bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-445. Clinical Complications and Quality of Life in People Living with HIV (PLWH) and Other Comorbidities
Authors: Lui Grace , Cheung Catherine , Yuen Ka-Ki , Wong Vivian , Au-Yeung Chuk-To , Ho Hang-Yee , Li Timothy 
Published: January 2025

Abstract

Background
Comorbidities in PLWH tend to cluster, and may raise risk of multiple clinical complications. It is important to understand the burden of these complications and health-related quality of life (QOL) in PLWH with comorbidities.

Methods
This is an ongoing prospective longitudinal observational study in Hong Kong to determine the prevalence and incidence of clinical complications among PLWH with ≥1 documented comorbidities (hypertension, diabetes, obesity, liver disease, kidney disease and cardiovascular disease). The endpoints are the prevalence of each clinical complication and QOL. Clinical complications are (i) high cardiovascular risk (QRISK3 &gt;10%), (ii) renal complication (glomerular filtrate rate &lt; 60 mL/min/1.73m2, or urine albumin:creatinine &gt;3 mg/mmol), (iii) liver steatosis and significant liver fibrosis (Controlled Attenuated Parameter &gt;248 dB/m and liver stiffness &gt;9.0 kPa, measured by transient elastography) and (iv) low bone mineral density (BMD) at lumbar spine and femoral neck (T score &lt; -1.0 if ≥50 years or Z score &lt; -2.0 otherwise, measured by dual energy X-ray absorptiometry). QOL was measured by EQ-5D-5L. Association between each comorbidity and the endpoints are determined by logistic or linear regression analyses, adjusted for age and gender.

Results
We included data from the first 279 PLWH (baseline characteristics in Table). Overall, 40.5% had high cardiovascular risk, 35.1% had renal complication, 10.8% had significant liver fibrosis, and 31.5% had low BMD at femoral neck (Figure 1A), while 14.3% had difficulty in mobility, 38.4% had pain or discomfort, and 34.1% had anxiety or depression (Figure 1B). EQ VAS was 80 (25th, 75th percentile 67, 85).
PLWH with hypertension and diabetes had significantly higher cardiovascular risk and renal complication. Diabetes and obesity were significantly associated with liver fibrosis, but lower risk of low BMD (Figure 2).
PLWH with diabetes had significantly greater impairment in mobility, while obesity was associated with a trend of pain or discomfort and anxiety or depression (Figure 3). Kidney disease was associated with worse EQ VAS (unstandardized B -7.032, p=0.022).

Conclusion
PLWH with comorbidities are vulnerable for multiple clinical complications and worse QOL.

Disclosures
Grace Lui, MBChB, Gilead Sciences: Grant/Research Support|MSD: Grant/Research Support
P-454. An Analysis of an Evolving Malignancy Profile in an Urban, Predominantly African-American Population Living with HIV
Authors: Rallo Melissa K , Leahy Nicholas , Riedel David J 
Published: January 2025

Abstract

Background
It is well known that HIV increases the risk of certain malignancies, including AIDS-defining cancers (ADCs) such as Kaposi Sarcoma, non-Hodgkin Lymphoma, and invasive cervical cancer. While the incidence of effective antiretroviral treatment (ART) has allowed the incidence of ADCs to decline, HIV-infected individuals are still at a higher risk for non-AIDS-defining cancers (NADC). A 2014 study conducted at the University of Maryland Medical Center (UMMC) showed that while HIV-infected patients presented with late-stage cancer and significant mortality, ART had a significant mortality benefit. While this study was pivotal, it’s important to consider how this malignancy profile continues to change. The purpose of this study is to characterize the numbers and types of cancers, patient demographics, ARTs, and mortality among HIV-infected patients in an urban population in order to contrast with data from an older cohort of data.

Methods
A retrospective cohort study was used to review 301 HIV-infected patients diagnosed with invasive cancer from January 1st, 2015 to December 31st, 2022 who were managed at UMMC.

Results
There were 322 cases of invasive cancer in this population. Patients were predominantly African American (81%) and male (61%). The majority of cases involved patients who were compliant with an ART regimen when they presented initially for diagnosis (79%) with a subset of patients meeting the criteria for AIDS (CD4 &lt; 200) at the time of cancer diagnosis (25%). The overall incidence of stage 3 or 4 cancer in the population was 45%, and 58% among HIV-infected patients who met the clinical criteria for AIDS. There were 139 deaths with a majority of the causes of death attributed to cancer progression or infection (68%).

