bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antiretroviral Therapy Prescribing Practices and Virologic Response in HIV-Infected Individuals with the M184V Mutation: Results from the 550 Clinic Cohort Study
Authors: Kirkpatrick Lauren , Peyrani Paula , Raghuram Anupama , Spencer Cathy , Bishop Mary , Wojak Maura , Ross Ashley , Wiedmar Jennifer , Truelove Daniel 
Published: October 2017

Abstract

Background
Human immunodeficiency virus (HIV) treatment guidelines recommend using a regimen that contains three fully active antiretroviral agents in patients with drug resistance mutations. However, some evidence suggests that protease inhibitor (PI) based regimens containing less than three fully active drugs may be as efficacious in achieving viral suppression (VS) as a three-drug regimen in the presence of a M184V mutation. The purpose of this study was to identify current prescribing practices and determine if VS can be achieved with regimens containing less than three fully active agents in patients with a M184V mutation.

Methods
A single-center retrospective chart review was conducted on patients receiving treatment at the 550 Clinic from January 2003 to July 2016. Patients were screened for a M184V mutation. Patients were excluded for lack of a genotype and inadequate documentation of viral load (VL) prior to initiating or changing therapy. Regimens were characterized as containing three fully active agents or less and evaluated for VS success (VL less than 200 copies/mL). Data was analyzed using descriptive statistics, Chi-square tests, and Fischer’s exact tests.

Results
A M184V mutation was identified in 100 of the 754 patients screened for inclusion. 90% of the 167 regimens evaluated contained less than three fully active drugs. PI-based regimens (n = 86) and integrase strand transfer inhibitor (INSTI)-based regimens (n = 25) were the most commonly prescribed regimens containing less than three fully active drugs. VS was achieved with 72% of regimens containing less than three fully active agents compared with 69% of those containing three fully active agents (P = 0.108). In patients with a baseline VL greater than 100,000 copies/mL, VS was achieved with 80% of INSTI-based regimens compared with 21% of PI-based regimens (P = 0.040). VS was achieved with 85% of INSTI-based regimens and 78% of PI-based regimens in those with a baseline VL less than 100,000 copies/mL (P = 0.513).

Conclusion
Regimens containing less than three fully active drugs may be as efficacious as regimens containing three fully active drugs in those with a M184V mutation. In those with a high baseline VL, INSTI-based regimens may have better efficacy compared with PI-based regimens.

Disclosures
All authors: No reported disclosures.
Moderate Levels of Pretreatment HIV Drug Resistance — Zimbabwe, April–July 2015
Authors: Da Silva Juliana , Dzangare Janet , Gonese Elizabeth , Mhangara Mutsa , Mugurungi Owen , Barr Beth , Lloyd Spencer , Raizes Elliot 
Published: October 2017

Abstract

Background
The World Health Organization (WHO) HIV Drug Resistance (HIVDR) report 2012 demonstrated that the levels of HIVDR to first-line antiretroviral therapy (ART) are increasing. This finding threatens to reverse a decade of gains in HIV/AIDS epidemic control. The WHO Global Action Plan for HIVDR emphasizes strengthening surveillance of drug resistance through the implementation of national cross-sectional surveys. We conducted such survey to determine the prevalence of HIVDR among ART-naive patients in Zimbabwe and to describe the profile of the surveillance drug resistance mutations (SDRM) encountered in the country.

Methods
A prospective, nationally representative, cross-sectional survey was conducted in 35 clinical sites selected using two stage probability proportional to size sampling. Patients were enrolled during April–July 2015. Specimens were sent for genotyping to CDC Atlanta. SDRM were interpreted using Stanford HIV Drug Resistance Database classification.

Results
A total of 361 subjects were surveyed. Most participants were female (60.3%) and the median age was 35.8 years. Thirty-four out of 361subjects presented with ≥1 SDRM (9.4%, 95% confidence interval: 6.8–12.8%) prior to initiation antiretroviral therapy (ART). Non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations were the most commonly detected mutation (n = 30). Only two patients presented with a nucleoside reverse transcriptase inhibitor mutation and one patient presented with a protease inhibitor mutation. In two patients, ≥3 SDRMs were detected, which may suggest they were not truly ART-naïve.

