on BID/TID ART regimens compared with the controls of 13% (P = 0.003). No differences in incident ART adverse events (12.8% TDR vs. 13.3% no TDR), drug interactions (1.6% vs. 1.0%) or reasons to stop or change ARVs were seen between study groups. The duration of ART on any given drug class was similar between the two populations (P = 0.6694) as was status of viral suppression at one year 73% vs. 65%.

Conclusion
Presence of TDR at baseline had little immediate impact on ART initiation or tolerance, but by limiting choices negatively impacted pill burden and dosing as well as drug costs.

Disclosures
All authors: No reported disclosures.
2517. Oral Fecal Microbiota Transplantation Increases Gut Microbiome Diversity and Alters the Microbiome Distribution in People with HIV
Authors: Utay Netanya S , Monczor Ana , Somasunderam Anoma , Jiang Zhi-Dong , Alexander Ashley , Vigil Karen J , Lake Jordan , Hanson Blake , DuPont Herbert , Arduino Roberto 
Published: October 2019

Abstract

Background
Reduced microbiota diversity (dysbiosis) in people with HIV (PWH) can damage the intestinal barrier and increase microbial translocation, resulting in inflammation, a driver of morbidity and mortality. We hypothesized that fecal microbiota transplants (FMT) would reverse dysbiosis in PWH.

Methods
We administered 6 weekly oral doses of a novel lyophilized fecal microbiota product from 2 healthy donors to 6 men who have sex with men with HIV on suppressive ART. Shotgun sequencing on stool before, after 6 weekly FMT, and 20 weeks after the last FMT (Weeks 0, 6 and 26), and from donors, was performed to determine bacterial community profiles. Biomarkers were measured by Luminex assays and ELISAs. All comparisons used Wilcoxon matched-pairs signed rank test.

Results
Median age at Week 0 was 41 years, CD4+ T-cell count 504 cells/mm3, VL < 20 copies/mL. Mean α diversity by observed species index increased from Week 0 to 6 (61.2 to 70.2, P = 0.29; Figure 1) and decreased by Week 26 (70.2 to 52.2, P = 0.33) to be similar to the donors’ (63.5, P = 0.86). Microbiome distribution by principal component analysis shifted toward the donors’ distribution in most participants at Week 6 but shifted away by Week 26 (Figure 2). Biomarkers did not change significantly during the study. PID3, with HIV > 35 years, had chronic constipation that resolved with FMT with a large shift in distribution but recurred at Week 26. Fusobacterium gonidiaformans, Porphyromonas somerae, and Haemophilus parainfluenzae comprised 27% of his microbiome at Week 0 but 0.73% at Week 6; untyped Bacteroides comprised 35% at Week 6. I-FABP (6,899 to 2,736 pg/mL), sCD14 (1.67 to 1.31 μg/mL), IL-6 (1.51 to 1.13 pg/mL) and sTNFRII (11,659 to 8,300 pg/mL) levels decreased in PID3; Week 0 levels in PID3 were higher than in other recipients. No related serious adverse events occurred.

Conclusion
Weekly FMT resulted in increased intestinal microbiome α diversity and a shift in microbiome distribution in most participants. These changes did not persist after stopping FMT. PWH with long-term HIV and/or greater inflammation or gut damage may be most likely to benefit from FMT. The effects of recurrent FMT were transient, suggesting longer duration of treatment or intermittent FMT boosting may be required to maintain its benefits.

Disclosures
All authors: No reported disclosures.
2519. Urban vs Rural HIV-infected Persons Have Differential Gene Expression for Estrogen Signaling, Inflammation, and Cytokine Production Pathways
Authors: Schafer Katherine R , Piggott Damani A , Abadir Peter , Zimmerman Kip , Langefeld Carl , High Kevin P 
Published: October 2019

Abstract

Background
People aging with HIV (PAWH) are living longer with effective antiretroviral therapy and new HIV diagnoses are rising in older populations. Concurrent with trends in age, the epidemiology of HIV infection in the United States has shifted geographically and racially; the Southeast and African Americans now have the highest HIV incidence and prevalence. Although there are marked health disparities for rural and African American PAWH, limited data exist comparing aging phenotypes between rural and urban PAWH, and no data exist comparing mechanistic pathways between these populations. Among African American PAWH, we hypothesize that rural PAWH will be more likely than urban PAWH to have a molecular profile of advanced aging associated with chronic disease burden and shorter health span.