Conclusion
An evolving ART regimen profile is continuing to mold the malignancy composition of patients living with HIV. When the current retrospective cohort was contrasted with the older cohort from 2000 to 2010, there were a few key changes – most notably a higher composition of females, a higher percentage of those with a documented ART regimen at the time of diagnosis, and a lower proportion of malignancies at diagnosis meeting Stage 3 or 4 criteria.

Disclosures
All Authors: No reported disclosures
P-458. Factors Associated with Completion of High-Resolution Anoscopy in a Cohort of Transgender Women – Findings from a Mixed-Methods Study
Authors: Harfouch Omar , Whitfield Darren , Mammaldi Tural , Mansfield Megan E , Eyasu Rahwa , Bijole Phyllis , Ebah Emade , Zoltick Meredith , Davis Ashley , Liu Tina , Jones Miriam , Silk Rachel , Sternberg David , Omari Habib , Kottilil Shyamasundaran , Masur Henry , Kattakuzhy Sarah , Rosenthal Elana S 
Published: January 2025

Abstract

Background
Guidelines recommend anal cancer screening in transgender women (TGW) – particularly those living with HIV (LWH) - using anal cytology followed by high-resolution anoscopy (HRA) in those with abnormal results. This study examines factors associated with completion of HRA in TGW with abnormal cytology.

Methods
We recruited 80 TGW using convenience sampling from 4/2021 – 9/2023. We collected survey data, serum samples, and anal swabs for cytology and HPV testing. TGW with abnormal cytology were scheduled for off-site HRA. Non-completion of HRA was defined as being scheduled for HRA but not completing it within 3 months of cytology result. We conducted semi-structured interviews with 8 TGW who completed HRA and 8 who didn’t complete HRA. We used chi-square tests and the weaved approach to compare factors associated with HRA completion from quantitative and qualitative data.

Results
Of 75 TGW with anal cytology collected, 48% had abnormal results and of those 39% completed HRA (Figure 1). Of 36 TGW with abnormal cytology 97% were black, 61% were unstably housed, 78% were LWH. In the last year, 48% engaged in transactional sex and 69% in receptive anal sex (Table 1). HRA completion was associated with being employed (p=0.01) and, among TGW LWH, an undetectable HIV viral load (p=0.01) (Table 1). Qualitative data identified patient-provider trust as a facilitator to HRA completion and experiences of stigma or discrimination related to gender identity as a barrier to HRA completion (Table 2). Mixed-methods analysis revealed that socio-economic challenges, including housing, and financial factors – notably health insurance - were a barrier to HRA completion (Table 3).

Conclusion
In a cohort of TGW, we found high rates of abnormal anal cytology and low rates of HRA completion, highlighting missed opportunities for anal cancer prevention. Interventions aimed at improving anal cancer screening and linkage to HRA for TGW must be intentional about eschewing stigma and creating environments affirming of gender identity, while addressing barriers to care due to prevalent socioeconomic challenges. Additionally, TGW LWH with a detectable HIV viral load may require further targeted interventions to improve both the HIV care continuum and the anal cancer screening cascade.

Disclosures
Shyamasundaran Kottilil, MD PhD, CDA Foundation: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Orsobio: Advisor/Consultant|Orsobio: Stocks/Bonds (Private Company)|Red Queen Therapeutics: Advisor/Consultant Elana S. Rosenthal, MD, Gilead Sciences: Grant/Research Support|Merck: Grant/Research Support
P-467. The clinical prognostic risk stratification system for HIV infected hepatocellular carcinoma
Authors: Chen Yifan , Zhao Han , Wang Yao , Liu Bo , Chen Zhimin , Tao Yu , Xun Yang , Yang Hua , Liu Rongqiu , Feng Lizhi , Liu Xinhua , Li Hengjing , Wang Sibo , Zhao Dong , He Haolan , You Hua 
Published: January 2025

Abstract

Background
Patients with human immunodeficiency virus (HIV) are more susceptible to liver cancer because of their compromised immune system. There is no specific prognostic model for HIV-infected hepatocellular carcinoma (HCC) patients.

