bluuebunny/crossref_metadata_2025_split huggingface dataset:
1266. Cancer among HIV-Positive Patients in Cali, Colombia: A Retrospective Hospital-Based Study
Authors: Parra-Lara Luis Gabriel , Carlos Bravo Juan , Eduardo Bravo Luis , Rosso Fernando 
Published: October 2019

Abstract

Background
Cancer has been a significant feature of the HIV epidemic from the beginning, being the most frequent Kaposi sarcoma (KS) and hematolymphoid malignancies. However, the behavior of these two diseases is limited in our context. The study aimed to determine the trends of cancer among HIV/AIDS patients between 2011 and 2016.

Methods
A retrospective hospital-based study was conducted at Fundación Valle del Lili, Cali, Colombia. The study included HIV-positive patients diagnosed with cancer after infection. HIV registry was cross-linked with a population-based cancer registry to obtain IARC/WHO ICD-O-3 classification and follow-up information on all patients. A descriptive analysis of the variables was performed. Survival analysis was carried out using the Kaplan–Meier method. Differences between cancer survival were assessed through the log-rank test.

Results
From 2,051 HIV-positive patient’s records between 2011 and 2016, 95 patients were diagnosed with cancer after HIV infection. The median age was 43 years (IQR=33–57), and 88% were male. Types of cancer were: Kaposi’s sarcoma 17%, hematolymphoid malignancies 21% and other cancer 62%. The probability of cancer diagnosis after HIV diagnosis was 36.26% (CI 95% [26.53–46.05]) at one-year follow-up for all malignancies. Overall survival of the patients was 77.41% (CI 95% [64.76–86]) at 5 years follow-up, since HIV diagnostic. Hematolymphoid malignancies and KS survival were 50% (CI 95% [20.85–73.61]) and 65.63% (CI 95% [35.80–84.14]) at 5 years follow-up, respectively. There was a statistically significant difference between KS, hematolymphoid and other cancer cases survival (P = 0.0178).

Conclusion
This study showed the role of HIV in cancer survival for KS and hematolymphoid malignancies mainly, in a developing country. It is necessary to join efforts in our context to reduce HIV cases and associated malignancies.

Disclosures
All authors: No reported disclosures.
1272. Feasibility and Successful Enrollment in Proof-of-Concept Trials to Assess Safety and Efficacy of a Broadly Neutralizing Monoclonal Antibody, VRC01, to Prevent HIV-1 Acquisitionin in Uninfected Individuals
Authors: Edupuganti Srilatha , Mgodi Nyaradzo M , Karuna Shelly , Andrew Philip , Kochar Nidhi , Marshall Kyle , Decamp Allan , Takuva Simbarashe , Anderson Maija , De La Grecca Robert , Gomez Lorenzo Margarita , Burns David , Goepfert Paul , McElrath Julie , Casapia Martin , Sanchez Jorge , Mukwekwerere Pamela G , Shava Emily , Lazarus Erica M , Hural John , Mascola John R , Cohen Myron , Corey Lawrence 
Published: October 2019

Abstract

Background
The Antibody-mediated Prevention (AMP) trials (HVTN 704/HPTN 085 and HVTN 703/HPTN 081) are the first efficacy trials to evaluate whether VRC01, a broadly neutralizing antibody (bnAb) that targets CD4 binding site of HIV envelope, prevents HIV acquisition in uninfected individuals. In these ongoing trials, 10 intravenous (IV) infusions of VRC01 are given every 8 weeks over a period of 2 years. We report on interim operational feasibility, enrollment and safety.

Methods
Participant recruitment was enhanced by extensive community engagement and education. Eligible participants were randomly assigned 1:1:1 to 10mg/kg, 30mg/kg of VRC01 or saline placebo. HVTN 704/HPTN 085 enrolled high-risk men (MSM) and transgender (TG) individuals who have sex with men at 26 sites in United States, Peru, Brazil, and Switzerland. HVTN 703/HPTN 081 enrolled high-risk heterosexual women at 20 sites in Botswana, Kenya, Malawi, Mozambique, South Africa, Tanzania, and Zimbabwe. HIV testing occurs monthly.