Conclusion
This study provides national estimates of HIVDR in a high burden country with broad access to ART and provides valuable inisight on the state of HIVDR in such setting. Zimbabwe has reached moderate levels of HIVDR in ART-naive patients, as specified by the WHO classification. These levels may impact the ability to achieve viral suppression in a significant number of patients initiating standard ART regimens in Zimbabwe, where NNRTI-based regimens are used as the first line. The use of drugs with high resistance barrier, such as dolutegravir, may improve the care of patients in the developing world, where individualized pretreatment genotype is not feasible.

Disclosures
All authors: No reported disclosures.
Use of Oral Fluid in a Rapid Syphilis Test Assay
Authors: Shannon Chelsea , Bristow Claire , De Cortina Sasha Herbst , Chang Jennifer , Klausner Jeffrey 
Published: October 2017

Abstract

Background
From 2014 to 2015, the syphilis rate in the United States increased by 19%, reaching its highest rate since 1994. Currently, point-of-care syphilis assays use fingerstick or venipuncture whole blood to identify Treponema pallidum (TP) antibodies by qualitative immunoassay. However, patients and providers prefer oral fluid testing to whole blood testing. In this study, we aimed to determine whether a rapid syphilis test intended for use on whole blood could be used to detect TP antibodies in oral fluid.

Methods
Oral fluid was collected from 72 participants using the Super•SAL™ Oral Fluid Collection Device (Oasis Diagnostics®, Vancouver, WA). The device uses an absorbent cylindrical pad to collect and filter ~1 mlml of oral fluid. Oral fluid filtrate was tested using the SD Bioline Syphilis 3.0 rapid test (Alere Diagnostics, MA) following manufacturer directions for whole blood. TP particle agglutination (TPPA) and rapid plasma reagin (RPR) results derived from participants’ medical records were used as reference values. We used three different definitions as comparators: 1: TPPA reactive; 2: TPPA and RPR reactive and 3: TPPA reactive and RPR titer &gt;1:4. Those with non-reactive TPPA and RPR results were considered seronegative. We calculated the sensitivity and specificity for definition 1 and sensitivity for definitions 2 and 3. We used the exact binomial method to determine 95% confidence intervals (CI).

Results
With definitions 1, 2, and 3, respectively, sensitivity was 83.3% (CI: 67.2, 93.6), 86.4% (CI: 65.1, 97.1), and 100% (CI: 71.5, 100). Specificity was 47.2% (CI: 36.5, 75.5).

Conclusion
The high sensitivity of the SD Bioline Syphilis 3.0 test using oral fluid suggests a strong potential for the development of accurate rapid oral syphilis tests. Sensitivity increased with higher RPR titer. False positive results may be due to the presence of non-venereal treponemal antibodies in oral fluid. Further research and development are needed to optimize specificity.

Disclosures
All authors: No reported disclosures.
Identifying African American Women with HIV Infection in an Expanded HIV testing and Linkage to Care (X-TLC) Program in Healthcare Settings on the South and West Sides of Chicago.
Authors: McNulty Moira C , Almirol Ellen , Ridgway Jessica P , Schmitt Jessica , Eavou Rebecca , Taylor Michelle , Kern David , Schuette Stephanie , Stonehouse Patrick , Tobin Audra , Glick Nancy , Pitrak David 
Published: October 2017

Abstract

Background
Women account for 25 % of HIV infections nationally, and African American (AA) women are disproportionately affected. We report important gender differences observed in an expanded HIV testing and linkage to care (X-TLC) program conducted on the South and West Sides of Chicago.

Methods
X-TLC is funded by CDPH with CDC prevention B funds. X-TLC has expanded from 3 sites to 14 sites, including acute care hospitals (academic, community), community health centers (CHCs), and family planning clinics. We report descriptive stats, group comparisons by Chi-square, and multivariate analyses adjusted for demographics.

