bluuebunny/crossref_metadata_2025_split huggingface dataset:
2490. Longer-Term Safety and Efficacy of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide in Virologically Suppressed Adults Living With HIV and End-Stage Renal Disease on Chronic Hemodialysis
Authors: Eron Joseph J , Lelievre Jean-Daniel , Kalayjian Robert , Slim Jihad , Wurapa Anson K , Stephens Jeffrey L , McDonald Cheryl , Cua Eric , Wilkin Arjun , McKellar Mehri , Cox Stephanie , Majeed Sophia , Blair Christiana , Carter Christoph C , SenGupta Devi , Brainard Diana M , Das Moupali 
Published: October 2019

Abstract

Background
HIV treatment for individuals with end-stage renal disease (ESRD) on hemodialysis (HD) has previously required complex dose-adjusted regimens. We evaluated the safety and efficacy of single-tablet, once-daily elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF) in people living with HIV (PLH) and ESRD on chronic HD.

Methods
Virologically suppressed adult PLH with ESRD on chronic HD for ≥ 6 months were switched to open-label E/C/F/TAF 150/150/200/10 mg once daily for 96 weeks. Efficacy was assessed as the proportion of participants who maintained virologic suppression (HIV RNA < 50 copies/mL) using the snapshot algorithm. Safety and participant satisfaction were assessed throughout the study.

Results
We enrolled 55 participants with median age 51 years (range 23–64) with median time on HD 6 years (range 1–17). In the per protocol analysis set, virologic suppression was maintained in 30 of 31 participants (96.8%, 95% CI [83.3%, 99.9%]) at week 96. In the full analysis set, virologic suppression was maintained in 30 of 55 participants (54.5%; 95% CI [40.6%, 68.0%]); one discontinued therapy due to lack of efficacy, and W96 data were unavailable for 24. Of the 24 participants lacking W96 data, 17 discontinued study drug early and 7 had missing data while on study drug; all had HIV RNA < 50 copies/mL at the last pre-week 96 check. Treatment-emergent AEs occurred in 53 (96.4%) participants, and study-drug-related AEs occurred in 7 (12.7%). Treatment-emergent AEs leading to premature study drug discontinuation occurred in 4 (7.3%) participants; two were considered study-drug-related (allergic pruritus and peripheral neuropathy in one participant each). No study-drug-related serious AEs were observed. 85.7% (30/35) of responding participants reported they were ‘much more satisfied’ with their regimen.

Conclusion
Single-tablet, once-daily E/C/F/TAF was effective in maintaining virologic suppression in PLH on chronic HD over 96 weeks of follow-up. E/C/F/TAF was well tolerated and was associated with improved participant satisfaction. These data demonstrate that E/C/F/TAF is a safe and effective alternative to more complicated regimens in PLH on chronic HD, with the potential to improve patient satisfaction and quality of life.

Disclosures
All authors: No reported disclosures.
2492. Differences between Individuals Currently Taking Integrase Inhibitor (INSTI)-based Therapy and Those Not Taking INSTIs in the Era of INSTIs as Recommended First-line Therapy
Authors: Monroe Anne K , Levy Matthew E , Greenberg Alan E , Moore Richard , Keruly Jeanne , Horberg Michael A , Mohanraj Bernadine , Kumar Princy , Castel Amanda 
Published: October 2019

Abstract

Background
Agents from the integrase inhibitor (INSTI) therapeutic class only are recommended as initial therapy for most patients with HIV. Clinicians now face a decision when treating ART-experienced patients on non-INSTI regimens: continue current therapy or switch to INSTI. Multiple factors may be considered in this decision: clinician/patient preference, comorbidities, tolerability, and resistance history. The objective of this analysis was to examine patient factors associated with currently taking an INSTI-based regimen.

Methods
We used data from the DC Cohort, a longitudinal observational cohort of patients receiving HIV care at 14 clinics between 2011–2018. Participants in the sample had ≥ 1 encounter between 4/1/17 and 3/1/18, were aged ≥ 18 years and were ART experienced. Participants were classified as currently, previously, or never on an INSTI. Independent variables included demographics, clinical characteristics, alcohol/tobacco use, HBV/HCV status and HIV-related variables (recent CD4 and HIV RNA, presence of resistance mutations). Multivariable multinomial logistic regression was used to identify factors associated with INSTI use status.