Methods
Clinical data of 85 patients with HIV-infected HCC was divided into a 7:3 ratio for training and internal validation sets, while the data of 23 patients with HIV-infected HCC was served as the external validation set. Data of 275 HIV-negative HCC patients was considered as external HIV-negative validation set. Variables associated with overall survival (OS) in the training set were used to develop the HIV-infected HCC prognosis (HIHP) model. The model was tested in the internal and external validation sets. The predictive accuracy of the model was assessed with conventional HIV-negative HCC prognostic scoring systems.

Results
The HIHP model demonstrated a significant association with OS in the training set, with a median OS of 13 months for low risk, 7 months for medium risk, and 3 months for high risk (p &lt; 0.001). The HIHP model showed a significant association with OS, and exhibited greater discriminative abilities compared to conventional HIV-negative HCC prognostic models both in the internal and external validation sets. In the external HIV-negative validation set, the HIHP model did not show better discrimination than conventional HIV-negative HCC scores.

Conclusion
The new model presented in the work provided a more accurate prognostic prediction of OS in HIV-infected HCC patients. However, the model is not applicable to patients with HIV-negative HCC.

Disclosures
All Authors: No reported disclosures
P-475. Anal Cancer Screening in HIV Positive MSM and TGW: A Multistage Quality Improvement Project
Authors: Kenison David , Zamor Rudline G , Shah Khushbu , Nath Sarath 
Published: January 2025

Abstract

Background
Men who have sex with men (MSM) and transgender women (TGW) living with HIV (PLHIV) have an estimated 37-fold increased risk of anal cancer compared to the general population. Currently there are no national guidelines on screening for anal cancer with cytological analysis creating discrepancies in anal cancer screening and increasing risk of progression to anal cancer. We reviewed the MSM and TGW PLHIV cohort in our institution to identify demographics, risk factors, and anal cancer screening rates, we also identified outcomes of patients with cytological testing.

Methods
We conducted a retrospective chart review of MSM PLHIV over the age of 18, who were seen in Stony Brook University HIV clinic from 02/01/21 to 02/01/24. Demographics, smoking history, HIV viral load, human papillomavirus (HPV) vaccination status, and sexually transmitted infection (STI) history was obtained from chart review and compared between patients with and without anal cancer screening with Chi square test.

Results
We identified a total of 160 MSM and 2 TGW. The majority of patients were unvaccinated for HPV (n=144; 88%). 84% had suppressed HIV viral load (n=137), 49% had a smoking history (n=80), and 35% had recent history of STI (n=57). Only 32% (n=53) patients had anal cancer screening done. We also found the patients who were less than 50 years, who had smoking history and recent STIs had a higher chance of being screened. Fifty-three patients were identified with prior cytological analysis, 15 (28.6%) with atypical squamous cells of unknown significance, 6 (11.3%) with low-grade, and 1 (1.9%) with high-grade squamous epithelial lesions.

Conclusion
We identified that anal cancer screening rates were low at our institution despite the prevalence of risk factors such as smoking, high prevalence of STIs and low HPV vaccination status. Nearly 50% of patients had abnormal cytological analysis, highlighting the importance of establishing and implementing anal cancer screening. We have implemented an institutional protocol from 03/01/24 to increase the screening rates for anal cancer for this high risk population.

Disclosures
All Authors: No reported disclosures
P-514. Enhancing the Pediatric Primary Care Provider’s Role in Adolescent HIV Prevention
Authors: Vicetti Miguel Claudia P , Thew Margaret , Ehrman Wendi , Mojica Lia 
Published: January 2025

Abstract

Background
Youth with a history of bacterial sexually transmitted infections (STIs) are at increased risk of HIV acquisition and should be counseled on HIV Pre-Exposure Prophylaxis (PrEP). PrEP counseling has been associated with high acceptability rates in primary care, but most pediatric providers do not discuss PrEP during clinic visits. We conducted a quality improvement project at primary care clinics affiliated with a tertiary not-for-profit children’s hospital serving the city of Milwaukee. The objective of this project is to increase rates of counseling on HIV testing and PrEP during primary care visits around an STI diagnosis, as part of a larger institutional initiative to increase PrEP utilization in at-risk youth.