Results
Since 2011, X-TLC has conducted 308,038 HIV screens, and 63.7 % of those tested were women. Overall seroprevalence for HIV was 0.56 %, and 30.5 % of HIV patients identified were cis-gender women (seroprevalence 0.15 %). The seroprevalence for women testing in EDs was higher (0.44 %). Similar to men, only 52.9 % of HIV positive women were new diagnoses. Women accounted for 28.5 % of all new diagnoses, compared with 15.4 % for Chicago overall. In 2016 X-TLC screened 91,865 persons for HIV, and 65.2 % of those tested were women. There were 193 new diagnosis and 32.1 % (62) were women, 85.7 % AA. In comparison, in 2015 there were 139 women with a new HIV diagnosis for all of Chicago. Women newly diagnosed were less likely to be linked to care (adjusted odds ratio, aOR, 0.54, 0.35–0.85). Linkage was lower for women diagnosed at CHCs (84.6 % vs. 76.3 %, P = 0.02). Most CHCs did not have on site HIV providers. At our site, however, women linked to care were more likely to be retained in care (aOR 0.58, 0.43–0.78). We also conduct targeted outreach testing, partner services (PS) testing, and social network strategy (SNS) testing, but women are not identified by these programs (16/171 tested women, 8 new diagnoses were men for PS; 507 tested, 471 men and 36 trans-gender women, 38 new positives, 0 cis-gender women for SNS).

Conclusion
More women than men were offered and/or accept HIV screening in healthcare settings. The proportion of seropositive women identified was higher than the national average. X-TLC is reaching a large proportional of AA women with HIV unaware of their status. Other testing strategies will rarely identify cis-gender women with HIV infection. Gender differences in linkage to and retention in care will require strategies targeted at women.

Disclosures
J. P. Ridgway, Gilead FOCUS: Grant Investigator, Grant recipient; N. Glick, Gilead FOCUS: Grant Investigator, Grant recipient; D. Pitrak, Gilead Sciences FOCUS: Grant Investigator, Grant recipient
Making a Big Impact on Expanding HIV Inpatient Testing with a Small EHR Modification
Authors: Nguyen Tri 
Published: October 2017

Abstract

Background
The CDC estimates over 1.2 million Americans are living with HIV and, of those, approximately 14% are unaware of their HIV-positive status. Since 2014, most hospitals adopted some form of Electronic Health Records (EHR) and the Centers for Medicare & Medicaid Services extended Medicare coverage for annual HIV screenings. Despite these developments, there has been limited progress in expanding HIV testing in inpatient settings. The present study was conducted at Jersey City Medical Center (JCMC) in an effort to expand HIV testing by implementing EHR modification in the form of testing prompts.

Methods
This study began on January 1, 2016 at JCMC, a teaching hospital that passed all lab work orders through an EHR system. The number of daily orders for HIV screenings was recorded for 145 consecutive days before EHR modification (n = 145) to establish baseline data. EHR modification occurred on the 146th day of the study (May 25, 2016). This modification featured testing prompts displaying CDC guidelines for screening patients over the age of 18 for HIV whenever a physician ordered lab work for admitted patients. Orders for HIV screenings on this transitional date were excluded from analysis. After EHR modification was completed, the number of daily orders for HIV screenings was recorded for an additional 145 consecutive days (n = 145) for comparison. Testing data was available for all 145 consecutive days before and 145 consecutive days after EHR modification.

Results
Since the beginning of this study—before testing prompts were implemented—JCMC inpatient units ordered an average of 8.53 (SD=3.25) HIV screenings per day. The average number of daily orders for HIV screenings increased twofold after EHR modification (M=17.39, SD=4.26), t(288) = 19.90, P &lt; .001. JCMC identified 86 HIV-positive and linked over 90% of these patients to care.

Conclusion
Conventional HIV screening methods in the inpatient setting might not be sufficient at detecting most HIV-positive cases. By implementing testing prompts in its EHR system to encourage increased testing for HIV, Jersey City Medical Center was able to increase the number of individuals aware of their HIV status and link them to care as needed.

Disclosures
T. Nguyen, Gilead FOCUS: Employee, Grant recipient
Viral Blips Were Infrequent in HIV-1-Infected Virologically-Suppressed Adults Treated with Tenofovir Alafenamide or Tenofovir DF Rilpivirine-Containing Regimens
Authors: Wohl David A , Kulkarni Rima , Garner Will , White Kirsten , Porter Danielle 
Published: October 2017

Abstract

Background
Differences between regimens in the frequency of transient episodes of viremia (viral blips) as well as the impact of these viral blips on the risk of virologic failure and resistance development is not fully understood. Here we investigate the frequency of viral blips in virologically-suppressed subjects switching to rilpivirine/emtricitabine/tenofovir alafenamide (R/F/TAF) vs. maintaining R/F/tenofovir disoproxil fumarate (TDF) and the association of viral blips with clinical outcome through Week 48 of study GS-US-366-1216.

