bluuebunny/crossref_metadata_2025_split huggingface dataset:
1521. High frequency of vitamin D deficiency in hospitalized patients with HIV: A prospective study in Colombia
Authors: Ortiz-Martínez Yeimer , Herrera-Caviedes Leidy , Figueroa-pineda Claudia , Melo-Amaya María J , Martínez Andrés F Henao 
Published: November 2023

Abstract

Background
Vitamin D deficiency is prevalent in people living with HIV (PLWH) and is linked to various negative health outcomes. Despite numerous studies in other regions, information regarding vitamin D status and its determinants among PLWH in Latin America is scarce. This study aimed to determine the frequency of vitamin D deficiency in hospitalized patients with HIV in Colombia and identify associated risk factors.

Methods
We conducted a prospective cohort study of hospitalized patients with HIV at a tertiary university hospital in Bucaramanga, Colombia, between December 2022 and April 2023. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured at admission and categorized as suboptimal (≤30 ng/ml), insufficient (≤25 ng/ml), deficient (≤20 ng/ml), or severely deficient (≤10 ng/ml). Demographic, clinical, and paraclinical data were collected, and multivariate logistic regression was performed to identify factors associated with vitamin D deficiency.
Table 1

Results
A total of 73 PLWH were included in the study. 75.3% were men with a mean age of 40.6 ± 11.85 years. 50.6% were on antiretroviral therapy (ART) at the time of admission. 69.8% had a CD4 count ≤ 200 cells/mm3, and 63% had a viral load &gt; 10,000 copies/ml. The in-hospital mortality was 19.35%. The median (IQR) 25(OH)D level was 21.28 ng/mL (13-27.8). Vitamin D deficiency was present in 49.3% of the participants, with 19.1% having severe deficiency. Insufficiency and suboptimal levels were found in 56.1% and 79.4%, respectively. No significant association was found between vitamin D deficiency and mortality or HIV-related factors, including ART, viral load, and CD4 count (Table 1). However, after multivariate analysis, albumin less than 3 g/dL was significantly associated with vitamin D deficiency (aOR 3.86, 95% CI: 1.37-10.85; p=0.01).

Conclusion
This is the first prospective study in Colombia that highlights the high frequency of vitamin D deficiency in hospitalized patients with HIV. The finding of a significant association between hypoalbuminemia and vitamin D deficiency suggests that malnutrition or TNF-mediated cachexia may be contributors to this problem. Further studies are needed to explore the implications of vitamin D deficiency in this population and to develop appropriate interventions.

Disclosures
All Authors: No reported disclosures
1541. HIV Risk Assessment in Boston Community Health Center Dental Clinics
Authors: Konstandt Daryl , Chafjiri Pegah Mohammah Alizadeh , Bolter Eric , Collins Elisabeth , Lodi Sara , Henshaw Michelle , Bazerman Lauri , Cho Janice , Coleman Caitlin , Paul Mina , Powell Elizabeth , Beckwith Curt 
Published: November 2023

Abstract

Background
Suffolk County (Boston), Massachusetts is identified by the CDC as a geographic hotspot for new HIV infections. The Ending the HIV Epidemic Initiative (EHE), implemented by the Department of Health and Human Services, aims to decrease new HIV infections by 90% in the next decade. Although HIV treatment radically improves lives, individuals must know their status to receive treatment. Fourteen percent of persons with HIV are unaware of their diagnosis and 23% of dental patients do not access primary medical care. Therefore, community health center dentists are uniquely positioned to contribute to the “Diagnose” pillar of EHE. Dental clinics can provide new opportunities for HIV testing for persons at increased risk for HIV within EHE designated jurisdictions. The purpose of this study was to assess HIV risk factors [sexually active men who have sex with men (MSM), multiple sexual partners, condomless sex, and intravenous drug use (IDU)] among community health center dental patients in the Boston area.

Methods
An anonymous, voluntary, 25 question survey was disseminated in English, Spanish and Haitian Creole within 5 community health center dental clinics in Boston. The data were compiled and analyzed with descriptive statistics using REDCap survey software and EXCEL.

Results
Of the 299 dental patients who completed the survey, the majority were female (55%), black (54%), non-Hispanic (52%) and 22-54 years old (56%). 24% of respondents reported at least one risk factor for HIV within the past year including 53 individuals with multiple sexual partners, 18 sexually active MSM and 3 IDU in the past year. Of the 188 persons that had sexual contacts in the past 12 months, 37% never used a condom. Thirty-four percent report never having an HIV test.