Methods
Rates of HIV testing and PrEP counseling were monitored monthly during baseline (July 2022-June 2023) and post-intervention periods (July 2023-June 2024) using Plan-Do-Study-Act (PDSA) cycles tracked via a statistical process control chart.
We included well child and sexual health-related office visits in youth aged 12 and older that occurred within 3 months of a bacterial STI diagnosis (gonorrhea, chlamydia, or syphilis). Interventions consisted of a clinician educational session, a prompt in the electronic health record (EHR) for missing HIV tests and a communication to the primary care provider containing internal PrEP resources following a patient’s STI diagnosis.

Results
From July 2022 to December 2023, we identified 255 primary care visits around an STI diagnosis (90.59% chlamydia, 25.49% gonorrhea, 0.39% syphilis and 16.47% co-infections). Patient characteristics are summarized in Table 1. Interim analysis showed counseling rates on HIV testing increased from 50% to 63% (Figure 1) and PrEP counseling from 5% to 15% (Figure 2) through December 2023. Data will continue to be measured through June 2024.

Conclusion
For the first 6 months of our project, clinician education combined with an EHR prompt and provider communications containing PrEP resources have resulted in a modest increase in counseling rates on HIV testing and PrEP for at-risk youth during primary care visits. These initial interventions demonstrate a promising start towards enhancing HIV prevention discussions in pediatric primary care.

Disclosures
All Authors: No reported disclosures
P-516. Implementation and Uptake of Long-acting Injectable PrEP at Atlanta VA Healthcare System
Authors: Harris Nadine M , DeSilva Kathryn E , Kuriakose Roseylee , Sorlie Stacy , Reed Sarah , Oliver Nora T , Moanna Abeer , Webster Andrew S , Cartwright Emily J 
Published: January 2025

Abstract

Background
Long-acting injectable (LAI) pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV and has the potential to expand PrEP access. Atlanta VA Healthcare System (AVAHCS) has one of the largest PrEP programs within the Veteran’s Health Administration (VHA). In mid-2023, we started a LAI PrEP program and quickly became the largest provider of LAI PrEP within VHA. We aim to share our experience building this program as well as describe uptake amongst patients

Methods
In May of 2023, a dedicated advanced practice provider (APP) was hired to manage the LAI program, working closely with an Infectious Disease (ID) clinical pharmacist and ID nurse to refer patients for LAI PrEP based on VA criteria (Figure 1, Figure 2). Active LAI PrEP patients are added to a database tracker and reviewed at weekly interdisciplinary team rounds

Results
From May 2023 to April 2024, 77 patients were referred for LAI PrEP. There are 62 active LAI PrEP patients, with a mean age of 41 years (23-83 years). Most were men (n=49, 79%) and self-identified as black race (n=51, 82%). The most common indication for LAI PrEP use (n=46, 74%) was being at high risk of HIV acquisition, or having special patient factors that affect adherence to oral PrEP (Table 1). Of the 15 patients who were referred for LAI PrEP but discontinued use , reasons cited included: adverse reactions (n=4, 40%), inability to adhere to clinic scheduling (n=3, 30%), no longer desiring PrEP (n=2, 20%), and relocation to another state (n=1, 10%); 5 never initiated LAI PrEP. There were 7 patients (46%) who resumed oral PrEP after LAI discontinuation.

Conclusion
We have rapidly expanded access to LAI PrEP at the AVAHCS using a model that may be replicated at other VA facilities. Assessment of risk and patient preference often guides the decision about starting LAI PrEP in our cohort and should be an important consideration when creating guidance about eligibility for LAI PrEP.

Disclosures
All Authors: No reported disclosures
P-519. Long-acting Injectable PrEP Uptake and Persistence in a Sexual Health Clinic
Authors: Massanet Nicholas Francisco , George Jonathan , Jajoo Veena , Bevard Kerri , Forstell Sheila , Acosta Maritza , Bookins Marcia , Somboonwit Charurut , Sherbuk Jacqueline E 
Published: January 2025

Abstract

Background
HIV pre-exposure prophylaxis (PrEP), a powerful tool for HIV prevention, has traditionally been taken as a daily oral medication. Long-acting injectable (LAI) cabotegravir is superior to daily oral PrEP for HIV prevention and was approved for use as LAI-PrEP in 2021. We aimed to evaluate the uptake of LAI-PrEP and six-month LAI-PrEP persistence in a sexual health clinic.
Participant characteristics (N=36)
LAI: Long acting injectable
PrEP: Pre-exposure prophylaxis

