bluuebunny/crossref_metadata_2025_split huggingface dataset:
322. Prolonged Amenorrhea Is Associated with Decreased Hip Bone Mineral Density in Women Living with HIV
Authors: King Elizabeth , Nesbitt Ariel , Albert Arianne , Pick Neora , Cote Helene , Maan Evelyn , Prior Jerilynn , Murray Melanie 
Published: October 2019

Abstract

Background
Women living with HIV (WLWH) have higher rates of long-term amenorrhea (no flow for ≥12 months) than HIV-negative women. However, little is known about the consequences of amenorrhea for WLWH. Both amenorrhea and HIV are associated with lower areal bone mineral density (BMD); though the combined effect of both on BMD remains unclear. In this cross-sectional study we investigated whether prolonged amenorrhea adversely affects BMD among WLWH.

Methods
We investigated BMD (using a Hologic bone densitometer) and prolonged amenorrhea among WLWH and HIV-negative control women of similar socioeconomic backgrounds aged 19–68 in the CARMA cohort. Participants were stratified by HIV status and history of prolonged secondary amenorrhea defined as a self-reported absence of menses for at least one year in the past or present, occurring at age <45 years and not due to surgery, breastfeeding, pregnancy or hormonal contraception. Hip and spine Z-scores (age- and race- standardized BMD values) were compared between groups using linear models, followed by multivariable analysis of BMD-related factors.

Results
WLWH (N = 129) had significantly lower hip (mean±SD −0.4 ± 0.9 vs. 0.3 ± 1.1; P < 0.001) and spine (−0.5 ± 1.3 vs. 0.2 ± 1.3; P = 0.001) Z-scores vs. controls (N = 129). Multivariable linear regression found prolonged amenorrhea was independently related to lower hip (P = 0.01), but not spine (P = 0.94) BMD. Within WLWH, the effect of amenorrhea was also additive to that of HIV, with hip Z-scores of -0.8±0.9for those with amenorrhea vs. -0.3±0.8for those normally cycling (P = 0.01). Amongst WLWH, those with prolonged amenorrhea had higher rates of illicit substance use, smoking, chronic opioid therapy, hepatitis C viral infection, and poorer HIV viral control than those with normal menstruation.

Conclusion
These data suggest that WLWH having prolonged amenorrhea of ≥1 year’s duration are at increased risk for hip bone loss, a finding influenced by comorbid, HIV-associated conditions. Screening WLWH for menstrual history will allow early discovery of osteoporosis risk, and stimulate preventative measures to mitigate bone loss.

Disclosures
All authors: No reported disclosures.
324. Outcomes of Immunomodulatory and Biologic Therapy in People Living with HIV: A Report from Two Academic Hospitals
Authors: Peluso Michael J , Eshun-Wilson Ingrid , Henrich Timothy J , Chin-Hong Peter 
Published: October 2019

Abstract

Background
The use of immunomodulatory drugs (IMDs) is increasingly common. However, data on outcomes of IMD use in people living with HIV (PLWH) are limited and may be biased due to selective reporting of certain outcomes. Institution-level data reflecting patient-time at risk have not been described.

Methods
We systematically identified all PLWH prescribed non-steroidal IMDs from 2012 to 2019 at two centers. We defined a treatment episode (TE) as an uninterrupted period on a particular IMD regimen. Patients contributed multiple TEs if interrupting or switching therapy. We excluded those with lymphoproliferative disorders or transplants. We quantified infections and blips, defined as a detectable viral load following an undetectable result.