Conclusion
One-quarter of dental clinic patients who completed the survey reported HIV risk factors, making community health center dental clinics an underutilized venue for HIV testing and prevention interventions. The goals of EHE require the implementation of HIV testing in new settings to reach persons who are missed by traditional HIV testing sites. Dental providers represent an important, yet untapped, workforce that can contribute to EHE.

Disclosures
All Authors: No reported disclosures
1564. Virological Suppression in People with HIV-1 (PWH) Receiving Dolutegravir/Lamivudine Was High and Similar across Age Groups despite Older PWH Having Increased Rates of Comorbidities and Polypharmacy (TANDEM Subgroup Analysis)
Authors: Brogan Andrew P , Slim Jihad , Verdier Gustavo , Harper Gavin , Mycock Katie L , Wallis Hannah , Donovan Cynthia 
Published: November 2023

Abstract

Background
Aging with HIV has unique challenges, including comorbidities and drug-drug interactions. TANDEM was a retrospective medical chart review conducted across 24 US sites. This subgroup analysis examines stable-switch PWH receiving dolutegravir/lamivudine by age.

Methods
Eligible PWH were adults initiating dolutegravir/lamivudine prior to September 30, 2020, with ≥6 months of clinical follow-up (Figure 1). Stable-switch PWH were defined as having HIV-1 RNA &lt; 50 copies/mL and on a stable antiretroviral regimen for ≥3 months upon dolutegravir/lamivudine initiation. Clinical characteristics, treatment history, and outcomes were analyzed for 3 age groups among dolutegravir/lamivudine stable-switch PWH. Analyses were descriptive.

Results
The number of dolutegravir/lamivudine stable-switch PWH in each age group was 86 (&lt; 50 years), 106 (≥50 years), and 20 (≥65 years). A greater proportion of PWH in the older age groups were female sex at birth (14.0% &lt; 50 years; 20.8% ≥50 years; 30.0% ≥65 years). More PWH in older age groups had reported comorbidity (12.8% &lt; 50 years; 34.9% ≥50 years; 45.0% ≥65 years) and polypharmacy (5.8% &lt; 50 years; 17.9% ≥50 years; 30.0% ≥65 years; Figure 2). Avoidance of long-term toxicities was the biggest driver for initiating dolutegravir/lamivudine in the older age groups (32.1% ≥50 years; 30.0% ≥65 years) while simplification/streamlining of treatment was the most common (27.9%) primary reason for PWH to switch to dolutegravir/lamivudine in the &lt; 50 years group (Figure 3). For PWH &lt; 50 years, 95.3% remained virologically suppressed for the study period. Similarly, 96.2% of PWH ≥50 years and 95.0% of PWH ≥65 years remained virologically suppressed for the study period (Figure 4). Three PWH with nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) resistance at baseline remained suppressed.

Conclusion
Virological suppression rates were high and similar by age group among dolutegravir/lamivudine stable-switch PWH despite higher rates of comorbidities and polypharmacy in the older age groups. This real-world analysis is consistent with clinical study data supporting dolutegravir/lamivudine as an effective treatment strategy in older PWH.

Disclosures
Andrew P. Brogan, PhD, ViiV Healthcare: Stocks/Bonds Jihad Slim, MD, FACP, ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support Gustavo Verdier, BSc, BPharm, MBA, ViiV Healthcare: Stocks/Bonds Gavin Harper, BA, ViiV Healthcare: Grant/Research Support Katie L. Mycock, MChem, ViiV Healthcare: Grant/Research Support Hannah Wallis, MS, ViiV Healthcare: Grant/Research Support Cynthia Donovan, PharmD, ViiV Healthcare: Stocks/Bonds
1578. Evaluation of comparative HIV care continuum outcomes following three years of program implementation of the PositiveLinks smartphone intervention among people with HIV with and without substance use
Authors: Hodges Jacqueline , Caldwell Sylvia , Otero Kori , Williams Brooke , Elliott Ben , Richey Lauren , Waldman Ava Lena , Dillingham Rebecca , Ingersoll Karen 
Published: November 2023

Abstract

Background
People with HIV (PWH) and substance use (PWSU) have demonstrated inferior HIV care continuum outcomes, including lower retention in care (RIC), poorer ART adherence, and lower rates of viral suppression (VS) relative to peers without substance use within the literature. We compared 3-year outcomes among people with and without substance use who are enrolled in a smartphone intervention, PositiveLinks (PL), to determine the relative impact of PL for this subgroup of PWH.