Results
Among 4584 participants (58.2% aged 50+ years; 69.4% male; 2.5% transgender; 80.3% Black; 36% MSM), most (65.0%) were current INSTI users; however, a sizeable proportion (28.3%) were never users and 6.7% were former users. Current and previous INSTI users were more likely to have a major NRTI, NNRTI or PI mutation compared with never users (see Table 1). Transgender participants (compared with males), were less likely to be current (vs. never) users (adjusted odds ratio (aOR) 0.48, 95% CI 0.32, 0.72). Younger participants (18–24 vs 50+ years) were more likely current users (aOR 1.90, 95% CI 1.18, 3.06), as were Hispanic participants (aOR 1.39, 95% CI 1.05, 1.84).

Conclusion
The majority of active DC Cohort participants were using INSTI-based therapy. Transgender and older individuals were less likely to be on INSTIs, indicating that they are more likely to be on PI-based or NNRTI-based therapy or not on therapy. Further research should explore whether this is detrimental for long-term HIV outcomes in these patient groups. Additionally, these results suggest resistance history as an important driver of INSTI prescription.

Disclosures
All authors: No reported disclosures.
2498. Perceptions of Injectable Antiretrovirals in an Urban HIV Clinic
Authors: Koren David E , Fedkiv Volodymyra , Zhao Huaqing , Bettiker Robert , Tedaldi Ellen , Samuel Rafik 
Published: October 2019

Abstract

Background
Although new injectable antiretrovirals (ARV) for HIV may soon be available, there is little research on patient preferences. We examined perceptions of injectable ARV among persons living with HIV (PLWH).

Methods
This cross-sectional study was conducted among PLWH presenting for an appointment at TempleHealth in Philadelphia, PA between March 11 and April 18, 2019. Respondents completed a self-administered survey comprising 29 questions about socio-demographic data, current ARV, and preferences regarding injectable ARV therapies. Responses were recorded on a 10-point Likert scale, on which responses in the 1–5 range were defined as unlikely and 6–10 range as likely to choose injectable ARV. The primary endpoint was to describe factors associated with likely vs. unlikely uptake of injectable ARV. Responses between groups were compared with Chi-square or Wilcoxon rank-sum tests.

Results
171 patients completed a survey with a 56% response rate. Demographics were 60% male, 70% African American, 33% LGBQ-identifying, 2% transgender, with a mean age of 48 ± 13 years. Percentages of likely uptake (55%, n = 94) and unlikely uptake (45%, n = 77) were similar. Median likelihood was 7 (IQR 7–10) and varied from likely (10, IQR 8–10) and unlikely (1, IQR 1–5) cohorts. There were no differences in overall likelihood based on current number of pills or pill frequency (P > 0.05). A likelihood trend was found among patients who missed one or more doses per week, however current adherence was not significant (p = 0.06). Likelihood of uptake means increased as the frequency of administration decreased: 1-week (5.7 ± 3.7), 2-week (5.9 ± 3.7), 1-month (7.3 ± 3.5), 2-month (7.3 ± 3.6), and 3-month (7.7 ± 3.4). Likelihood of uptake decreased as duration of a potential injection site reaction increased: 1 day (6.2 ± 3.5), 2–3 days (4.6 ± 3.3), 4–6 days (3.6 ± 3.1), 7 days or longer (3.0 ± 3.2). Respondents preferred their doctor’s office (60%) over self-injection (23%), assisted injection at home (11%), pharmacy (4%), or special injection center (2%) for administration setting.

Conclusion
Our study indicates that availability of injectable administration has potential to find acceptance among PLWH.

Disclosures
All authors: No reported disclosures.
2511. Characterization of Patient Pill Preferences from a Prospective Placebo vs. Placebo Ease of Swallowability Study
Authors: Osborn Zachary F , Acosta Tommy J Parraga , Lee Jean C , McNicholl Ian , McKinnon John E 
Published: October 2019

Abstract

Background
HIV therapy has been moving toward smaller size, once a day regimens in hopes of improved adherence. Surprisingly, few publications characterize HIV patient’s pill preferences. To evaluate HIV-negative or treatment-naïve pill preference, we conducted a prospective randomized study at the Infectious Diseases Clinic at Henry Ford Hospital in Detroit, MI.