Results
35 patients contributed 55 TEs comprising 24,020 patient-days at risk. 29/35 (83%) were male, median age was 53 (IQR 39–59), median CD4 nadir was 197 (IQR 100–314), and 12/35 (34%) had a prior opportunistic infection. TEs utilized TNF inhibitors (19/55, 35%), PD-1 inhibitors (11/55, 20%), antimetabolites (7/55, 13%), interleukin inhibitors (7/55, 13%), and other agents (7/55, 13%). 4/55 (7%) involved in dual therapy. 32/35 (94%) patients were on antiretroviral therapy (ART) at IMD initiation; one was off therapy, one already on IMDs-acquired HIV, and one was an elite controller. Median CD4 count was 472 (IQR 337–807); CD4 was < 500 in 28/55 TEs (51%). Preceding plasma HIV RNA was undetectable in 36/55 (65%) TEs. Of these, 18 (50%) were associated with a viral blip within 1 year; one blip was >200 copies and none resulted in sustained viremia. Compared with other agents, PD-1 inhibitors were associated with a higher blip rate (incidence rate ratio 4.3, 1.3–12.3). 17/55 (32%) TEs were initiated with detectable plasma HIV RNA, which declined on ART in 13/15 (87%) TEs with follow-up testing; one patient stopped ART and one later suppressed. 9/55 (16%) TEs involved an infectious complication (7 soft-tissue infections, 2 pneumonias), although none was clearly attributed to IMDs. 36/55 (65%) TEs had good therapeutic response.

Conclusion
IMDs can be used without major complications in PLWH on ART, including those not yet suppressed or with CD4 counts < 500. PD-1 inhibitors may be associated with a higher rate of viral blips, although the clinical significance is unclear.

Disclosures
All authors: No reported disclosures.
330. Survival of HIV-Positive Patients with Hemophagocytic Lymphohistiocytosis
Authors: Brown Timothy J , Prokesch Bonnie C , Nagalla Srikanth , Wysocki Christian 
Published: October 2019

Abstract

Background
Hemophagocytic lymphohistiocytosis (HLH) is a rare but life-threatening disorder resulting from dysregulated cytokine production. The diagnosis of HLH requires five of eight abnormalities: fever, splenomegaly, bicytopenia, hypertriglyceridemia and/or hypofibrinogenemia, hyperferritinemia, hemophagocytosis on biopsy, low or absent NK cell activity, or elevated soluble CD25. The link between Human Immunodeficiency Virus (HIV) and HLH is incompletely understood; we sought to further define the characteristics and outcomes of this patient population.

Methods
We performed a retrospective study on HLH patients with and without concurrent HIV infection treated at our institution from January 2008 to July 2018. At the time of HLH diagnosis, we extracted data on the HIV status and associated malignancies. The primary outcome was overall survival from time of diagnosis of HLH in patients with HIV vs. those without HIV. Secondary analysis was performed with survival by HIV and malignancy status. Survival was analyzed by Kaplan–Meier curves with hazard ratios calculated using the log-rank test with significance set at P ≤ 0.05.

Results
Forty-three patients were included; 11 had HIV at the time of diagnosis of HLH and all met criteria for AIDS at time of inclusion. Patients with HIV who were diagnosed with HLH had similar survival compared with patients without HIV (Hazard ratio for death (HR) 0.87 [95% confidence interval (CI) 0.37–2.904]). All patients with malignancy had a worse survival (HR for death 3.648 [95% CI 1.804–9.169] P = 0.0009), regardless of HIV status. HLH in HIV patients with malignancy resulted in a trend toward worse survival (HR = 3.86 95% CI 1.09–22.60, P = 0.0578) compared with those without malignancy, although the limited number of patients prohibits a definitive conclusion. In HIV-negative patients, the presence of malignancy is associated with worse survival (HR 3.56 [95% CI 1.475–10.11] P = 0.0063).

Conclusion
In this retrospective, single-institution review of HLH patients, HIV was not associated with worse overall survival compared with patients without HIV. The presence of malignancy resulted in worse survival in the overall population. Further investigation is needed to optimize the care of these patients.

Disclosures
All authors: No reported disclosures.
350. Outcomes for Joint Arthroplasty in Persons Living with HIV
Authors: Mandimika Charisse L , Barakat Lydia A , Golden Marjorie 
Published: October 2019

Abstract

Background
Persons living with HIV (PLHIV) now have dramatically improved life-expectancy with age-related morbidities requiring total joint arthroplasties. We present here an institutional review of PLHIV who underwent total joint arthroplasty and prosthesis-related adverse outcomes at one year.

Methods
This was a retrospective chart review in a large academic medical center. Inclusion criteria were adult PLHIV undergoing total joint arthroplasty between 2013 and 2017. Arthroplasty-related adverse outcomes within the first-year post-surgery were recorded. Patients were identified using ICD-10 codes and classified as having a PJI using Infectious Diseases Society of America (IDSA) criteria.