Methods
We performed retrospective chart review of clinical encounter and laboratory data and ICD-diagnoses for 600 PWH enrolled in PL from 2017-2020. Substance use was categorized by diagnoses of illicit substance use and/or substance use-related visits conducted at the UVA Ryan White Clinic. Patients with no documented substance use, or documented tobacco or reported alcohol use with no criteria for a substance use disorder were considered non-substance using. We analyzed HIV clinical outcomes (VS, RIC by HRSA-1 measure) for PL members in each group at baseline (April 2017) and three years later (April 2020, t-test).

Results
Chart review for the 3-year period of interest for 600 PWH enrolled in PL revealed 117 PWH meeting criteria for substance use and 483 not meeting criteria. A mean of 13 Ryan White Clinic visits were conducted per person among 117 PWSU, compared to 8 visits each among 483 PWH without documented substance use (p&lt; .01) over 3 years. Among PWSU, RIC increased from 56% to 79% (p&lt; .01) while among PWH without substance use, RIC increased from 47% to 69% (p&lt; .01). VS increased significantly among PWSU from 71% to 90% (p&lt; .01), while among PWH without documented substance use, VS increased from 70% to 87%, (p&lt; .01). Differences between groups for RIC and VS were not statistically significant at either time point.

Conclusion
A sample of 600 PWH using PL demonstrated comparable HIV clinical outcomes across 3 years regardless of substance use status. This sample selects for PWSU who stayed enrolled in PL at 3 years, and may not reflect outcomes expected for a broader population of variably engaged PWSU offered non-tailored mobile health interventions for HIV care. Further analysis is planned to determine whether covariates including demographic characteristics and PL usage patterns influence outcomes observed.

Disclosures
Sylvia Caldwell, MPH, DHSc, Warm Health Technology: Advisor/Consultant Ben Elliott, MSW, Warm Health Technology: Advisor/Consultant Ava Lena Waldman, M.H.S., CHES, CCRP, Warm Health Technology: Advisor/Consultant Rebecca Dillingham, MD MPH, Warm Health Technology: Advisor/Consultant
1579. Incidence and Predicting Factors of Opportunistic Infections after Initiation of Antiretroviral Therapy: A Retrospective Cohort Study
Authors: Wongkittipong Prapon , Kiertiburanakul Sasisopin 
Published: November 2023

Abstract

Background
Antiretroviral therapy (ART)-associated opportunistic infections (OIs) is the term proposed to encompass all OIs diagnosed after ART initiation, and it is not uncommon. We aimed to determine the incidence of OIs and the predicting factors for OIs developing after ART initiation among Thai people living with HIV (PLHIV).

Methods
In the university hospital setting, a retrospective cohort study was conducted among naïve PLHIV who initiated ART between January 2016 and December 2019.

Results
A total of 401 PLHIV were included in the analysis. Of these, the mean (SD) age was 37.1 (11.9) years, 74.3% were male, and 57.6% had heterosexual risk. There were 247 (61.6%) diagnosed with AIDS and a median (IQR) CD4 count at ART initiation was 166 (49-314) cells/µL. The most common prior OIs were tuberculosis (26.4%) and Pneumocystis jirovecii pneumonia (11.5%). Of all, 38 (9.5%) PLHIV developed OIs after initiating ART with an incidence rate of 25.6/1000 person-years. The median time (IQR) from ART initiation to the OIs occurrence was 26.5 (14-73) days. PLHIV who develop OI after ART initiation were more likely to have lower mean body mass index (BMI) (20.1 vs 22.3 kg/m2), lower median CD4 counts (36 vs 188 cells/µL), lower mean hemoglobin levels (10.8 vs 12.4 mg/dL), a higher proportion of AIDS diagnosis (86.5% vs 57.9%), having prior OIs (78.9% vs 35.5%), and a higher proportion of initiation with dolutegravir (DTG)-based regimen (10.5% vs 3%) (p &lt; 0.05, all). By multivariate Cox proportional hazard regression, having BMI ≤18.5 kg/m2 (aHR 2.28; 95% CI 1.18-4.42, p=0.015), symptomatic at presentation (aHR 13.59; 95% CI 3.24-56.9, p &lt; 0.001), SGPT &gt;55 U/L (aHR 2.09; 95% CI 1.06-4.15, p=0.035), and initiation with DTG-based regimen (aHR 4.39, 95% CI 1.54-12.48, p=0.006) were statistically significant associated OIs after ART initiation. The OI-associated mortality was 5.3%.