Methods
GS-US-366-1216 is a randomized, double-blind, phase 3b study evaluating the safety and efficacy of switching to R/F/TAF from R/F/TDF in HIV-1-infected virologically-suppressed subjects. For the viral blip analysis, treated subjects with ≥1 post-baseline HIV-1 RNA value were included. All on-drug HIV-1 RNA data points and FDA snapshot outcome data through Week 48 were utilized. Plasma HIV-1 RNA was measured using the Roche Taqman 2.0 assay. A viral blip was defined as any post-baseline HIV-1 RNA value ≥50 c/mL preceded and followed by HIV-1 RNA &lt;50 c/mL.

Results
Of the 627 subjects included in the analysis, 23 (3.7%) experienced ≥1 blip through Week 48 and were distributed similarly between treatment groups (10/315, 3.2% R/F/TAF; 13/312, 4.2% R/F/TDF; P = 0.53; median 6 viral load measurements per subject). Twenty subjects had single blips (8 R/F/TAF, 12 R/F/TDF) and 3 subjects experienced 2 blips each (2 R/F/TAF, 1 R/F/TDF). Of 26 total blip events, 19 (73%) were low-level at 50–199 c/mL. Among subjects with blips, 22/23 (96%) were virologic successes at Week 48 (9/10, 90% R/F/TAF; 13/13, 100% R/F/TDF), similar to those subjects without blips (568/604, 94% overall; 287/305, 94% R/F/TAF; 281/299, 94% R/F/TDF). One subject in the R/F/TAF group had 2 blips prior to experiencing virologic rebound with mutations also detected at baseline (determined by retrospective proviral DNA sequencing).

Conclusion
Viral blips were infrequent among subjects switching to R/F/TAF or maintaining R/F/TDF through Week 48 of study GS-US-366-1216. No differences in blip frequency or virologic failure post-blip were observed between treatment groups. Most blips were low-level (&lt;200 c/mL) and most subjects with blips remained suppressed through Week 48.

Disclosures
D. A. Wohl, Gilead Sciences Inc.: Consultant and Investigator, Consulting fee and Research grant; ViiV: Consultant and Investigator, Consulting fee and Research grant; Janssen: Consultant, Consulting fee; Bristol Myers Squibb: Consultant, Consulting fee; R. Kulkarni, Gilead Sciences, Inc.: Employee and Shareholder, Salary; W. Garner, Gilead Sciences, Inc.: Employee and Shareholder, Salary; K. White, Gilead Sciences, Inc.: Employee and Shareholder, Salary; D. Porter, Gilead Sciences, Inc.: Employee and Shareholder, Salary
Principal Components and Costs of HIV-Associated Hospitalizations in the United States: A National Study in the Current Era
Authors: Santos Carlos , Tenorio Allan 
Published: October 2017

Abstract

Background
HIV-associated illness in the US has evolved with the advent of antiretroviral therapy and aging of the HIV-infected population. While changes in the causes of mortality in these patients are well documented, reasons for hospitalization and costs associated with hospital stays are not well studied at the national level.

Methods
We collected billing and demographic data of 84,666 HIV-associated hospitalizations across 3,564 hospitals nationwide using the 2012 and 2013 National Inpatient Sample, and used principal component analysis to arrive at predominant themes of HIV-associated hospitalization. Components with eigenvalues greater than one were retained, and orthogonal rotation was performed to identify variables that significantly loaded each component. Estimated hospital costs were determined by multiplying inflation-adjusted charges with hospital-specific cost-to-charge ratios and inverse wage indexes, and average costs associated with principal components were computed.

Results
Kidney disease predominated as a theme for HIV-associated hospitalization and accounted for 9% of the total variance. This was followed by liver disease, opportunistic infections with Pneumocystis and Candida, septicemia, and substance abuse, which accounted for 7%, 6%, 5% and 4% of the total variance respectively. Other significant contributors to hospitalization were heart disease, low socioeconomic status, complicated diabetes mellitus, and other opportunistic infections. The highest costs were associated with septicemia which averaged $25,557 per hospitalization, whereas the lowest costs were associated with substance abuse which averaged $7,534 per hospitalization.

Conclusion
Kidney and liver disease are important components of HIV-associated hospitalization in the current era reflecting an aging population overlain with complications from HIV and viral hepatitis. Opportunistic infections continue to be major contributors to hospitalization indicating ongoing challenges in access and adherence to antiretroviral therapy. Research efforts should focus on ameliorating HIV-related kidney and liver disease, as well as implementing strategies to promote early diagnosis and treatment of HIV.