Results
A total of 40 patients met the criteria. The median age was 59 years and 53% of patients were male. The median CD4 count and RNA viral load were 587 (range 94–1920) cells/mm3 and 0 (range 0—189,000) copies/mL, respectively. The most common procedure was hip replacement (55%) and the most common indication for arthroplasty was avascular necrosis (43%). Adverse outcomes including PJI, dislocation, prosthesis loosening, seroma and chronic pain were identified in 28% of patients. PJI occurred in two patients and both required surgical revision. Modifiable risk factors present in both patients were active smoking, history of substance use disorder, chronic pulmonary disease, depression and hepatitis C antibody positivity. Both patients had CD4 counts >600 cells/mm3. Both were on atazanavir containing antiretroviral regimens. Neither patient was screened for MRSA carriage. Causal organisms were MRSA and MSSA respectively and each patient received 6 weeks of antimicrobial therapy.

Conclusion
This study supports that when medically optimized, PLHIV have favorable outcomes. The two patients who developed PJI had multiple non-HIV modifiable risk factors predisposing them to PJI. In one case, the patient’s isolated organism was MRSA, for which the patient did not receive appropriate pre-operative antimicrobial prophylaxis. This highlights the importance of routine screening for appropriate pre-operative prophylaxis in patients undergoing joint arthroplasty, independent of HIV status.

Disclosures
All authors: No reported disclosures.
352. Characteristics Associated with Pre-Frailty in Older People Living with HIV
Authors: Mazonson Peter , Loo Theoren , Berko Jeff , Chan Sarah-Marie , Westergaard Ryan , Sosman James 
Published: October 2019

Abstract

Background
Frailty is a concern among older people living with HIV (PLHIV). There is a paucity of research characterizing PLHIV who are at risk of becoming frail (pre-frailty). To investigate how HIV impacts older PLHIV in the United States, a new study called Aging with Dignity, Health, Optimism and Community (ADHOC) was launched at ten sites to collect self-reported data. This analysis uses data from ADHOC to identify factors associated with pre-frailty.

Methods
Pre-frailty was assessed using the Frailty Index for Elders (FIFE), where a score of zero indicated no frailty, 1–3 indicated pre-frailty, and 4–10 indicated frailty. A cross-sectional analysis was performed on 262 PLHIV (age 50+) to determine the association between pre-frailty and self-reported sociodemographic, health, and clinical indicators using bivariate analyses. Factors associated with pre-frailty were then included in a logistic regression analysis using backward selection.

Results
The average age of ADHOC participants was 59 years. Eighty-two percent were male, 66% were gay or lesbian, and 56% were white. Forty-seven percent were classified with pre-frailty, 26% with frailty, and 27% with no frailty. In bivariate analyses, pre-frailty was associated with depression, low cognitive function, depression, multiple comorbidities, low income, low social support and unemployment (Table 1). In the multiple logistic regression analysis, pre-frailty was associated with having low cognitive function (Odds Ratio [OR] 8.56, 95% Confidence Interval [CI]: 3.24–22.63), 4 or more comorbid conditions (OR 4.00, 95% CI: 2.23–7.06), and an income less than $50,000 (OR 2.70, 95% CI: 1.56–4.68) (Table 2).

Conclusion
This study shows that commonly collected clinical and sociodemographic metrics can help identify PLWH who are more likely to have pre-frailty. Early recognition of factors associated with pre-frailty among PLHIV may help to prevent progression to frailty. Understanding markers of increased risk for pre-frailty may help clinicians and health systems better target multi-modal interventions to prevent negative health outcomes associated with frailty.

