bluuebunny/crossref_metadata_2025_split huggingface dataset:
1056. At the Intersection of Drug Use, Motherhood, and Hepatitis C: An Evaluation of Our Present State
Authors: Niestrath Rebecca G , Green Julianne , Espinosa Claudia M 
Published: January 2021

Abstract

Background
The epidemic of drug abuse has led to increased incidence of hepatitis C virus (HCV) infection in young adults, including women of childbearing age. Infected pregnant women can transmit HCV vertically to their infants, and exposed infants require close follow-up. Few studies focus on illicit drug use during pregnancy in HCV positive mothers. We sought to describe rates of illicit drug use during pregnancy in a convenience cohort of infants perinatally exposed to HCV in an area with high rates of HCV and illicit drug use.

Methods
Infants born to HCV positive mothers in the Louisville, KY metro area and surrounding hospitals were followed at a pediatric infectious disease clinic after institution of a clinical protocol. Records of exposed infants attending the clinic between 2012 and 2018 were analyzed retrospectively. Cases were identified using V01.79 (ICD9) and Z20.5 (ICD10) billing codes. Maternal information was extracted from the infant electronic medical record or the maternal record if available. Demographic and clinical information was collected using a standardized instrument. Descriptive statistics described the data and logistic regression was used to assess associations.

Results
A total of 505 infants attended the clinic for evaluation of perinatal exposure to HCV. Records with no information regarding maternal drug use during pregnancy were excluded, leaving 440 for analysis. Mean maternal age was 28 years (IQR 25-31), and parity 2 (IQR 1-3). The majority of mothers (89.0%, N=380) had a history of any illicit drug use and 81.1% (N=355) had a history of intravenous drug use (IVDU). Most (63.2%, N=278) reported continued illicit drug use during pregnancy. The most common drugs used during pregnancy were heroin (45.4%), THC (22.9%), and amphetamines (25.4%). Prenatal care was associated with less maternal illicit drug use during pregnancy (aOR, 0.33; p &lt; 0.0001).

Conclusion
HCV positive pregnant women have high rates of prior and continued use of illicit and IVDU during pregnancy. Pregnancy represents a unique opportunity to link HCV infected women to care. Public health programs supporting these women and elimination of state restrictions to treat this population will prevent future exposures. Additional qualitative studies to identify needs for this population are needed.

Disclosures
Claudia M. Espinosa, MD, MSc, AstraZeneca (Speaker’s Bureau)Gilead (Grant/Research Support)Kentucky Rural Association (Consultant)Merck (Grant/Research Support)Sanofi (Consultant)
1058. Demographics of Hepatitis C Virus Antibody and RNA Positivity within an Emergency Department Screening Program
Authors: Segal Talia A , Ata Ashar , Rowden Adam , Wales Danielle P , Waxman Michael 
Published: January 2021

Abstract

Background
In support of the recent United States Preventive Services Task Force’s (USPSTF) revised recommendations for non-targeted HCV screening, we have noted a shift away from active infections within the birth cohort (patients born between 1945-1965), as these individuals have often undergone successful treatment, and a shift towards younger adults who are RNA positive, especially people who use intravenous drugs (PWID).

Methods
Located in Northeastern New York State, Albany Medical Center conducts routine emergency department (ED) HCV screening, with active linkage to care. We performed a retrospective study of our HCV linkage to care data from April 2019 to June 2020. Patients were offered screening if they belonged to the birth cohort, were PWID, or at staff discretion. We estimated the effect of birth cohort, intravenous drug use and other potential risk factors on RNA positivity via Chi-square tests and Modified Poisson Regression.

Results
There were 242 people that were HCV antibody positive. The mean age was 50.9 years-old, with 118 (46.8%) in the birth cohort and 103 (42.56%) PWID. As compared to the birth cohort, a significantly greater proportion of non-birth cohort patients were PWID (62% vs 21.2%, p&lt; 0.01) and homeless (17.7% vs 9.3%, p=0.05). Birth cohort patients were 0.55 times (95%CI: 0.39 to 0.79) less likely to be RNA positive. PWID were 2.22 times (95% CI: 1.58 to 3.13) and homeless people were 2.05 times (95% CI: 1.50 to 2.80) more likely to be RNA positive. After multivariable adjustment, birth cohort was not a significant risk factor for RNA positivity but PWID (RR: 1.84; 95% CI: 1.26 to 2.68) and homelessness (RR: 1.69; 95% CI: 1.20 to 2.39) were significantly associated with RNA positivity.

