bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-405. A Case Against Universal Candida auris Screening
Authors: Patel Palak , Roessler Eric , Vasquez Nicole Perez , Steele Molly , Rezaeian Saba , Hill Kristy , Landon Emily , Zuccaro Patricia D 
Published: January 2025

Abstract

Background
Candida auris (C. auris) is an emerging multidrug resistant pathogen that is prevalent in congregate living facilities like skilled nursing facilities (SNFs) and long term acute care hospitals (LTACHs). CDC recommends that individuals who recently resided in SNFs or LTACHs undergo active surveillance for C. auris colonization on admission to an acute care hospital.

Methods
University of Chicago Medicine is an 800 bed tertiary academic medical center. To assess feasibility of C. auris screening, UCM piloted active surveillance for high risk patients in the 24 bed medical intensive care unit (MICU). During the study period, 6/26/2023 to 4/3/2024, charge nurses screened newly admitted patients each shift and notified provider teams to order a C. auris screening for anyone who had previously resided in a SNF or LTACH. The screening test, a combined axilla and groin swab, was collected from each eligible patient and sent for PCR assay to Mayo Clinic Laboratories (Rochester, MN). Patients known to be C. auris colonized were not retested. The infection prevention and control team audited MICU admissions to ensure patients were not missed.

Results
398 patients were admitted to the MICU and 94 were identified as high risk (previously in SNF or LTACH). Of these, 6 were already known to be C. auris colonized and were not tested. 88 total patients were swabbed for C. auris and 5 were positive, representing 5.7% of screened individuals. Turnaround time for this sendout lab was 4-5 days on average. During this time period, 4 patients in MICU developed a C. auris infection. Of those 4 patients only 1 was screened on admission and had a negative screen.

Conclusion
While the burden of swabbing high risk patients was low, the burden of screening all admissions to identify those who were high risk was not. This strain on our workforce, coupled with the unexpectedly low rate of colonization, has prevented expansion of the program. Additionally, the long turnaround time for the screen requires either isolating all high risk patients for a large part of their hospital stay or enduring significant transmission risk if forgoing isolation, while awaiting screening results.

Disclosures
All Authors: No reported disclosures
P-440. Shortened steroid regimen in people living with HIV/AIDS with associated moderate and severe P. jirovecii pneumonia
Authors: Peralta Prado Amy Bethel , Flores-Andrade Xavier A , León-Rodríguez María I , Ahumada-Topete Víctor H , Ávila-Ríos Santiago 
Published: January 2025

Abstract

Background
The 21-day steroid regimen in people with P. jirovecii pneumonia (PCP) showed positive clinical outcomes reducing mortality and immune reconstitution inflammatory syndrome (IRIS) incidence. However, steroids can perpetuate an immunocompromised state, having a negative impact on morbidity.
Respiratory Function test in PLWHIV with shortened vs conventional steroid regimen for PCP

Methods
This is an open-label, randomized non-inferiority controlled trial in adults living with HIV, to elucidate the effect of a shortened steroid regimen (sSR) of 8 days for moderate and 14 days for severe PCP compared to conventional 21-day steroid regimen (cSR) by mortality, IRIS incidence, and respiratory function. Herpesviruses and HIV viral loads, CD4 T cells (CD4), and respiratory function tests were performed at admission and at day 90.

Results
A total of 44 participants were randomized, 23 in sSR and 21 in cSR. Mechanical ventilation (MV) was equal between groups (13 participants each group (OR = 0.8, 95%CI = 0.24-2.67). HIV viral loads at admission and at day 90 were similar between groups (p = 0.34 and p = 0.33 respectively). Similarly, CD4 did not show differences at admission and day 90 (p = 0.82 and p = 0.73). Respiratory function tests were similar between both groups (Figure attached). The CMV, EBV, and HHV-8 viral loads did not show statistical differences. A total of 3 participants presented IRIS in sSR vs 2 in cSR (OR = 1.5, 95%CI = 0.23-9.96) and mortality was not statistically different (OR = 3, 95%CI = 0.29-31.35). The sSR group had a shorter hospital stay (12 vs 18 days; p = 0.37).

Conclusion
Preliminary analysis shows that reducing steroid duration may be safe, since a sSR achieved non-inferiority compared with a cSR, by presenting similarities in mortality, IRIS incidence, hospital-stay duration, MV requirements, herpesviruses and HIV viral loads, and in respiratory function tests; suggesting that at 90 days follow-up, the use of a sSR is not inferior compared to cSR in this preliminary analysis.