Methods
In February 2023, an LAI-PrEP pilot was implemented in a county sexual health clinic serving a diverse patient population in a designated ending the HIV epidemic in the South. Through state funding, patients at risk of HIV through sexual transmission were eligible to receive initial doses of LAI-PrEP at no cost and same-day initiation was encouraged. We evaluated the first 12 months of implementation. The primary outcome was LAI-PrEP persistence at 6 months. Statistical analyses were performed (SPSS version 29) using chi-square test for categorical variables with a significance level of 0.05.
LAI-PrEP – long-acting injectable pre-exposure prophylaxis

Results
During the 12-month period, 55 people initiated LAI-PrEP, with 36 eligible for the six-month PrEP persistence evaluation. This population was 83% men, 31% Black, 58% Hispanic/Latino, and the median age was 32 (range 20-58) years. 75% received oral PrEP previously. LAI-PrEP six-month persistence rate was 72% (26 of 36). Among the 10 people with LAI-PrEP discontinuation, 1 transitioned to oral PrEP, 2 no longer had an indication for PrEP (change in serodifferent relationship status), and 7 were lost to follow-up. LAI-PrEP persistence differed by race (46% Black vs 88% white, p=0.007) and sexual orientation (37% heterosexual, 89% gay, 67% bisexual, p=0.019).
LAI-PrEP – long-acting injectable pre-exposure prophylaxis

Conclusion
In the first year of LAI-PrEP implementation, LAI-PrEP uptake was favorable in our clinic, especially among priority populations for HIV prevention. Loss to follow-up was the most common reason for discontinuation, but change in PrEP method or loss of PrEP indication accounted for 30% of discontinuations. Nevertheless, the differences in persistence rates suggest a need for targeted interventions to improve long-term adherence in minority and heterosexual groups. Addressing PrEP persistence in these populations is crucial for optimizing the impact of LAI-PrEP in communities with a high burden of new HIV infections.

Disclosures
All Authors: No reported disclosures
P-523. Impact of Tailored Education on Engagement in Sexual Health and HIV Prevention Services Among US Women
Authors: Sheth Anandi N , Vincent Shaina Y , Simone Laura , Napolitan Chris , Carter Jeffrey D , Rodriguez Melissa , Meza Jimenez Jenniffer A , Molloy Leah 
Published: January 2025

Abstract

Background
Women in the US are facing increasing barriers to sexual health services. This project aimed to enhance sexual health literacy and linkage to HIV prevention among US women.

Methods
From 6/2023-8/2023, six patient education sessions on sexual health and HIV prevention were held in women’s health clinics in California, Georgia, and Virginia. Surveys were given to participating patients and healthcare professionals (HCPs) before/after each session and one month later. Content was shared nationally through an online toolkit for HCPs and a public social media video.

Results
Among the 88 patients who attended a sexual health education session (mean age: 44 years; 60% Black, 83% previously tested for HIV), baseline awareness of pre-exposure prophylaxis (PrEP) (23%) and resources for HIV testing/prevention (63%) significantly increased to 71% (P &lt; .001) and 84% (P = .002), respectively, after the sessions. More women felt confident in HIV prevention after the education than before (93% vs. 82%, P = .028). After education, all participating HCPs (n = 6) correctly identified that a woman’s HIV risk is nearly constant throughout life and that PrEP should be offered to anyone who asks for it, compared to 50% correctly answering each question at baseline (P = .181). When asked about patients’ barriers to HIV/STI testing, HCPs most frequently chose fear of judgment (50%), while patients reported cost concerns (27%) and test-related anxiety (26%). When asked what would make testing easier, learning about free or low-cost local testing centers was most frequently chosen by both patients (49%) and HCPs (67%). Discordances were observed regarding PrEP barriers. The top patient-reported barrier was insurance coverage/medication costs (48%), while HCPs perceived fear of side effects as the main barrier (67%). One month later, 73% (n = 19/26) of patients had gotten tested for HIV, and HCPs had discussed HIV screening/prevention with 94 women and helped 38 start PrEP. As of 1/2024, the online toolkit and social media video were accessed by 1,057 and 4,054 people, respectively.

Conclusion
This tailored educational initiative offered insights into women’s barriers to HIV screening and prevention, after which women’s participation in HIV testing and awareness of PrEP improved.

Disclosures
All Authors: No reported disclosures