Conclusion
These data suggest that the RNA positivity rate is higher among the non-birth cohort age group but is explained by the higher prevalence of drug use and homeless. The findings support USPSTF’s new guidelines for testing all adults and shed light on the demographics of populations at risk for active infection vs. populations who are antibody positive and RNA negative. Further research might explore (a) whether these findings are applicable to other clinical settings and geographic locations and (b) the feasibility of targeting patients with active infection in settings such as the ED.

Disclosures
Talia A. Segal, BS, GILEAD FOCUS Foundation (Grant/Research Support) Ashar Ata, MD, MPH, PHD, GILEAD FOCUS Foundation (Grant/Research Support) Adam Rowden, DO, GILEAD FOCUS Foundation (Grant/Research Support) Danielle P. Wales, MD, MPH, Gilead (Grant/Research Support) Michael Waxman, MD, MPH, Gilead FOCUS Foundation (Grant/Research Support)
1065. Hepatitis C Virus Care Cascade Assessment–One Step Closer to Micro-Elimination
Authors: Chowdhury Jehan F , Winston Anna , Zeina Tanya , Shim Hong Gi , Vindenes Tine 
Published: January 2021

Abstract

Background
Hepatitis C virus (HCV) is a leading cause of advanced liver disease and death. In the United States about 3.5 million people are living with HCV, but only 50% are aware of the infection, 16% are prescribed treatment, and only 9% achieve sustained viral response. The World Health Organization published an HCV elimination goal for 2030 that strives to achieve a 65% reduction in HCV-related deaths and 90% reduction in transmission. An important step toward this goal is micro-elimination at local hospitals by addressing care gaps in the HCV care cascade.
Figure 1

Methods
We created a retrospective cohort of patients who tested positive for HCV antibody (HCV Ab+) between 2016 and 2018 at Tufts Medical Center in Boston, Massachusetts. We assessed achievement of care cascade steps including HCV viral load (VL) testing, linkage to care, treatment initiation, and sustained viral response (SVR). We also assessed patient demographics, clinical factors and HCV risk factors. We used STATA/IC 14.1 to conduct bivariate analysis to identify factors associated with loss to follow-up across each care cascade step.

Results
A total of 24,308 HCV antibody tests were done during this timeframe, of which 5% (n=1,222) were HCV Ab+. After excluding duplicate tests, 1,041 unique patients with HCV Ab+ were included. This cohort had a mean age of 47 years and were 61% male, 66% white, 72% on public insurance, 12% HIV-positive, 13% HCV treatment-experienced. The most frequent HCV risk factor was injection drug use, occurring in 64% of patients. Of patients with HCV Ab+, 76% (n=791) were tested for an HCV VL, of which 50% (n=393) had detectable VL and 50% (n=398) had undetectable VL. Of the patients with a detectable VL, 58% (n=226) were linked with care. Following care linkage, 69% (n=155) initiated treatment, of which 90% (n=139) completed treatment, of which 97% (n=135) achieved SVR (Figure 1). Factors that were significantly associated with getting a VL test and linking to care included private insurance, HIV co-infection, absence of intravenous drug use and cirrhosis; however, these factors were not significantly associated with achieving subsequent steps.

Conclusion
Assessment of the HCV care cascade at our hospital allowed us to identify clear care gaps and areas needing improvement towards a local micro-elimination.

Disclosures
All Authors: No reported disclosures
1069. Loss to follow-up does not impact SVR for HCV infection
Authors: Kottilil Sita K , Kamat Mrunal , Gupte Amit , Shah Samir 
Published: January 2021

Abstract

Background
Recent advances in hepatitis C treatment using direct acting antiviral (DAA) agents can lead to sustained virologic response (SVR) in almost all treated subjects. These data along with the availability of generic DAAs have generated optimism to eliminate HCV infection globally. However, recent pilot projects aimed at HCV elimination have resulted in disappointing SVR due to lack of follow up of patients after they complete treatment. In this study, we evaluated the SVR among those who did not follow up for the 12 week post treatment visit versus that of those who did,
Aim – To determine SVR among those who follow up compared to those who have delayed follow up to assess SVR.
Table

Methods
226 patients who underwent treatment for hepatitis C in a subspecialty clinic in Mumbai, India between 2014-16, with complete laboratory and clinical data available were included in this analysis. All patients completed 12 weeks of treatment with an approved DAA regimen. 137 patients had adequate follow up post treatment for SVR (Group A) and 89 patients were “no shows” for SVR (Group B) and had to be actively followed to obtain HCV RNA levels at least 4 weeks after SVR visit. Graph Pad prizm and student t test were used to determine the difference between SVR among the two groups.