Methods
Fifty patients were recruited, receiving questionnaires regarding factors influencing the ease of swallowability, medication habits, pill preferences and adherence while being randomized to receive placebo pills representing currently FDA approved combination antiretrovirals DTG/ABC/3TC and BIC/FTC/TAF. Statistical analyses presented are descriptive.

Results
Patients preferred pills or tablets (84%) as their preferred form of medication. Patient’s ideal pill length size was reported between 4–9 millimeters (96%), with no responses > 13 mm. The most important factors for ease of swallowability were stated as size (40%) and smoothness (38%). Interestingly, 80% of participants then reported that size and shape of the pills was only “some or less” important to them for their pills; however, 32% of participants stated that size, and shape (16%), could make them not want to take a pill daily. When offered the choice of regimens, patients preferred taking more, smaller pills (42%) vs. fewer larger pills (36%) or liquids (14%). Three most common factors indicated as making medication adherence difficult included taking multiple doses daily (38%), large pills (16%), and multiple pills per dose (14%). When given free response, pills having a smooth coating was reinforced by 10 of the 25 (40%) participants who commented.

Conclusion
Patient preferences for medications are varied and nuanced, but carry implications on patients self-reported likelihood to remain adherent to a regimen. Care should be taken in a clinical setting, such as HIV, to take pill characteristics into account when selecting antiretroviral regimens for patients.

Disclosures
All authors: No reported disclosures.
2514. Real-time Antiretroviral Electronic Adherence Monitoring In Young African American Men Who Have Sex With Men
Authors: Dworkin Mark S , Panchal Palak , Jimenez Antonio , Garofalo Robert , Haberer Jessica , Wiebel Wayne 
Published: October 2019

Abstract

Background
Antiretroviral therapy adherence remains a challenge, particularly for young African American men who have sex with men (YAAMSM). We enrolled 40 YAAMSM for 3 months of electronic adherence monitoring (EAM). These data may be useful in developing an antiretroviral EAM intervention that responds to missed doses with real-time text messages.

Methods
YAAMSM (age 18–34 years) living with HIV and taking ART participated in a quantitative and qualitative study that included ART adherence monitoring with a Wisepill electronic monitoring device for up to 3 months. Interviews were performed during April 2017–April 2019 at baseline and follow-up. Monitoring data were reviewed to determine timing and patterns of missing their first true adjudicated miss for durations of 1 dose, 3 consecutive days, and 7 consecutive days. Follow-up qualitative interviews included exploring acceptability of monitoring.

Results
The median age was 28 years and median participant observation time was 90 days (interquartile range 88–90 days) (n = 40 participants). Among those with at least 2 weeks follow-up and adjudication (n = 32), 100% missed at least 1 day. Most (82%) of these participants were <80% adherent in at least one of their monitored months. One dose and 3-day misses did not cluster (e.g., no disproportion on weekends). Most (88%) first missed doses occurred during the first 9 days monitored and most (69%) of the 13 who missed 3 consecutive days missed within the first monitored month. Four participants missed 7 consecutive days. Among 31 with a follow-up interview, 28 (90%) felt receiving a text because of device monitoring would affect their medication taking in the future. Illustrative quotes included, “It made me more responsible” and “…it makes you want to do it right.”

Conclusion
Most YAAMSM living with HIV in this study had adherence below the target threshold of >80%. These data support development of a text message responsive real-time electronic adherence monitoring intervention approach.

Disclosures
All authors: No reported disclosures.
145. Liver Steatosis as a Risk Factor for Invasive Group B Streptococcus Infection in Non-Pregnant Adults
Authors: Papic Neven , Gjurasin Branimir , Vince Adriana 
Published: October 2019

Abstract

Background
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease associated with metabolic syndrome and systemic changes in immune response. However, the impact of NAFLD on bacterial infections is unknown. Group B Streptococcus (GBS) infection is a significant cause of invasive disease among adult non-pregnant patients with high mortality rates, associated with diabetes mellitus and obesity as the most common underlying conditions. The aim of this study was to analyze the association of liver steatosis with invasive GBS disease outcomes.