Results
In October 2018, the AMP trials completed enrollment of 4,625 participants. Enrollment met or exceeded targets throughout the trial period, peaked at 298 participants/month, and was slowed mid-trial to allow for sufficient drug supply at trial sites. In HVTN 704/HPTN 085, 2701 (target N = 2700) MSM/TG participants 18–50yrs were enrolled with median age of 28; 99% born male; 90% identified as male gender and 5% TG female. Race/ethnicity was 32% White, 15% Black and 57% Hispanic/Latino/a. 28% had a sexually transmitted infection (STI) including gonorrhea (GC), chlamydia (CT) or syphilis at enrollment. In HVTN 703/HPTN 081,1924 (target N = 1900) women 18–40yrs were enrolled with median age of 26;100% were born female (53% female gender, 47% gender not assessed); 99% were Black. 26% had a STI at enrollment including GC, CT, trichomonas or syphilis. Overall 36,945 infusions have been given so far with no serious procedural complications due to IV administration. Retention and adherence to the rigorous study schedule (monthly visits for 2 years) remain within an acceptable range.

Conclusion
The AMP trials have exceeded enrollment of target populations and are maintaining high rates of retention. With exceptional safety and operational feasibility, they are paving the way for future large-scale bnAb trials for HIV prevention and/or treatment.

Disclosures
All authors: No reported disclosures.
1287. PrEP-Engaged or PrEP Curious?: A Characterization and Comparison of Initial PrEP Appointment Attenders vs. Nonattenders
Authors: Kahal Deborah A , Goldstein Neal , Szabo Susan 
Published: October 2019

Abstract

Background
Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP), with adequate adherence, is highly effective prevention of HIV-1 infection amongst high-risk individuals. While over 1 million individuals are PrEP-eligible in the U.S., those at highest risk for HIV, specifically young non-white men who have sex with men (MSM), represent some of the least penetrated groups to benefit from PrEP. No published data exists to characterize individuals with unattended initial PrEP appointments.

Methods
Our program, a Ryan White funded HIV clinic that also provides Hepatitis C and PrEP care, prospectively collected demographic data on all patients with an attended initial PrEP appointment between November 2015 and March 2019. We retrospectively abstracted the same data for individuals with unattended initial PrEP appointments (including cancelations and no shows) during the same period. Descriptive statistical analyses used rank-sum tests for skewed data (age) and Chi-squared tests for categorical data (all other variables).

Results
33% (34/103) of all individuals did not attend an initial appointment (table). Younger age and nonprivate insurance were the 2 sociodemographic variables that were significantly associated with unattended vs. attended initial appointments. Amongst those whose HIV risk factors were known, MSM were more likely to attend their appointment compared with non-MSM. 77% (26/34) of individuals with unattended initial appointments did not reschedule (figure). Notably, 12% (4/34) PrEP-eligible individuals previously presented to the clinic yet did not re-present for dedicated PrEP evaluation.

Conclusion
A significant proportion of individuals schedule but do not attend initial PrEP appointments. This cohort, particularly younger patients and those with nonprivate insurance, represents a distinct population - with a “near” yet incomplete engagement in care – for whom HIV prevention efforts and concerted outreach should be focused. Same day, rapid PrEP starts deserve serious consideration in order to capitalize on patient engagement when the opportunity presents. The paucity of data highlights the need for research of those who are PrEP-interested but not fully PrEP-engaged.

Disclosures
All authors: No reported disclosures.
1292. Integrating HIV and Hepatitis C Screening in a High-Risk Emergency Department Population
Authors: Chechi Tasleem , Tran Nam , Sage Allyson C , Waldman Sarah , May Larissa S 
Published: October 2019

Abstract

Background
With the acceleration of the hepatitis C (HCV) epidemic in the United States and the ongoing public health impact of undetected human immunodeficiency virus (HIV) co-infection, there is a critical need for enhanced secondary prevention efforts where patients accessing care are not routinely screened. The purpose of this program was to implement routine opt-out HIV and HCV screenings in a high-volume urban emergency department (ED) through the use of an EMR enhancement to increase a provider’s likelihood of testing eligible patients, and to provide linkage to care for patients identified to have positive tests.