Disclosures
All authors: No reported disclosures.
363. Characterization of HIV/HBV Co-Infected Patients at an Outpatient HIV Clinic and Evaluation of Management Practices as a Measure for Quality Improvement
Authors: Ntem-Mensah Afua Duker , Chua Joel V , Sharaf Salma , Woo John S 
Published: October 2019

Abstract

Background
About 10% of patients living with the human immunodeficiency virus (HIV) are coinfected with chronic hepatitis B infection (HBV). Individuals with HIV are at increased risk of having HBV progress to chronic infection. Current guidelines recommend at least two active agents against HBV in HIV/HBV coinfected patients one of which must include tenofovir. Due to the increased risk of developing fibrosis and hepatocellular cancer (HCC) in this population, current guidelines recommend yearly evaluation of the liver function with imaging, liver function tests (LFTs), and vaccination against Hepatitis A. In our study, we sought to determine the characteristics of dual-infected patients in our clinic and our management practices in accordance with guidelines.

Methods
A retrospective, observational, single-center cohort study in adults coinfected with HIV and chronic HBV from 2013 to 2018 at an urban HIV outpatient practice. Patients with acute hepatitis B infection and isolated hepatitis B core antibody were not included in our study. The study assessed the management practices evaluating appropriate medication for HBV, screening for hepatocellular cancer, and Hepatitis A vaccination.

Results
Of the 3,248 HIV patients seen at our clinic within this period, 128 patients (3.9%) were HBV coinfected. Only active patients (N = 81) were included in the quality improvement analysis. Although 90% of coinfected patients were on appropriate anti-HBV therapy, and 96% had annual LFTs done, only 39.5% had documented hepatitis A vaccination and only a quarter (25.9%) had HCC screening done at the recommended interval.

Conclusion
Long-term management of HIV/HBV involves preventing and monitoring for liver failure and HCC. Based on our clinic data, our management practices for ensuring that our patients receive imaging for HCC will need to be revised.

Disclosures
All authors: No reported disclosures.
373. Immune Reconstitution Inflammatory Syndrome in Patients with HIV/AIDS and Histoplasmosis: A Case Series
Authors: Boulougoura Afroditi , Laidlaw Elizabeth , Roby Gregg , Mejia Yolanda , Pau Alice , Sheikh Virginia , Sereti Irini , Manion Maura 
Published: October 2019

Abstract

Background
Immune Reconstitution Inflammatory Syndrome (IRIS) in HIV infection is the unexpected clinical deterioration due to worsening (paradoxical) or uncovering (unmasking) of an infection or malignancy upon initiation of antiretroviral therapy (ART). Histoplasma capsulatum (H. capsulatum) is the most common endemic mycosis in patients with AIDS, usually manifesting as disseminated disease at CD4 counts < 150 cells/μl. In the ART era, histoplasmosis IRIS has been described in case reports, but there has been a limited description regarding clinical presentations and pathogenesis in the United States.

Methods
ART-naive HIV+ patients with a CD4+ T-cell count < 100 cells/µL enrolled in prospective studies at the National Institutes of Health (NIH) (NCT00286767, NCT02147405) were evaluated to identify those with histoplasmosis and followed after ART initiation to identify those who would eventually develop IRIS.

Results
From a total of 271 patients, we identified 9 patients with histoplasmosis. The median age, CD4+ count and HIV VL of these 9 patients was 36 years, 40 cells/mm3 and 193,184 copies/mL, respectively. Two patients developed IRIS only to histoplasmosis (1 unmasking and 1 paradoxical), 2 patients developed IRIS to both histoplasmosis and nontuberculous mycobacteria (NTM) and 3 patients developed IRIS to other infections (1 VZV, and 2 NTM). The manifestations of histoplasmosis IRIS in our cohort ranged from worsening lymphadenopathy to small bowel obstruction and worsening pulmonary symptoms.

Conclusion
Histoplasma-related IRIS can present with worsening lymphadenopathy, small bowel obstruction, and worsening pulmonary symptoms. The emergence of IRIS appears to be very common in people with HIV and disseminated histoplasmosis but the underlying trigger may be histoplasma, other co-infections or both.

Disclosures
All authors: No reported disclosures.
385. Arthroscopic vs. Open Surgery for Septic Arthritis of the Knee: A Systematic Review and Meta-Analysis
Authors: Sornprom Suthanya , Molloy Iida , Yong Taylor 
Published: October 2019

Abstract

Background
Septic arthritis is a joint-threatening and life-threatening infection, with the knee representing the most frequently involved joint. There is no definitive treatment algorithm for the management of this condition, which typically includes surgical debridement to decompress the joint, followed by organism-specific intravenous antibiotics.