Methods
A retrospective, cohort study of all non-pregnant adult patients diagnosed with invasive GBS infection (GBS isolated from the normally sterile site) was conducted at the University Hospital for Infectious Diseases Zagreb during a 14-year period.

Results
Of the 127 patients with invasive GBS, 90 had complete data and were included in the study. Disease primarily presented as bacteremia without focus (34; 37.8%), cellulitis/erysipelas (27; 30.0%), pneumonia (11; 12.2%) and endocarditis (8; 8.9%). The most common co-morbidities were diabetes (36; 40.0%), dyslipidemia (35; 38.9%), cardiovascular (32; 35.6%), peripheral vascular disease (18; 20.0%) and malignancy (16; 17.8%). Based upon the results of abdominal US the patients were divided into two groups: with steatosis (39; 43.3%) and without steatosis (51; 56.6%). The patients with liver steatosis were younger (63 ± 13 vs. 71 ± 14 years, P = 0.01), had higher AST (45.0; IQR 30–71 vs. 28.5; IQR 20–71, P = 0.047) and ALT (38; 25.5–55.5 vs. 21.5; 14–40, P = 0.009). There were no differences in clinical presentation and comorbidities between groups. The in-hospital mortality was 43.5% in patients with steatosis (17/39) and 17.6% (9/51) in control group (P = 0.009). Logistic regression analysis showed that endocarditis (OR 200.8; 95% CI 11.5–3512.5), primary bacteremia (6.5; 1.7–25.0), qSOFA ≥2 (20.2; 4.2–97.6) and liver steatosis (8.4; 2.0–35.1) were associated with in-hospital mortality.

Conclusion
Our findings showed that invasive GBS disease has significant mortality, which is independently associated with liver steatosis.

Disclosures
All authors: No reported disclosures.
146. Infective Endocarditis in South Korea: a 12-year Single-Center Experience of 419 Patients
Authors: Ho Kim Jung , Jae Lee Hi , Ji Lee Woon , Seong Hye , young Ahn Jin , Jin Jeong Su , Su Ku Nam , Hyun Lee Seung , Yong Choi Jun , Yeom Joon-Sup , Goo Song Young 
Published: October 2019

Abstract

Background
Infective endocarditis (IE) is a potentially lethal disease that has undergone constant changes in epidemiology and pathogen. Treatment of IE has become more complex with today’s myriad healthcare-associated factors as well as regional differences in causative organisms. Therefore, it is necessary to investigate the overall trends, microbiological features, clinical characteristics and outcomes of IE in South Korea.

Methods
We performed a retrospective cohort study of patients with the diagnosis of probable or definite IE according to the modified Duke Criteria admitted to a tertiary care center in South Korea between November 2005 and August 2017. Poisson log-linear regression was used to estimate time trends of IE incidence rate and mortality rate. Risk factors for in-hospital mortality were evaluated by multivariate logistic regression analysis including an interaction term.

Results
There were 419 IE patients (275 male vs. 144 female) during the study period. The median age of the patients was 56 years. The annual incidence rate of IE of our institution was significantly increased. (RR 1.05; 95% CI, 1.02–1.08; P = 0.006) The mortality rate showed trends toward down, but not statistically significant (P = 0.875). IE was related to a prosthetic valve in 15.0% and 21.7% patients developed IE during hospitalization. The mitral valve was the most commonly affected valve (61.3%). Causative microorganisms were identified in 309 patients (73.7%) and included streptococci (34.6%), followed by Staphylococcus aureus (15.8%) and enterococci (7.9%). The in-hospital mortality rate was 14.6%. Logistic regression analysis found aortic valve endocarditis (OR 3.18; P = 0.001), IE caused by staphylococcus aureus (OR 2.32; P = 0.026), a presence of central nervous system embolic complication (OR 1.98; P = 0.031), a high SOFA score (OR 1.22; P = 0.023) and a high Charlson’s comorbidity index (OR 1.11; P = 0.019) as predictors of in-hospital mortality. On the other hand, surgical intervention for IE was found to be a protective factor against mortality. (OR 0.25, P < 0.001)

Conclusion
Although IE has been increasing, the mortality rate has not yet reduced significantly. Studies on causative organisms of IE and risk factors for mortality are warranted in improving prognosis.