Results
Demographics of both groups of patients are shown in the table below. SVR for the patients with good follow up (Group A) was 97.1% (133/137) and that of patients with poor follow up (Group B) was 97.8% (87/89), which was not statistically different (p &gt;0.05). There were no baseline demographics that was associated with poor follow up, including age, gender, genotype, baseline fibrosis score, ALT levels, previous treatment status, or duration of treatment (P &gt;0.05)

Conclusion
Lack of follow up after completion of treatment with DAAs is associated with identical SVR compared to those with adequate follow up. These findings suggest lack of follow up after completion of treatment should have minimal effect on HCV elimination projects. In the future, HCV elimination projects need not focus on determination of SVR as long as treatment follow up is ensured

Disclosures
All Authors: No reported disclosures
1071. Social Determinants of health (SDOH) among PWID living with HCV
Authors: Corro Luis Gonzalez , Gutierrez Nataly Rios , Cunningham Chinazo O , Litwin Alain H , Norton Brianna L , Norton Brianna L 
Published: January 2021

Abstract

Background
Though people who inject drugs (PWID) represent the overwhelming majority of those living with HCV, most have not been treated. Many HCV+ PWID represent the most marginalized persons in society, often experiencing poverty and poor access to care. We set out to determine the social determinants of health (SDOH) among a population of HCV+ PWID and determine if poor SDOH were related to reduced HCV treatment uptake.

Methods
The HCV-GET UP study was a randomized controlled trial to assess the effectiveness of an HCV group evaluation intervention vs. individual HCV treatment among PWID within a primary care clinic in the Bronx, NY. HCV treatment was provided according to national guidelines.. Here, we include all patient characteristics and baseline social determinants of health (SDOH), obtained through questionnaires using Audio Computer-Assisted Self-Interview (ACASI) technology. We performed bivariate analyses between treatment initiation and the various factors of the SDOH using chi square tests.

Results
The majority of the 84 participants enrolled were black (35%) or Hispanic (60%) males (77%), aged 51 (SD11). The majority are on NY State Medicaid insurance (68%), indicating that their income is less than 138% of the Federal Poverty Level. 42% of participants report running out of money for basic needs on a daily or weekly basis, 69% receive food stamps, and 23% are homeless. Nearly half (45%) of participants have less than a high school education, 57% have ever been incarcerated, 48% report not having transportation to get to a medical appointment, and 25% do not trust doctors. A total of 57% of participants initiated HCV treatment, and no factors of SDOH were associated with treatment initiation.

Conclusion
We found that HCV+ PWID have extremely poor SDOH. Despite this, over half of participants initiated HCV treatment, indicating participants willingness to receive HCV treatment, and resilience in overcoming SDOH. Poor SDOH, such as homelessness, should not be a reason to delay HCV treatment in this population; however, we risk severely muting the health benefits of HCV cure in this population, if we do not address the underlying SDOH that will certainly lead to poor health outcomes, and early death.

Disclosures
Chinazo O. Cunningham, MD, MPH, General Electric Health (Other Financial or Material Support, My husband is currently employed by General Electric Health and receives stock and stock options.)Quest Diagnostics (Other Financial or Material Support, My husband was previously employed by Quest Diagnostics and received stocks and stock options.) Alain H. Litwin, MD, MPH, MS, Gilead (Advisor or Review Panel member)Merck (Advisor or Review Panel member)
1073. The Time is Now for Rapid Initiation of Hepatitis C Virus (HCV) Treatment
Authors: Radford Colton P , Deming Paulina , Walraven Carla 
Published: January 2021

Abstract

Background
An estimated 65,000 New Mexicans are infected with HCV, accounting for ~3% of the state’s population with intravenous drug use being the most common risk factor for the acquisition of HCV. In 2020, the US Preventive Service Task Force recommended universal HCV screening for all adults aged 18 to 79 years old. HCV screening requires a two-step process involving a HCV antibody (Ab) test followed by a confirmatory HCV ribonucleic acid (RNA) test to detect active infection. Acute HCV infections are typically asymptomatic leaving many individuals unaware of their diagnosis for years. New Mexico was one of the first states to abandon the requirement for specialist referral, fibrosis staging, and abstinence from substance abuse to facilitate HCV treatment. Despite removal of these barriers, major gaps in access to HCV treatment still persist. The objective was to develop a HCV connect-to-care cascade for the University of New Mexico Hospital (UNMH) to understand the potential barriers preventing patients from receiving appropriate care.