Methods
From November 27, 2018 to March 31, 2019, EMR-based HIV and HCV screening was implemented in a quaternary care ED in Northern California. EMR best practice alerts were developed based on a combination of local and CDC guidelines and populated on registered patients receiving blood laboratories or receiving STI testing. Laboratory HIV/HCV screening utilized a unique two-specimen collection scheme to enable molecular testing without requiring patient return visits. Patients were excluded if they chose to opt out from testing or the provider deemed opt out was not possible. Upon notification of a positive test result through the EMR, a patient navigator was responsible for providing disease education and linking patients to care.

Results
The prevalence of HCV antibody positivity was 9.6% (637/6,627) and 0.97% (55/5,628) for HIV. Of the 255 HCV-RNA positives, 110 were known and 145 newly diagnosed. Of the 90 HIV patients, 31 were known and 8 newly diagnosed. Although current CDC hepatitis C screening guidelines recommend screening all adults born during 1945–1965, we conducted universal screening of adults 18 years or older. Of those screened antibody-positive for HCV 64% fell within the 1945–1965 birth cohort.

Conclusion
Introducing routine opt-out testing using an automated EMR-based screening program is an effective method to identify and screen eligible patients for HIV and HCV in episodic care safety net settings where universal screenings are not routinely implemented. The unexpectedly high rate of HIV seroprevalence suggests the ED environment continues to be an important setting to access populations not receiving routine care despite longstanding CDC recommendations for universal screening.

Disclosures
All authors: No reported disclosures.
1294. Long-Term Impact of an HIV Testing Program on High-Risk HIV Screening in the Emergency Department
Authors: Baron Jillian T , Schwartz Alexis , Davis Ebony , Uspal Julie E , Kelly Brendan 
Published: October 2019

Abstract

Background
Emergency Departments (EDs) are important sites for HIV testing. However, there is little guidance on how best to implement HIV testing in the ED. The purpose of this study was to evaluate HIV screening practices of high-risk individuals presenting to an ED in the absence (ED1) and in the presence (ED2) of an established HIV testing program within the same academic hospital.

Methods
We performed a retrospective chart review of all individuals 18 years or older presenting to either ED between January 1, 2016 and December 31, 2018. High-risk of HIV infection was determined by receipt of bacterial sexually transmitted infection (STI) testing for Neisseria gonorrhoeae or Chlamydia trachomatis. The primary outcome was receipt of any HIV test in the ED. Overall proportions of patients tested for HIV at the same time of STI testing were compared between sites by chi-square test. Predictors of HIV testing were analyzed by logistic regression.

Results
During the study period, 7,956 individuals received STI testing at ED1 and 10,815 received STI testing at ED2. The majority of individuals receiving STI testing at both sites were female, 81.2% at ED1 and 66.4% at ED2 (P <0.001). Only 4.0% of individuals received HIV testing at ED1 compared with 47.4% at ED2 (P <0.001). Individuals were significantly more likely to receive HIV testing at the time of STI testing in the ED with an HIV testing program (aOR 19.66, 95% CI 17.28–22.37). In the ED without an HIV testing program, individuals were more likely to receive HIV testing if they were male (aOR 3.57, 95% CI 2.78–4.55) and less likely if they were black (aOR 0.57, 95% CI 0.50–0.97). In the ED with an HIV testing program, individuals were more likely to receive HIV testing if they were male (aOR 2.17, 95% CI 1.92–2.44) and more likely if they were black (aOR 1.74, 95% CI 1.37–2.20).

Conclusion
Overall, the presence of an HIV testing program in the ED significantly increased the probability that individuals would receive an HIV test at the time of bacterial STI testing and mitigated disparities in care. The results of this study will help guide ongoing interventions to improve HIV screening among high-risk individuals in the emergency department.

Disclosures
All authors: No reported disclosures.
1299. Cluster of False-Positive “Fifth-Generation” HIV Test Results During Implementation of a Routine HIV Screening Program in an Emergency Department
Authors: Trotter Andrew B , Maheswaran Anjana , Kate Mannion Mary , Baghikar Sara , Lin Janet 
Published: October 2019

Abstract

Background
In November 2014, the University of Illinois Hospital (UI Health) introduced an electronic medical record (EMR)-driven HIV screening program in the emergency department (ED). In October 2016, our hospital laboratory introduced “Fifth-generation” HIV testing using the Bio-Rad BioPlex 2200 HIV Antigen/Antibody diagnostic assay. Fifth-generation HIV testing has the advantage of separately detecting and reporting HIV antibody and HIV-1 p24 antigen. Although the literature and manufacturer report high sensitivity and specificity of this test, we encountered higher than expected rates of false-positive tests during the introduction of this test.