Methods
Demographics, clinical data, and RNA were collected from 14 matched pairs from rural (Wake Forest University, Winston-Salem, NC) and urban cohorts (ALiVE cohort, Johns Hopkins University, Baltimore, MD) matched on age, sex, Short Physical Performance Battery score, smoking status, and sample collection date. Raw sequences were examined for quality, aligned using STAR, and normalized using DESeq2. DESeq2 tested matched pair differential gene expression. Genes with an average read count threshold > 5, a genomic control adjusted P-value < 0.01 and a fold change > 1.3 were retained for further analysis using STRING, MCODE, and IPA to find functional and biological patterns.

Results
Of the 399 genes meeting significance criteria, 212 showed higher expression in the rural group; the remaining 187 genes showed lower expression in the rural group. Top enriched canonical pathways in the IPA analysis identified differential estrogen signaling (P < 0.0001), inflammation (P < 0.001), and cytokine production (p = 0.005). Protein–protein interactions involved in cell–cell signaling and intracellular trafficking were also differentially identified between the 2 populations.

Conclusion
Urban and rural PAWH have differential gene expression, particularly centered around estrogen signaling and inflammatory cytokine production. These findings merit further investigation to determine clinical significance, including correlation with phenotypes and healthspan between rural and urban PAWH.

Disclosures
All authors: No reported disclosures.
2521. Prevalence and Associated Factors of Protective Antibody Responses against Diphtheria, Tetanus, and Pertussis among HIV-Infected Thai Adolescents Stable on Combination Antiretroviral Treatment
Authors: Sudjaritruk Tavitiya , Kanjanavanit Suparat , Prasarakee Chanidapa , Sarachai Saowalak , Taweehorm Wanvisa , Aurpibul Linda , Sintupat Kamolrawee , Khampan Ratchaneekorn 
Published: October 2019

Abstract

Background
To assess the prevalence and associated factors of protective antibodies against diphtheria, tetanus, and pertussis among HIV-infected adolescents stable on combination antiretroviral treatment (cART).

Methods
A multicenter seroprevalence study was conducted. Perinatally HIV-infected Thai adolescents (11–25 years) who had previous evidence of severely immune suppression (CD4 < 15% or < 200 cells/mm3), were currently stable on cART (CD4 > 350 cells/mm3 for > 6 months or CD4 > 200 cells/mm3 with viral suppression [VS; HIV RNA < 50 copies/mL] for > 12 months) and had completed a 5-dose series of diphtheria, tetanus, whole cell pertussis (DTwP) vaccine during childhood were enrolled. Adolescents who received immunosuppressive agents or blood components within 6 months were excluded. Protective antibodies for diphtheria, tetanus, and pertussis were defined as diphtheria toxoid IgG ≥ 0.1 IU/mL, tetanus toxoid IgG ≥ 0.1 IU/mL, and anti-pertussis toxin IgG ≥ 5 IU/mL, respectively. Logistic regression analysis was performed to identify factors associated with protective antibody response to each antigen.

Results
Of 150 adolescents, 47% were male, a median age was 19 years. Forty (27%) and 0 (0%) adolescents had ever received tetanus, diphtheria (Td) or tetanus, diphtheria, acellular pertussis (Tdap) vaccine during adolescence, respectively. A median duration since the last dose of DTwP/Td vaccine was 12 years. At enrollment, 67% of adolescents were on NNRTI-based cART regimens, a median cART duration was 13 years. A median CD4 was 29%, and 90% had VS. Prevalence of protective antibodies against diphtheria, tetanus, and pertussis were 37%, 82%, and 52%, respectively. Proportion of adolescents with protective antibodies and geometric mean concentrations of antibodies to all antigens declined over time after the last immunization (Figures 1–3). Associated factors of protective antibodies to diphtheria, tetanus and pertussis are shown in Table 1.

Conclusion
Although having completed a 5-dose series of DTwP during childhood, significant proportion of our perinatally HIV-infected adolescents had no protective antibodies to those antigens, particularly diphtheria and pertussis, when entering adolescence. Tdap vaccination is a crucial strategy to prevent such diseases in the future.