Methods
This was a retrospective, single center, descriptive study conducted at UNMH, a level 1 trauma, tertiary care academic medical center with 527 beds. All patients with a positive HCV Ab, RNA, or genotype obtained in 2018 were included in this study. There were no exclusions.

Results
In 2018, over 11,000 unique patients received HCV testing in any form resulting in a total of 14,566 HCV tests being performed.
2018 UNMH Connect-to-Care Cascade

Conclusion
Of the patients who screened positive, only 61.7% were referred for treatment, representing the largest gap in the cascade. However, once patients were seen in the clinic, 88.5% completed treatment with 100% having sustained virologic response (SVR). With the pan-genotypic HCV treatments having fewer side effects and high clinical success rates, it’s feasible that HCV treatment may no longer require a specialist. Similar to the rapid initiation of antiretrovirals in newly diagnosed HIV patients, where immediate access to treatment within days of diagnosis resulted in improved retention in care, decreased time to viral suppression, and decreased viral transmission, rapid initiation of HCV treatment may be the wave of the future.

Disclosures
All Authors: No reported disclosures
1078. Renal Transplant Recipient Resistomes Reveal Expansive Sub-Clinical Burden of Resistance After Treatment for ESBL-Producing Bacterial Infections
Authors: Woodworth Michael , Conrad Roth , Strudwick Amanda F , Babiker Ahmed , Pouch Stephanie M , Pouch Stephanie M , Mehta Aneesh , Friedman-Moraco Rachel , Adelman Max W , Konstantinidis Kostas , Kraft Colleen 
Published: January 2021

Abstract

Background
Renal transplant recipients have frequent infection and colonization with antibiotic resistant (AR) bacteria. However, little is known about the burden of AR following targeted antibiotic treatment.

Methods
This was a prospective study conducted as part of a single center clinical trial at Emory University. Demographic and clinical data regarding transplant and AR bacterial infection were abstracted. Stool samples were collected from renal transplant recipients treated with antibiotics for ESBL-producing gram negative infections. Bacterial cultures with AR-selective media and Illumina short-read sequencing were performed on stool samples. Confirmatory phenotypic isolate AR testing was performed with the Vitek2 platform. Resistome profiles were produced by assembling short reads into scaffolds using MetaSPAdes, predicting protein coding sequences using Prodigal and classifying proteins as antimicrobial resistance determinants using AMRFinderPlus. AMRFinderPlus results for patients were then compared to fecal metagenomes from 3 healthy Human Microbiome Project controls. Differences in AR genes in renal transplant patients vs controls were compared.

Results
Metagenome sequencing was performed for 6 (5 female) patient stool samples. Stools were collected a median of 30 days after infection. The median number of AR genes per patient metagenome was 48.5 (range 23 to 87 genes). The median number of AR genes per control metagenome was 24 (range 16 to 25 genes). We detected 97 unique AR genes across all samples, 63 of which (65%) were detected in patient samples but not controls. All AR genes found in control metagenomes were present in at least one patient metagenome. No AR genes detected in patients were common to all patients. Subsets of clinically relevant genes corresponded with patient stool AR bacteria culture results.
Antimicrobial resistance gene detection heatmap for renal transplant recipient stool samples after antibiotic treatment for ESBL infection.

Conclusion
Viable AR bacteria and diverse AR gene profiles were frequently detected from renal transplant recipient stool samples after antibiotic treatment for infection. These data suggest that AR bacterial colonization and AR gene profiles may require distinct treatments other than systemic antibiotics for eradication.