Disclosures
All authors: No reported disclosures.
What Determines Do-Not-Resuscitate Status in Critically Ill HIV Patients?
Authors: Turvey Shannon L , Gregory Anne , Bagshaw Sean , Sligl Wendy I 
Published: October 2017

Abstract

Background
Mortality and morbidity of people living with HIV have declined in the era of combination antiretroviral therapy (cART). However, Intensive Care Unit (ICU) admission rates remain high. In this study, we identified predictors of Do-Not-Resuscitate (DNR) status in critically ill HIV patients.

Methods
Retrospective cohort study of all first-time admissions of HIV-infected patients to five ICUs in Edmonton, Alberta from 2002 to 2014. Data collected included demographics, comorbidities, markers of HIV disease severity and control, admission diagnoses, severity of illness, organ failure, and DNR status. Multivariable logistic regression analysis was performed to identify factors associated with DNR status.

Results
During the study period, 282 patients were admitted to the ICU for the first time. Mean (SD) age was 44 (±10) years, 169 (60%) were male, 134 (48%) aboriginal, 153 (55%) co-infected with hepatitis C virus, and 184 (65%) had a history of polysubstance use. Median (IQR) CD4 count and viral load were 125 (30–300) cells/mm3and 28,000 (110–270,000) copies/mL, respectively. Only 98 (35%) patients were receiving cART at the time of admission while 45 (16%) were newly diagnosed in the ICU. Most common admission diagnosis was sepsis 189 (64%), 213 (76%) received mechanical ventilation, 133 (47%) vasopressor support and 35 (12%) renal replacement therapy. Sixty-seven (24%) patients were DNR and support was withdrawn in 42 (15%). In multivariable analysis, APACHE II score (adjusted odds ratio [aOR] 1.13; 95% CI, 1.08–1.19, P &lt; 0.001), coronary artery disease (CAD) (aOR 5.7; 95% CI, 1.2–27.8, P = 0.03), prior opportunistic infection (OI) (aOR 2.6; 95% CI, 1.2–5.6, P = 0.015) and duration of HIV infection (aOR 1.07 per year; 95% CI, 1.01–1.14, P = 0.025) were independently associated with DNR status. Other factors such as ethnicity, HIV risk factor(s), CD4 count and viral load were not associated with DNR status.

Conclusion
In this relatively young cohort, one in four patients had DNR status during ICU admission. DNR designation was associated with severity of illness, along with CAD, prior OI, and duration of HIV infection. Future work should characterize the timing of patient DNR orders relative to ICU admission and describe patient and provider-specific factors that may influence decision-making towards DNR status.

Disclosures
All authors: No reported disclosures.
Less Is More: Surgical Procedure Time and Risk of Infections, Length-of-Stay, and Readmission across Three Distinct Surgeries
Authors: Parikh Ronak , Shah Nirav , Saeed Huma , Bhaimia Eric , Lahrman Frances , McNulty Moira C , Robicsek Ari , Padman Rema , Grant Jennifer 
Published: October 2017

Abstract

Background
Longer surgical total procedure times (TPT) have been associated with increased postoperative complications. It is unclear what the effect of TPT is on length-of-stay (LOS) or 30-day readmission rate (RAR).

Methods
We performed a retrospective study of patients undergoing knee arthroplasty (KA), colectomy, and craniectomy at NorthShore University HealthSystem from 1/2007 to 12/2013. Clinical data were extracted from the Data Warehouse and charts were reviewed. We standardized surgery times for each procedure and categorized into two groups: times &lt;75‰ (short procedures) vs. times &gt;75‰ (long procedures). We used χ 2 and t-test to compare categorical and continuous variables. We performed multivariate logistic regression for predictors of surgical site infection (SSI).

Results
In univariate analyses, long procedures were associated with higher incidence of fevers, SSI, longer LOS, and 30-day RAR (Table 1). TPT was not associated with other postoperative complications. TPT remained an independent predictor of SSI in multivariate (MV) analysis (Table 2).

Conclusion
High TPT was associated with increased SSI, LOS, and 30-day RAR. Understanding variation in TPT may help decrease SSI and healthcare utilization.

Disclosures
All authors: No reported disclosures.