Disclosures
All authors: No reported disclosures.
2533. HIV Training Pathways in Residency: A National Survey of Curricula and Outcomes
Authors: Budak Jehan , Sears David , Wood Brian , Dhanireddy Shireesha , Dhanireddy Shireesha , Teherani Arianne , Schwartz Brian , Schwartz Brian 
Published: October 2019

Abstract

Background
Despite dramatic advances in the care of people with HIV (PWH), the shortage of HIV providers is worsening. An approach to this workforce shortage has been integration of robust HIV training into residency. We created a national survey to describe curricula and outcomes of formal HIV training pathways and how this may impact the HIV workforce shortage.

Methods
We designed a cross-sectional study of Internal Medicine (IM) and Family Medicine (FM) Residency HIV pathways in the United States. We identified programs via literature review, internet search, and snowball sampling. A draft survey was piloted with two pathway directors, and in January 2019, the final survey was sent via email to all pathway directors. This survey included 33-items, predominantly quantitative, and focused on program organization, curricular content, graduate outcomes, and challenges. We used descriptive statistics to summarize numeric responses.

Results
Twenty-five residency programs with dedicated HIV pathways were identified; 11 IM and 15 FM. The majority of the programs are in the West and Northeast United States. Twenty-four (96%) of programs have completed the survey. Since the first program was established in 2006, 228 residents have graduated from HIV pathways in the United States (151 IM, 77 FM). Programs have varying goals, application procedures, clinical requirements, didactic structures, graduation requirements, and assessments of competency. Of graduates, 108 (47%) have American Academy of HIV Medicine (AAHIVM) certification. Ninety-two (42%) of graduates are reported as currently providing primary care to ≥ 20 PWH (the majority in the West and Northeast United States). The most commonly cited reported barrier to graduates finding jobs caring for PWH are lack of job opportunities in their geographic area.

Conclusion
HIV pathways in IM and FM programs are heterogenous in their structure and curricula. Less than 50% of pathway graduates remain in the HIV provider workforce, and the majority of those work in the West and Northeast United States. The impact of these programs might be enhanced by interventions to increase graduate retention in this workforce and to launch pathways in the areas of greatest need, such as the Southern United States.

Disclosures
All authors: No reported disclosures.
2535. The Stairway to Antibiotic Heaven: Evaluating a Scaffolded Video Series on Empiric Antibiotic Selection
Authors: Larnard Jeffrey , Zucker Jason , Gordon Rachel 
Published: October 2019

Abstract

Background
Inappropriate antibiotic use and spread of resistance is a well-known problem. In academic settings, house staff often make initial decisions regarding antibiotic use. Recently, there has been increasing interest in using “whiteboard animations” as a way of delivering educational content. We introduced a supplemental series of short whiteboard animation videos on empiric antibiotic selection during a blended transition to residency course for fourth year medical students. Our aim was to determine whether the videos were an effective learning resource.

Methods
A total of eight whiteboard animation videos on empiric antibiotic selection were created using Camtasia. Learning was scaffolded using a pneumonia case and an antibiotic “ladder” to provide context for the antibiotics discussed. Questions were interspersed throughout the videos. Students completed an eight question pretest and then an eight question post-test after completing the modules. Qualtrics was used to randomly select questions for the pre- and post-tests from a common question bank. After each individual video module, students were also offered a post-module survey with Likert scaled questions evaluating student perception of the module. All tests and surveys were anonymous. Scores of pre- and post-tests were compared with unpaired t-tests.

Results
We received a total of 37 pre-tests and 14 post-tests. The average score on the pre-test was 66% compared with 93% on the post-test (P < 0.0001). We also received seventy-four post-module surveys across the eight videos. When asked whether the particular video module was an effective way to learn about antibiotic coverage, 98% of responses responded “agree” or “strongly agree.” 90% of responses also answered “agree” or “strongly agree” when asked if they were more likely to remember the spectrum of activity of the presented antibiotics after watching the module.

Conclusion
While further studies are needed our results suggest that whiteboard animation videos may be an effective way to teach empiric antibiotic selection to medical students preparing for internship.

Disclosures
All authors: No reported disclosures.