Disclosures
All Authors: No reported disclosures
1081. Characteristics and Outcomes of Nocardiosis in a Solid Organ Transplant Cohort
Authors: Gianos Andrew T , Lewis Jessica , Wray Dannah , Gnann John W , Jandhyala Deeksha 
Published: January 2021

Abstract

Background
Solid organ transplant (SOT) recipients are at increased risk for nocardiosis, an infection associated with high risk of relapse and/or mortality. Novel antimicrobial regimens may be associated with improved outcomes. Here we describe a cohort of SOT recipients with Nocardia infection, to address knowledge gaps regarding the epidemiology of, risk factors for, and outcomes of nocardiosis in SOT.

Methods
This is a single center retrospective study performed at a 700 bed academic transplant center. Cases of nocardiosis were identified via review of microbiology laboratory records; transplant status was ascertained via the electronic medical record. All SOT recipients with a culture growing Nocardia species between 1/1/2007 and 12/31/2019 were included.
Figure 1. Epidemiologic curve

Results
We identified 27 SOT recipients with nocardiosis. The incidence of nocardiosis increased over the study period (Figure 1). Demographic data are shown in Table 1. Induction immunosuppression varied; 37% received an interleukin-2 receptor antagonist, 30% received anti-thymocyte globulin, and 18% received steroids alone. The majority of positive cultures were from respiratory specimens (63%) and the most common species identified were N. nova complex and N. farcinica (Table 2). The majority of patients were lymphocytopenic and received treatment for rejection. 92% of subjects received a sulfonamide agent as part of their treatment regimen and 73% received an oxazolidinone (Table 3). 73% of subjects had resolution of infection without relapse; 15% expired.

Conclusion
The epidemiology and risk factors for nocardiosis in this SOT cohort are consistent with established literature. Less than a third of cases occurred in subjects who had received lymphocyte-depleting induction immunosuppression; however, most subjects were lymphocytopenic at diagnosis. While nearly all subjects received a sulfonamide as part of their treatment, the majority also received an agent from the newer drug class of oxazolidinones. Overall outcomes were positive, but treatment varied, thus limiting the ability to determine if a particular combination regimen is beneficial. Multicenter randomized studies are needed to better address knowledge gaps particularly pertaining to treatment.

Disclosures
All Authors: No reported disclosures
1083. Clinical Efficacy of Tedizolid for the Treatment of Mycobacterium abscessus complex Infections in Solid Organ Transplant Recipients
Authors: Poon Yi Kee , Monogue Marguerite , Sanders James , Hoz Ricardo M La 
Published: January 2021

Abstract

Background
Mycobacterium abscessus complex is a rapidly growing mycobacteria notoriously refractory to therapy due to inherent antimicrobial resistance mechanisms. Tedizolid is an oxazolidinone with in vitro activity against many nontuberculous mycobacteria species, including M. abscessus complex. This study describes the clinical outcomes of solid organ transplant (SOT) recipients with M. abscessus complex infection treated with tedizolid at a single medical center.

Methods
This retrospective cohort study included adult SOT recipients who met the ATS/IDSA criteria for nontuberculous mycobacterial infection and were treated with a multi-drug regimen that included tedizolid for at least four weeks between January 1, 2010 to August 31, 2019. Symptomatic improvement was defined as either decreased cough or sputum production for pulmonary infection and decrease in size of the primary lesion for skin or surgical site infection. The criteria for a microbiologic response was more than one negative culture with the causative species and sustained until the end of treatment. Clinical cure was defined as improvement of symptoms without proven negative cultures during and sustained until the end of treatment. A patient was considered cured if both symptomatic (if applicable) and microbiologic criteria were fulfilled. The clinical outcomes were compared from the initiation of tedizolid-containing regimen to the end of any M. abscessus complex treatment.

Results
Twelve patients were included. Mycobacterium abscessus abscessus (7/12, 58%) was the most common subspecies. The distribution of infections were as follows: five (42%) disseminated infections, five (42%) pulmonary infections, five (42%) surgical site infections, and four (33%) skin and soft tissue infections. Six patients were cured or clinically cured for all sites of infection (50%), three patients died (25%), and one patient had two recurrences (Table 1).
Table 1. Patient demographics and outcomes of M. abscessus complex infection.

Conclusion
Most patients had multiple sites of infection, and treatment required combination antimicrobial therapy and appropriate surgical management. In this small cohort, tedizolid-containing regimens demonstrated a potential benefit in symptomatic and microbiologic improvement in SOT recipients with M. abscessus complex infection.

Disclosures
All Authors: No reported disclosures