Disclosures
All Authors: No reported disclosures
P-461. Positive Aging Consultations: A Model for Expanding Geriatric HIV Care
Authors: Gorvetzian Sarah , Erlandson Kristine M , Iriarte Evelyn , Walker Jacob 
Published: January 2025

Abstract

Background
People living with HIV (PWH) experience geriatric syndromes commonly found in much older populations and may benefit from
geriatrician consultation. We aim to describe a referral-based model at the University of Colorado.

Methods
The Positive Aging Consultations, a referral-based model, sought to connect high-risk PWH ≥ 50 years old with geriatric care. High-risk patients (experiencing geriatric syndromes, polypharmacy, multimorbidity, or advance care planning needs) were referred for geriatric consultation at the UCHealth Seniors Clinic; those taking ≥ 10 medications were referred for clinical pharmacy consultation. Patients were screened for functional status, preventative care, socioenvironmental factors (living situation, food access, transportation, social support, and elder abuse), and cognitive/mental health concerns (depression, anxiety, and memory loss). Geriatricians placed orders or communicated recommendations to the patient’s primary HIV provider. HIV providers completed a survey about their experience with the program. Additional data was collected via chart review.

Results
From January 2018 to July 2019, 11 patients underwent geriatric consultation. The average age was 69 years old (SD=7; range 59-80). Geriatricians most often made recommendations regarding referral to other health or community-based services (n=9), medication changes (n=8), osteoporosis screening (n=6), and memory loss management (n=5). Advance directives were discussed in all visits. All but one HIV provider (n=7) said they would refer patients to the program in the future.

Conclusion
The Positive Aging Consultations program improved access to geriatric care with minimal setup costs, but with limited uptake
over a one-year period. Limitations of the program included low utilization, lack of longitudinal geriatric care, geriatrician
shortage, and potential financial barriers.

Disclosures
Kristine M. Erlandson, MD MS, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|ViiV: Advisor/Consultant
P-484. Community Food Pantries Provide Unique Opportunities for Linkage to HIV Care in Newly Diagnosed Individuals
Authors: Pickard Marc , Rosmarin-DeStefano Corey , Mendez-Baez Christian , Landaverde Karina , Tirado Keven , Escalante Flavia , Vera Sonia , Caro Mauricio , Finkel Diana 
Published: January 2025

Abstract

Background
Food insecurity has been associated with sexual risk behavior that increases Human Immunodeficiency Virus (HIV) risk in cis women and sexual and gender minority (SGM) individuals such as transactional sex for money or food and multiple sexual partners. SGM people and cis women experiencing insecure immigration status also often face financial and housing instability, stigma, discrimination, lack of social support as well as food insecurity. North Jersey Community Research Initiative (NJCRI) is a non- profit organization in Newark, NJ that provides medical care and support services for highly vulnerable and hard to reach patient populations including unhoused individuals, people living with HIV/AIDS, LGBQTIA community members, people who use drugs and new immigrants. In 2023, NJCRI expanded food pantry status neutral services to the community and offered onsite HIV counselling and testing to pantry visitors.

Methods
From April 2023 to April 2024, NJCRI provided HIV testing for 3630 individuals with 1025 being tested at the pantry.

Results
There were 63 total positive tests with 13 diagnosed at the pantry. Of those diagnosed at the pantry, 2/3 (9) identified as SGM and 1/3 (4) as cis women. All the SGM individuals were Latinx. All reported to be new migrants. All diagnosed were linked to care and services and started on ART on the day of diagnosis.OrganizationTotal Test (Statewide)NJCRI Pantry TotalTotal (+) - StatewideNJCRI Pantry - (+)NJCRI363010256313Self-IdentificationSGMn/ax429Cis-Womenn/ax94EthnicityLatinxn/an/a4213Blackn/an/a170Othern/an/a40

Conclusion
Migrant individuals from known groups for higher HIV associated risk experiencing food insecurity benefit from HIV testing at nontraditional testing sites. Food pantries run by trusted community partners who provide integrated HIV care and prevention services can serve as entry points for HIV care for new immigrants. Community organizations serving this community should be aware of the opportunity to engage individuals in HIV care and prevention services and link to care.