Disclosures
All authors: No reported disclosures.
2524. Prevalence and Associated Factors of Seroprotection Against Japanese Encephalitis Virus Among HIV-Infected Thai Adolescents Stable on Combination Antiretroviral Treatment
Authors: Sudjaritruk Tavitiya , Kanjanavanit Suparat , Prasarakee Chanidapa , Sarachai Saowalak , Taweehorm Wanvisa , Aurpibul Linda , Saheng Jutamad , Sintupat Kamolrawee , Khampan Ratchaneekorn , Yoksan Sutee 
Published: October 2019

Abstract

Background
To determine the prevalence and associated factors of seroprotection against Japanese encephalitis (JE) virus among HIV-infected adolescents stable on combination antiretroviral treatment (cART).

Methods
A multicenter seroprevalence study was conducted in Thailand. Perinatally HIV-infected adolescents who aged 11–25 years, had previous evidence of severely immune suppression (CD4 < 15% or < 200 cells/mm3), were currently stable on cART (CD4 > 350 cells/mm3 for > 6 months or CD4 > 200 cells/mm3 with viral suppression [VS; plasma HIV RNA < 50 copies/mL] for > 12 months), and had completed a 3- or 4-dose series of mouse brain-derived inactivated JE vaccine (MBDV) during childhood were enrolled. Adolescents who had clinically or serologically confirmed recent JE virus infections, or received immunosuppressive agents or blood components within 6 months were excluded. Plaque reduction neutralization (PRNT50) assay was conducted to assess neutralizing antibodies to JE virus, and titers of ≥ 10 were considered seroprotective. Logistic regression analysis was performed to identify associated factors of JE seroprotection.

Results
Of 98 eligible adolescents, 54% were female, a median age was 19 years, and 11% were overweight. Ninety-five percent and 5% of adolescents received 3 and 4 doses of MBDV during childhood, respectively. A median duration since the last dose of MBDV was 16 years. At enrollment, 71% were on NNRTI-based cART regimens, a median cART duration was 13 years. A median current CD4 was 29%, and 89% had VS. Seroprotection against JE virus was identified in 28 (29%) adolescents; of whom, the geometric mean titer (GMT) of neutralizing antibody was 64 (95% CI: 39–106). Proportion of adolescents with JE seroprotection and GMT of neutralizing antibodies to JE virus slightly decreased over time after the last immunization (Figure 1). In a multivariable logistic regression analysis, seroprotection against JE virus was associated with younger age and greater current CD4 count (Table 1).

Conclusion
The majority of our perinatally HIV-infected adolescents did not maintain seroprotection against JE virus although having completed a series of MBDV during childhood. JE revaccination is an important tool for disease prevention in these adolescents who live in JE endemic areas.

Disclosures
All authors: No reported disclosures.
2525. Understanding PrEP in Female Adolescents: A Parent/Adolescent Dyad Perspective
Authors: Shah Meera , Murray Ashley , Gillespie Scott , Camacho-Gonzalez Andres 
Published: October 2019

Abstract

Background
Adolescents aged 13–24 years account for 23% of HIV diagnoses in the Atlanta Metropolitan Area, indicating the need for new prevention strategies. Pre-Exposure Prophylaxis (PrEP), recently approved for adolescent use, is effective in HIV prevention and is often marketed to young men who have sex with men (MSM); however, problems with access, scalability and waning adherence have limited its use in this population and more broadly. A 2016 CDC HIV surveillance report showed 19.2% of new HIV diagnoses were attributed to heterosexual transmission in women aged 13–24, relative to 0% in their heterosexual male counterparts, and 5.4% in same-aged MSM. This study assesses parent and female adolescent knowledge on HIV risk and PrEP perception to inform potential implementation strategies.

Methods
PrEP acceptability and barrier surveys were administered to 102 adolescent-parent dyads attending an adolescent clinic and emergency room in Atlanta, Georgia. Eight female adolescent-parent pairs were randomly selected to participate in in-depth phone interviews. Responses were analyzed using computer-assisted thematic analyses.

Results
Of the 8 female adolescent participants (mean age = 18.9 years), all were African American, and 1 was sexually active. Of the 8 parent participants (mean age = 44.1 years), all were female and African American. None of the participants had ever used PrEP. Analysis indicated that both parents and adolescent females had poor HIV risk assessment and knowledge, as well as barriers to PrEP usage including concerns about side effects, cost, and desire for alternative PrEP delivery methods and/or schedules. Finally, adolescent females expressed reliance on self-efficacy to be able to discuss HIV protection methods with their partner.