Conclusion
The OIs after ART initiation are not uncommon. Malnutrition, symptomatic at presentation, abnormal liver enzyme, and initiation with DTG-based regimens is predicting factors of OI occurrences. It is crucial for physicians to monitor and appropriate treatment of OIs after ART initiation.

Disclosures
All Authors: No reported disclosures
1595. Accumulating Antiretroviral Therapy Safety Data In Pregnancy: Barriers To Clinician Reporting To The Antiretroviral Pregnancy Registry In North America And Internationally
Authors: Stavroula manta M , O’Bryan Jessica , Giles Michelle , Short William R , logue-Chamberlain Erin , Krishnaswamy sushena 
Published: November 2023

Abstract

Background
Clinical trials evaluating antiretroviral therapy (ARV) often exclude pregnant women, delaying the accumulation of safety data in pregnancy, and use of newer ARVs in women of reproductive age. The Antiretroviral Pregnancy Registry (APR) is the largest international exposure registry of ARV use in pregnancy, but only 0.5% of reports come from Australia and 70% of reports are from the United States (US). A decline in reporting was noted during the COVID-19 pandemic.

Methods
Surveys were developed independently and disseminated to clinicians who provide care to women with HIV or their children through email distribution lists of the peak infectious diseases societies in Australia and the US Reproductive Infectious Diseases and HIV email distribution list. The surveys assessed awareness of the APR and barriers to contributing data.

Results
In total, 146 clinicians (80 Australia, 66 US) completed the surveys. Of US respondents, 59% (39/66) used the APR clinically and 55% (36/65) had contributed data to the APR. The key barriers to reporting included lack of time, funding and staff/administrative support, and complexity of the reporting system. In contrast, in Australia, less than half (47.5%, 38/80) of respondents were aware of the APR, and only 10% (8/80) had ever contributed data. The perceived barriers to contributing data in this context were a lack of knowledge (unaware that clinicians outside the US could report, uncertainty about how to report, belief that only adverse pregnancy outcomes should be reported) and feeling their individual contribution would be insignificant when providing care for small numbers of pregnant women. Clinicians in both countries identified consent and ethics review board requirements as barriers to contributing data.

Conclusion
The barriers to reporting data to the APR are likely context specific. The findings from Australia may apply to other high resource settings. Further efforts are required to address these barriers to increase reporting of ARV use in pregnancy. This would increase the acquisition of ARV pregnancy safety data and address the disparity in treatment options faced by women of reproductive age with HIV.

Disclosures
Stavroula mantaM, B Pharm, Gilead: Received funding for project: BRAVVO Michelle Giles, MBBS PhD, Gilead: Grant/Research Support William R. Short, MD, Gilead Sciences: Advisor/Consultant|ViiV: Advisor/Consultant|ViiV: Honoraria sushena Krishnaswamy, MBBS, Gilead: Grant/Research Support|Pfizer: Advisor/Consultant
1602. Determinants of Early Virologic Failure Among HIV patients on First-line Antiretroviral Therapy
Authors: Ramos Diana G , Roman Arthur Dessi E 
Published: November 2023

Abstract

Background
The initiation of anti-retroviral therapy (ART) effectively restores immune function and reduces HIV-related morbidity and mortality. However, virologic failure while on ART may lead to increased morbidity and compromised quality of life. The aim of this study was to determine the prevalence and determinants of early virologic failure (VF) among HIV patients on first-line ART enrolled at the Research Institute for Tropical Medicine, Philippines.

Methods
A retrospective cohort study was conducted involving treatment-naive HIV patients who were started on ART during the period of January 2004 – December 2018. Early virologic failure was defined as HIV-1 viral load of &gt; 1,000 copies / ml of plasma blood taken within 6 months or more of first-line ART. Data regarding patients’ sociodemographic profile, baseline clinical characteristics, and treatment-related information were collected through database review. Data were analyzed using STATA 15.0. Descriptive statistics, cross-tabulations, and univariate and multivariate logistic regressions were utilized. P &lt; 0.05 was used to determine clinical significance.