Methods
We retrospectively reviewed the results of our ED HIV screening program from October 2016 to March 2019 to describe the outcomes of HIV testing, determine the rates of false-positive HIV tests and determine if false-positive rates were temporally clustered. We also investigated various potential causes of higher than expected false positives including pre-analytical and analytical error. We defined a false-positive test as a repeatedly reactive initial HIV antigen and/or HIV-1 antibody result with a subsequent negative or indeterminate HIV-1/2 antibody differentiation immunoassay and negative HIV-1 nucleic amplification test.

Results
During the review period, out of a total of 17,385 HIV tests which were performed, 85 tests were confirmed positive and 27 were false positives. This represents an HIV prevalence of 0.5%. Eighteen of the 27 false positives occurred during an 8 month period between October 2016 and April 2017 (see Figure 1). During our investigation of potential causes of the false-positive tests, we discovered that a reagent lot for the test was changed in June 2017 which resulted in a significant decrease in the false-positive rate (0.33% to 0.07%).

Conclusion
We provide data which suggests that a reagent lot may have been the cause of higher than expected false-positive tests for HIV testing. Monitoring of testing outcomes during implementation of a routine HIV testing program can help identify potential root causes of false-positive tests.

Disclosures
All authors: No reported disclosures.
1311. Ryan White HIV Care Continuum Model Doubled the Rate of Community HIV Viral Suppression for Newly Diagnosed Patients: A 10-Year Review
Authors: Rizk Christina , Zhao Alice , Miceli Janet , Shea Portia , Villanueva Merceditas , Barakat Lydia A 
Published: October 2019

Abstract

Background
It is estimated that 1,295 per 100,000 are people living with HIV (PLWH) in New Haven, which is the second highest rate of HIV prevalence in Connecticut. Since 2009, New Haven has established the Ryan White (RW) HIV Care Continuum. The main goals of HIV care are early linkage to care, ART initiation, and HIV viral suppression. This study is designed to understand the trends and outcomes in newly diagnosed PLWH in New Haven County.

Methods
This study is a retrospective medical record review of all newly diagnosed RW eligible PLWH from January 1, 2009 to December 31, 2018. The data were collected in REDCap database and included demographics, HIV risk factor, presence of mental health and/or substance abuse disorder, date of diagnosis, date of initial visit, and ART initiation. Health outcomes such as AIDS at diagnosis and rate of viral suppression were evaluated. The data were then analyzed to show the trends over 10 years.

Results
From January 1, 2009 to December 31, 2018 there were 420 newly diagnosed RW PLWH. Sixty-seven percent of those were male, 56% were non-white, 47% self-identified as Men who have Sex with Men (MSM), and 41% were heterosexual. Twenty-nine percent had AIDS-defining condition at the time of the diagnosis. Thirty-four percent of the 420 patients had a mental health and/or substance use disorder; 53% of those were MSM and 51% were non-white. Over the 10-year period, it was noted that the duration between date of HIV diagnosis and linkage to care as well as ART initiation decreased. This decline was associated with a substantial increase in viral suppression. The average time between the dates of HIV diagnosis and initial visit decreased from 269 days in 2009 to 13 days in 2018. Moreover, the average time between the dates of diagnosis and ART initiation dropped from 308 days in 2009 to 15 days in 2018. The 1-year HIV viral suppression rate subsequently doubled from 44% in 2009 to 87% in 2018 (P < 0.01).

Conclusion
The Ryan White HIV Care Continuum Model with emphasis on early linkage to care and ART initiation can have a significant impact on HIV viral suppression at a community level for newly diagnosed patients. Another important observation in this study was the alarming high rate of AIDS at diagnosis, which highlights the need for universal HIV testing, and early diagnosis.