Disclosures
All Authors: No reported disclosures
P-491. Advancing HIV Care: Implementing Comprehensive Screening and Linkage Services in Diverse Urban Settings
Authors: Owino Racquel , Gonzales Delana , Landin Steven , Mendez Tanya Khalfan , Lewis Roseanne , Espinoza Michelle , Bravo Juan , Krull Kimberlee , Johnston Kasandra , Hernandez Maria , Emanuel Tatiana , Riviello Ralph , Taranova Anna 
Published: January 2025

Abstract

Background
University Health is South Texas’ largest provider of specialty HIV/AIDS care to a 28-county region with an incidence rate of 21 per 100,000. San Antonio is designated as an HIV priority jurisdiction by the U.S. Department of Health and Human Services. University Health is suited to provide HIV services through its Emergency Department (ED), often the first point of care for indigent individuals, and screening at more than 19 primary care clinics and the Bexar County Adult Detention Center (BCADC).

Methods
University Health implemented opt out HIV screening at three sites; 11 outpatient clinics, the ED, and the BCADC for adults 18 years and over following Centers for Disease Control and Prevention guidelines. EMR system prompts providers to order the preferred HIV confirmatory test using a Care Gap flag alert in outpatient clinics and a Best Practice Advisory in the ED. An HIV screening prompt on BCADC’s EMR system alerts providers to order and conduct an HIV rapid OraQuick swab. Upon identification of all confirmed diagnosis by a provider, the navigation team facilitates linkage to care.

Results
From January 2023 to April 2024, 26,265 individuals were screened in the ED, identifying 205 as positive (0.8% seropositive). Among these, 34% were newly diagnosed, 64% were previously diagnosed, and 2% are pending diagnoses status. Among these, 57% of positive cases were linked to care. From January 2024 to April 2024, 2,415 individuals were screened in 11 ambulatory clinics, resulting in the identification of 3 positive cases (0.1 % seropositive), with 67% being new diagnoses and 33% being previously diagnosed. Of those with a positive result, 67% were linked to care. In the BCADC, spanning from February 2024 to April 2024, 2,473 individuals were screened, resulting in 20 positive cases (0.8% seropositive), with 70% being new diagnoses, 25% previous diagnoses, and 5% pending diagnoses status. Of those with positive diagnoses, 20% were linked to care.

Conclusion
Multi-site expansion of HIV screening and linkage to care services promotes early detection, increased accessibility, and targeted interventions within a HIV priority jurisdiction. Universal screening aligns with national and global goals to end the HIV/AIDS epidemic.

Disclosures
All Authors: No reported disclosures
P-492. Quantification of HIV Shedding in Viremic Patients
Authors: Linfield Rebecca , Zulli Alessandro , Jong Sehee , Wolfe Marlene , Boehm Alexandria , Parsonnet Julie 
Published: January 2025

Abstract

Background
Identifying pockets of undiagnosed HIV is a critical step in the U.S. Ending the HIV Epidemic (EHE). Wastewater-based epidemiology represents a novel way to build agnostic population-level data about disease distribution. We detected HIV virus in two sewersheds in Northern California. We are now conducting a study to measure how much HIV virus is shed into urine and stool, to better estimate cases represented by wastewater detection.
HIV-1 RNA Detected in Concentrated Urine

Methods
We are recruiting participants from HIV clinics in San Mateo and Santa Clara Counties. Patients must be 18 years or older with HIV-1 viral load of &gt;10,000 copies/ml at the time of recruitment. Subjects are asked to provide 5 weekly self-collected blood (Tasso), urine, and stool samples. The plasma is analyzed by established HIV-1 RNA quantitative PCR techniques. Nucleic acids from urine, concentrated (centrifuged) urine, and stool are suspended in DNA/RNA Shield, then extracted using the ZymoBIOMICS DNA/RNA Miniprep Kit (ZymoBIOMICS #R2002). HIV genome-specific primers target the Long Terminal Repeat (LTR) region of the HIV-1 genome. Droplets for digital droplet PCR are generated using the AutoDG Automated Droplet Generator. Reverse transcriptase PCR, which quantifies RNA and DNA combined, and direct PCR, which quantifies DNA, is then carried out with the Mastercycler Pro. Thresholding is performed using QX Manager Software.
HIV-1 RNA Detected in Stool

Results
Two patients have been enrolled to date. Patient 1 was started on antiretroviral therapy after the first sample was obtained; Patient 2 was started on antiretroviral therapy 10 days before the first sample was collected. HIV-1 RNA was found in 87.5% (7/8) of concentrated urine samples, including 85.7% (6/7) of samples obtained while on ART (Table 1). Among stool samples, 25.0% (2/8) yielded HIV RNA, but only 14.3% (1/7) of those obtained on ART (Table 2). Nucleic acids were not detected in unconcentrated urine. Plasma viral load testing is pending, so only the initial clinical HIV-1 viral loads at enrollment are shown.