Methods
Search Methods. MEDLINE (1965–2018), SCOPUS (1973–2018), The COCHRANE Library (2006–2017), EMBASE (1974–2018), reference lists, and scientific meetings were searched for relevant studies on the treatment of native knee septic arthritis by three independent reviewers. No language restrictions were used. Selection criteria included all studies reporting on native knee septic arthritis in adults treated with arthroscopy and open arthrotomy with irrigation and debridement. Data Collection and Analysis Studies were identified, subjected to inclusion and exclusion criteria, and reviewed by three independent reviewers. Patient characteristics, interventions, and outcomes were extracted, and the trials were rated for quality based on established criteria. A meta-analysis was conducted for the primary outcome, reoperation occurring after arthroscopic vs. open arthrotomy irrigation and debridement for the treatment of septic arthritis. We used a qualitative analysis for secondary outcomes physical function and hospital length of stay.

Results
From 624 abstracts, eight trials met inclusion criteria, one randomized controlled trial and seven retrospective cohorts. Quantitative meta-analysis showed arthroscopic irrigation and debridement resulted in fewer reoperations compared with open arthrotomy (RR = 0.76; 95% CI 0.59–0.97, P = 0.03, I2 = 24%), Figure 1. A qualitative summary of seven included studies assessing physical function showed arthroscopic debridement results in improved functional outcomes and range of motion compared with open arthrotomy. Based on four trials, qualitative summary demonstrated that arthroscopic debridement results in decreased hospital length of stay compared with open arthrotomy.

Conclusion
Arthroscopic irrigation and debridement is favored over open arthrotomy with regard to lower rates of reoperation, improved functional outcomes, and shorter hospital length of stay.

Disclosures
All authors: No reported disclosures.
394. Impact of Day of Admission and Time to Diagnostic Arthrocentesis on Mortality and Other Outcomes in Solid-Organ Transplant Recipients with Septic Arthritis: A Nationwide Analysis
Authors: Contreras Anez Gustavo , Arevalo Ana B , Murray Shane E , Olivo Freites Christian 
Published: October 2019

Abstract

Background
Multiple cases have been reported assessing the outcomes for solid-organ transplant recipients (SOTR) admitted to the hospital with septic arthritis of a native joint (SANJ); however, there are no data evaluating the outcome of these patients when they are admitted on the weekend compared with the rest of the week.

Methods
The NIS database of the year 2016 was utilized to identify all SOTR with SANJ using ICD-10 codes. SOTR status was defined as those adults with a history of a transplanted organ including heart, lungs, a combined heart and lung, liver, kidney, intestine or pancreas. Admissions between midnight Friday and midnight Sunday were classified as weekend admissions. Early arthrocentesis was defined as percutaneous arthrocentesis performed within 24 hours of admission. Odds ratios (OR) were calculated for primary and secondary outcomes including in-hospital mortality rate, rates of diagnostic arthrocentesis and early arthrocentesis, length o¬f stay and total hospital charges. These results were compared after univariable and multivariable logistic regression adjusted for age, gender, race, day of admission, Charlson comorbidity index and median household yearly income in the patient’s zip code. We used STATA-15 for statistical analysis.

Results
We identified 319 SOTR with SANJ. Compared with SOTR admitted with SANJ on weekdays, those admitted on weekends had increased in-hospital mortality rates (odds ratio[OR] 11; 95% [CI] 1.2–97.9, P < 0.05), but similar, length of stay (P > 0.05) and hospital charges (P > 0.05). However, regardless of the day of admission those who received an early arthrocentesis had a lower length of stay (P < 0.05), and lower total hospital charges (P < 0.05).

Conclusion
Our study showed that compared with SOTR admitted with SANJ on weekdays, those admitted on weekends had increased mortality rates but similar length of stays and total hospital charges. However, patients who received an early arthrocentesis had a significantly lower length of stay and hospital charges regardless of the day of admission. These results add weight to the hypothesis of negative outcomes in weekend admissions. Moreover, we believe that our findings require further investigation to establish the role of early arthrocentesis in the management of septic arthritis.

Disclosures
All authors: No reported disclosures.