Disclosures
All authors: No reported disclosures.
1313. Complementary Effects of Medical Follow-up and Virologic Suppression for Reincarcerated Inmates Living with HIV
Authors: Badowski Melissa E , Stafford R Kane , Drummond Brian W , Chiampas Thomas D , Michienzi Sarah M , Patel Mahesh C , Young Jeremy 
Published: October 2019

Abstract

Background
Although prison presents an opportunity to achieve virologic suppression (VS) among people living with HIV, continued success is not guaranteed upon release.

Methods
A retrospective cohort study was performed in reincarcerated Illinois prisoners from January 1, 2016 to July 31, 2018. Patients were included if they were age ≥18 years, carried a diagnosis of HIV/AIDS, on antiretroviral therapy (ART) at the time of release, and had CD4 and HIV-1 RNA labs drawn within 6 months of release and reincarceration. Potential subjects were excluded if reincarcerated within 30 days due to a technical violation and not receiving ART at the time of prison release. Primary and secondary endpoints were percent of patients achieving VS upon reincarceration and percent of patients following at an HIV clinic while released. Statistical analysis included descriptive statistics, chi-square, and paired t-tests.

Results
Among 505 patients released during the study period, 95 patients were reincarcerated and 80 were included (Figure 1). Demographic information can be found in Table 1. Fifty-one patients (64%) reported follow-up at an HIV clinic while released, whereas 29 (36%) did not. Patients who had VS at the time of prison release were more likely to make their follow-up appointment (90%) compared with those who did not (69%) (P < 0.001). In addition, patients making their follow-up appointment were also more likely to have VS at the time of reincarceration (86% vs. 10%, P < 0.001). Recidivist patients adherent to ART were less likely to experience decreases in mean CD4 count (P = 0.03) (Table 2). Subjects reporting a history of substance use were more likely not to re-engage in post-release HIV care (P = 0.001), but no difference was noted in patients with a documented psychiatric history (P = 0.2).

Conclusion
Patients failing to meet VS at the time of prison release should be targeted for more intensive re-entry medical and case management support to ensure adherence to follow-up and maintenance of immunologic function.

Disclosures
All authors: No reported disclosures.
1314. HOME CARE: Reaching Our Lost to Follow-up Patients and Overcoming Barriers to Care Utilizing Nontraditional Care Models
Authors: Goldman Erin , Union Sheronda , McClendon Tammie , Veltman Jennifer 
Published: October 2019

Abstract

Background
Of the 11098 people living with HIV in southeast Michigan, over 30% are out of care, with transportation being the most commonly identified barriers. To address this barrier and re-engage patients into care, we introduced an HIV homecare program. The objective of this study was to describe the implementation of the homecare program and document the outcomes of patients enrolled.

Methods
In 2016, WSUPG ID clinic saw 1990 patients and had additional 95 clients who were virally unsuppressed and lost to care for 12 months. We called all 95 of these clients and offered homecare. We also advertised our program internally, to the Detroit Public Health Departments’ Data to Care Program (Link up Detroit), and to community-based organizations. Referred patients were seen by a NP/MA team supervised by an infectious disease attending. HIV medical care delivered in home utilized same standards of care as for outpatient setting, including lab draws and counseling. Patients also had the ability to text/call provider directly on the program cell phone. This project was funding through a Part A Ryan White MAI grant.

Results
Of the 95 clients out-of-care, 38 (40%) were unreachable, 41 (43%) were reachable and 16 (17%) did not qualify (relocation, incarcerated, deceased, in-care at the time of call). 5 (5%) enrolled in homecare and additional 29 patients were referred to our program. A total of 34 patients enrolled from September 20, 2017 to September 20, 2018. Among the 34 clients, mental health barriers were the most frequently reported (depression in 20, schizophrenia or bipolar in 7, anxiety in 23, and history of trauma in 11). Of the 34 clients, 24 have achieved virologic suppression at least once during their enrollment. Among the 26 clients with 6+ months of follow-up, 17 have achieved virologic suppression.

Conclusion
Homecare offers a new, innovative healthcare delivery system which is effective at achieving viral suppression in a challenging patient population and is a successful strategy to re-engage patients in care.

Disclosures
All authors: No reported disclosures.