Conclusion
HIV-1 RNA is present in concentrated urine but also in stool samples of viremic patients, even up to five weeks after initiation of ART. When the study is complete, our results will bolster how to interpret HIV-1 detected in wastewater.

Disclosures
All Authors: No reported disclosures
P-494. The Silver Tsunami Is Upon Us: Over Half of Persons with HIV in the United States Are Aged ≥ 50 Years and Almost Half Have Been Living with Diagnosed HIV for ≥ 15 Years
Authors: O’Connor Siobhan M , Balaji Alexandra B , Grytdal Scott , Wu Baohua , Hu Xiaohong , Brooks John 
Published: January 2025

Abstract

Background
On average, persons with diagnosed HIV (PWH) are living longer, and PWH who are engaged in effective care can expect lifespans comparable to persons without HIV. Understanding changes in the age structure of PWH can help plan where to direct healthcare resources to match need, especially medical needs related to aging and to preventive care for AIDS- and non-AIDS-related comorbidities.

Methods
Using data from CDC’s National HIV Surveillance System (NHSS) for PWH aged ≥ 13 years in the United States, we compared changes in the number of PWH alive at each year-end over the period 2010-2021, examined changes in their age structure, and for 2021 calculated duration of HIV infection since diagnosis for all PWH aged ≥ 18 years.

Results
During 2010-2021, the overall number of PWH increased 29.9%, from 835,004 in 2010 to 1,084,351 in 2021 (Fig 1). The number of PWH aged ≥ 50 years increased 96.3%, from 295,464 to 580,011, and the number aged ≥ 65 years increased 335%, from 33,646 to 146,485 (Fig 2). At year-end 2021, overall median age was 51 years, 53.5% of all PWH were aged ≥ 50 years, and 13.5% were aged ≥ 65 years. Of all adult PWH, 45.8% (497,005) had lived with HIV over 15 years since diagnosis. Among the subset of 12,563 PWH living with perinatally acquired HIV, the median age at year-end 2021 was 26 years; 31.4% were infected at least 30 years, and 76.6% at least 20 years.

Conclusion
From 2010-2021, the number of PWH aged ≥ 50 years increased markedly and overall median age of PWH aged ≥ 13 years increased to exceed 50 years; 1 in 7 were aged ≥ 65 years. By year-end 2021, PWH aged ≥ 50 years totaled over one half million, among whom 1 in 4 was aged ≥ 65 years. Almost half of adult PWH had lived with diagnosed HIV for at least 15 years and three-quarters of young adults with perinatally acquired HIV had lived with HIV for 20 years or more. Our findings highlight the large and rapidly growing need not only for expertise treating older PWH but also integration of prevention strategies to minimize the impact of AIDS- and non-AIDS-related comorbidities of aging in PWH with long-standing HIV.

Disclosures
All Authors: No reported disclosures
P-495. Anal Cancer Screening and Referral Practices in an Academic Medical Center Affiliated HIV Clinic in Columbus, Ohio
Authors: Hassan Syeda F , Lipps Ashley , Patel Yesha , Sobhanie Mohammad Mahdee , Malvestutto Carlos , Koletar Susan L 
Published: January 2025

Abstract

Background
Rates of anal cancer (AC) in people living with HIV (PLWH) are higher than the general population. Screening for AC can be performed using cytology +/- high-risk human papillomavirus (hrHPV) testing. Until recently, there were no evidence-based consensus guidelines available regarding who should be screened for AC or management of abnormal cytology results. The International Anal Neoplasia Society (IANS) guidelines recommend AC screening in PLWH starting at age 35 for men and transgender women who have sex with men (MSM) and starting at age 45 for other PLWH. Guidelines recommend referrals for high resolution anoscopy (HRA) in those with cytology results of atypical squamous cells of unknown significance (ASCUS)/hrHPV+ or worse. The objective of this study is to evaluate existing AC screening and HRA referral practices in the Ohio State University Wexner Medical Center (OSUWMC) Infectious Diseases Clinic (IDC) to identify gaps in care based on the new IANS guidelines.