Conclusion
Female adolescents use unreliable methods to ensure HIV prevention, and with poor HIV knowledge, are at risk of transmission. Thus, PrEP may be a viable option for adolescent females at high risk for infection. PrEP implementation strategies in adolescents needs to consider HIV risk assessment, PrEP education, potential options for alternative dosing and delivery, and continued implementation work, focused beyond just the young MSM community.

Disclosures
All authors: No reported disclosures.
2528. Inflammation and Plasma Selenium and Chromium in Ugandan Children Living with HIV
Authors: Dirajlal-Fargo Sahera , Sattar Abdus , Shan Lingpeng , Bowman Emily , Nazzinda Rashida , Musiime Victor , Funderburg Nicholas , McComsey, Grace A 
Published: October 2019

Abstract

Background
Selenium deficiency has been reported to be associated with HIV disease progression and chromium deficiency with insulin resistance and hyperlipidemia. Here, we assessed selenium and chromium status in a cohort of Ugandan HIV+, HIV exposed uninfected (HEU) and HIV negative (HIV−) children and their associations with markers of systemic inflammation, immune activation, and gut integrity.

Methods
This is a cross-sectional study in HIV+, HEU and HIV unexposed uninfected (HIV-) children aged 2–10 years old enrolled in Uganda. HIV+ children were on stable ART with undetectable viral load. We measured plasma concentrations of selenium and chromium as well as markers of systemic inflammation, monocyte activation, gut integrity and insulin resistance (HOMA-IR).

Results
Among HIV+ children (n = 57), 93% had viral load ≤ 20 copies/mL, mean CD4 was 34% and 77% were receiving a non-nucleotide reserve transcriptase regimen. Mean age of all participants was 7 years and 55% were girls. Mean selenium concentrations were higher in the HIV+ group (106 µg/L) compared with the HEU (84 µg/L) and HIV− (98 µg/L) groups (p . Mean chromium concentrations were 1 µg/L; 1 HIV+ child and 6 HEU children had chromium levels > 1 µg/L (p.

Conclusion
In this cohort of HIV+ children on ART in Uganda, plasma selenium and chromium concentrations appear sufficient. Higher plasma selenium concentrations were associated with lower systemic inflammation and higher gut integrity markers. Although our findings do not support the use of selenium supplementation broadly for HIV-infected children in Uganda, further studies are warranted to assess the role of selenium supplements in attenuating heightened inflammation.

Disclosures
All authors: No reported disclosures.
2534. Development of an Infectious Diseases Fellowship Well-Being Program
Authors: Budak Jehan , Brickman Cristina , Abdoler Emily , Wallender Erika , Mulliken Jennifer S , Kerkhoff Andrew D , Lampiris Harry , Babik Jennifer M , Koss Catherine , Schwartz Brian , Schwartz Brian 
Published: October 2019

Abstract

Background
Burnout in graduate medical education is common and reported in ~70% of Internal Medicine (IM) residents. Most studies have described interventions focused on residency training, but fellowship training suffers from similar challenges and likely similar levels of burnout. After conducting a needs assessment amongst fellows within our Infectious Diseases (ID) fellowship program, we developed a wellness program to address these issues.

Methods
In Spring 2018, we reviewed the existing literature and consulted with local experts on trainee well-being. Based on our findings, we designed a multi-tiered approach to enhance wellness amongst fellows. An ID Fellowship Well-Being Committee (WBC) was created in September 2018 to lead the intervention. The WBC includes an even mix of fellows and faculty at multiple levels at all three main teaching hospitals associated with the program. Meetings occur every other month, and co-chairs (one faculty and one fellow) report back to the program director quarterly. Topic areas and interventions are described in Table 1. Fellows were sent a qualitative survey to evaluate the impact of the well-being interventions to date.

Results
Four of 5 first year fellows responded to the survey, and all felt the retreat should be repeated yearly. Themes identified from the survey included benefits of having protected time together, convening in a low pressure and informal setting to provide feedback, and spending quality time in a non-clinical setting with co-fellows. Fellows cited the wellness retreat as a strength at our annual fellowship external program review.

Conclusion
Burnout is likely high among IM sub-specialty fellows, and interventions are needed to support the well-being of those trainees. We describe a roadmap for the development of a well-being program at a relatively large, academic ID fellowship program led by a mixed fellow and faculty committee. We will continue to monitor data on fellow burnout and make programmatic changes based on feedback. We are hopeful that our work will empower other programs to engage in developing their own well-being programs.

Disclosures
All authors: No reported disclosures.