Results
Among the 1900 subjects included in this study, 1839 were males (96.79 %). The mean age at ART initiation was 30.36 years (SD 6.89) with a baseline CD4 count of 232.30 cells / mm3 (SD 204.19). The average time from ART initiation to the first VL determination was 4 years (SD 28.62). A total of 72 (3.79 %) subjects were found to have virologic failure. Multivariate logistic regression showed that patients with age 15-20 years were 5-6 times more likely to have VF (1 / adjusted OR 0.18 = 5.55, p-value of 0.024) while patients with baseline CD4 count of &lt; 50 cells/mm3 were 3 times (1 / adjusted OR 0.35 = 2.86, p-value &lt; 0.01) more likely to have virologic failure.

Conclusion
The prevalence of early virologic failure among HIV patients on first-line anti-retroviral therapy is 3.79 %, relatively lower compared to other published data. Early virologic failure was most likely to occur among patients 15-20 years old and/or those with baseline CD4 count below 50 cells/mm3. Presence of these factors should be used as a marker for intensified adherence counselling especially in the absence of reliable or readily available viral load monitoring.

Disclosures
All Authors: No reported disclosures
2076. Intestinal colonization with multidrug-resistant organisms, horizontal transmission and risk for bloodstream infection
Authors: Karakosta Polyxeni , Meletis Georgios , Kousouli Elisavet , Protonotariou Efthymia , Vourli Sophia , Christina Georgiou Panagiota , Mamali Vasiliki , Skoura Lemonia , Zarkotou Olympia , Pournaras Spyros 
Published: November 2023

Abstract

Background
The association between rectal colonization and subsequent bloodstream infections (BSI) by multidrug-resistant organisms (MDROs) remains to be clarified. We aimed to investigate the relative risk of BSI in rectal carriers of MDROs and in the case of carbapenem-resistant Enterobacteriaceae (CRE), whether BSI was due to the patient’s own colonizing strain.

Methods
We retrospectively included all adult inpatients hospitalized from Jan 2019 to Dec 2022, in ICUs or medical wards of 3 Greek hospitals (Athens: “Attikon” Hospital, Piraeus: Tzaneio Hospital, Thessaloniki: AHEPA Hospital), who were screened for intestinal MDRO carriage at admission and weekly. Screening was performed by selective media and immunochromatography for the carbapenemase in CRE. Patients were followed up for BSI by the same colonizing organism; relative risk (95% CI) was estimated after adjustment for ICU hospitalization and age. MDROs included CRE, carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA) and vancomycin-resistant enterococci (VRE). The CRE-colonizers and BSI-pathogens were analyzed for carbapenemase type to identify potential similarities.

Results
Of 4,427 patients screened, 1,321 (29.8%) were colonized by CRE, 1,255 (28.3%) with CRAB, 252 (5.7%) with CRPA and 859 (27.9% of 3,082 patients tested) with VRE. Of those, 207 (15.7%), 247 (19.7%), 23 (9.1%) and 30 (3.5%) subsequently developed CRE-BSI, CRAB-BSI, CRPA-BSI and VRE-BSI, respectively. Intestinal CRE colonization was associated with 4-fold higher risk of subsequent CRE-BSI, after adjusted for ICU stay and age [RR (95%CI): 4.1 (3.2, 5.2)]. The respective relative risk (95%CI) for BSI in patients with colonization by CRAB, CRPA and VRE were 2.3 (1.9, 2.8), 8.2 (5.1, 13.4) and 2.1 (1.3, 3.4). To evaluate possible horizontal transmission, 286 paired CRE strains from 143 patients were analyzed; in 111 (77.6%), both colonizers and BSI pathogens belonged to the same bacterial species and carried the same carbapenemase type.Table 1:Rectal colonization with MDROs and the risk for BSI from the same pathogenTable 2:Carbapenemase types in rectal carriers of CRE who developed subsequent BSI with the same pathogen

Conclusion
Intestinal colonization by MDROs was associated with increased risk of BSI by the colonizing bacteria. Clinicians should evaluate this information for empiric treatment, while genome-wide data are needed to substantiate horizontal transmission.

Disclosures
All Authors: No reported disclosures