Methods
This was a single-center, retrospective study evaluating PLWH age &gt;18 years old who underwent AC screening at the OSUWMC IDC between October 1, 2020 and September 30, 2023. Demographic and clinical outcomes were obtained.

Results
During the study period, 257 PLWH had anal cytology performed. Demographic information is shown in Table 1. Of 257 patients screened, median age was 49. 250 patients (97.3%) were men, including 241 (93.7%) MSM. 241 patients (93.8%) had HIV viral load &lt; 40 copies/mL and 251 (97.7%) had CD4 counts &gt;200 cells/mm3. Clinical outcomes, including cytology results, referrals to colorectal surgery (CRS) and results of HRA are shown in Table 2. Of patients with ASCUS/hrHPV+ or worse on cytology, 60/67 (90%) were referred to CRS and 31/67 (46%) underwent HRA.

Conclusion
Anal cancer screening was completed predominantly in MSM living with HIV. Further efforts are needed to promote anal cancer screening among other at-risk groups, such as women and MSW living with HIV. CRS referral practices based on cytology results were highly variable. Though most patients with ASCUS/hrHPV+ or worse were referred to CRS for HRA (consistent with new guidelines), less than half completed an HRA. Additional investigations are needed to determine individual and system level barriers to HRA in this patient population.

Disclosures
Carlos Malvestutto, MD MPH, Gilead Sciences: Advisor/Consultant|Viiv Healhcare: Advisor/Consultant
P-498. One Small Step for Man, One Giant Leap for Ending the HIV Epidemic
Authors: Mann Yasmeen , Hagerman Thomas , Malick Allison , Rao Sanjana , Harris Charlalynn , Santana-Garcés Maria , Manteuffel Jacob , Gudipati Smitha , Brar Indira 
Published: January 2025

Abstract

Background
To achieve the goal to “End the HIV Epidemic” by 2030, unique interventions are needed to increase testing and subsequently link people with HIV (PWH) to care for rapid start of antiretroviral therapy (ART). Extending testing to include emergency department (ED) based HIV screening initiatives are effective in new case identification, earlier detection, and are encouraged by Centers for Disease Control and Prevention guidelines. Collaborations of infectious diseases (ID) providers with ED providers provides improved linkage to care for HIV and rapid initiation of ART. We describe our combined ED and ID HIV testing and linkage to care program.

Methods
This is a retrospective analysis of newly diagnosed PWH at Henry Ford Health (HFH) via reactive HIV fourth generation test by an ED based opt-out HIV screening program from 7/16/2020 – 10/28/2023. A best practice alert (BPA) prompted providers to order an HIV screening test for patients ages 18-65 years old without a previously documented HIV fourth generation test. Patients were informed of the test when ordered and could opt-out of testing if desired. Follow up and linkage to care was provided by a team of ID providers.

Results
During the study period, a total of 48,725 fourth generation HIV screening tests were performed, of which 629 tests were reactive (1.24% of tests performed). Of the reactive tests, 86 patients (0.18% of all tests) were found to have a new diagnosis of HIV. Median CD4 cell count was 297 cells/mm3 (IQR: 98-614), 34 patients required hospitalization with 7 (8%) admitted with an opportunistic infection. Excluding the 34 patients hospitalized, the median time from positive result to first attended appointment was 5 days (IQR 2-13) and median time from screening test result to initiation of ART was 6.5 days (IQR: 4-16). At 3- or 6- months following HIV diagnosis, 40 (47%) had an HIV-1 follow-up viral load reported (see Table 1).

Conclusion
HIV testing and early linkage to care are two key pillars of the “End the HIV Epidemic” initiative. As shown by our study, collaboration between ED and ID providers ensures increased testing in the ED, improved linkage to care, and rapid start of ART which will help in achieving the goals of these two pillars.

Disclosures
Indira Brar, MD, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Merck: Grant/Research Support|ViiV Healthcare: Grant/Research Support|ViiV Healthcare: Honoraria