bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-441. Gut Permeability Response to Inulin Supplementation in Well-Controlled HIV Patients with Metabolic Syndrome
Authors: vikraman Praveen Kumar , Shamayl Ahmed , Mani Valli , Sohail Rubab , Akerman Meredith , Sison Cristina , Hirsch Bruce 
Published: January 2025

Abstract

Background
HIV infection is known to cause abnormally increased gut permeability resulting in chronic inflammation. Serum levels of Zonulin protein are elevated in persons with increased gut permeability. The objective of this study is to assess whether Inulin (fiber) supplementation will result in a decrease in gut permeability in well-controlled HIV patients with metabolic disorder as measured by baseline and post-intervention Zonulin levels.
Statistical Results
There was a statistically significant increase in median Zonulin levels from baseline to post-intervention (p=0.002)

Methods
10 subjects were selected from patients enrolled in care at the Center for AIDS Research and Treatment (CART) based at North Shore University Hospital. Eligibility criteria included well-controlled HIV patients with evidence of metabolic syndrome. The duration of the study was 6 weeks and the intervention was Inulin supplement use. Bloodwork drawn pre- and post-intervention included Zonulin levels, A1c, Fructosamine, Cholesterol, Triglycerides, HDL, LDL, and non-HDL levels. BMI was also checked. Patients were provided with organic Inulin powder and instructed to take 1 tablespoon once a day for the first week and advance to twice a day for the rest of the study. Every week patients were contacted via telephone to assess compliance and side effects. The primary endpoint was the assessment of baseline and post-intervention Zonulin levels, with the secondary endpoint including baseline and post-intervention BMI, A1c, Fructosamine and Lipids. Descriptive statistics were computed and significance was determined via Wilcoxon signed-rank test.
Pre and Post Intervention Zonulin levels in all 10 subjects

Results
Among the patients enrolled 80% were male, 60% were White, 80% were not Hispanic or Latino, and the median age was 60.5. Flatulence and bloating were the most frequent side effects of inulin reported. The median Zonulin levels at baseline were 177.9µg/mL, and post-intervention were 532.4µg/mL. There was a statistically significant increase in Zonulin levels from baseline to post-intervention (p=0.002). There was no significant difference between baseline and post-intervention for any of the other parameters in the dataset.

Conclusion
Inulin supplementation resulted in a statistically significant increase in Zonulin levels, which goes against our hypothesis. Whether this is due to underlying worsening of pre-existing gut dysbiosis or other factors needs further study.

Disclosures
All Authors: No reported disclosures
P-455. Post-Transplantation Infection and Rejection Outcomes in Kidney Transplant Recipients Living with Human Immunodeficiency Virus (HIV): A Single-Center Experience Over a Decade of Evolving Practices
Authors: Nagam Meghna , Huml Anne , Poggio Emilio , Modi Anita R 
Published: January 2025

Abstract

Background
The development of integrase inhibitor and injectable antiretroviral therapy (ART), use of lymphocyte-depleting induction, and implementation of the HIV Organ Policy Equity (HOPE) Act have revolutionized kidney transplant eligibility, peri-transplantation management, and post-transplantation outcomes for people living with HIV and advanced kidney disease in the last decade. We describe our experience with HIV-positive recipients over this important period.

Methods
We conducted a retrospective chart review of all adults living with HIV and advanced kidney disease who underwent kidney transplantation at our center between 2013-2024. Data was collected on demographics, ART and induction regimens, and post-transplantation outcomes: patient/allograft survival, infections, and rejection episodes within the first year.

Results
Sixteen patients (14 Male, 13 Black, Mean Age 51y) underwent 17 kidney transplantations. Ten transplantations occurred from 2013-2022; seven occurred within 18 months of our center’s implementation of the HOPE Act. HIV-associated nephropathy accounted for all six transplantations from 2013-2017; hypertension and diabetes mellitus accounted for most transplantations in later years. Four patients transplanted prior to 2017 received basiliximab, of whom one experienced rejection within a year; 13 subsequent transplantations were induced with anti-thymocyte globulin (ATG), with three complicated by rejection. Rejection incidence was comparable between recipients of 3 mg/kg and 4.5 mg/kg ATG. Two patients suffered graft loss (rejection, BK nephropathy). Eleven patients had infections within a year, predominantly urinary tract infections and cytomegalovirus viremia. No opportunistic infections were identified. Three out of the four patient deaths in this cohort were due to complications of coronavirus disease 2019.

Conclusion
Recent advancements in HIV care and solid organ transplantation practices converged to facilitate pre-transplantation optimization, increase opportunities for transplantation, and improve post-transplantation outcomes for people living with HIV and advanced kidney disease. When used with integrase inhibitor-based therapy, ATG can prevent rejection without precipitating opportunistic infections.

Disclosures
All Authors: No reported disclosures
P-457. Impact of Switching to Bictegravir- or Dolutegravir-based Antiretroviral Therapy on Weight in People Living with HIV during the COVID-19 Pandemic
Authors: Karam Nardine , Douglas Monica , Moy Stanley 
Published: January 2025

Abstract

Background
Integrase strand transfer inhibitors (INSTIs) have been associated with weight gain with dolutegravir (DTG) and bictegravir (BIC) potentially carrying a higher risk than raltegravir (RAL) and elvitegravir (EVG). The COVID-19 pandemic has also been linked to weight gain. However, there are limited data that contextualize the impact of the COVID-19 pandemic on weight in people living with HIV (PLWH) receiving INSTIs. This study aims to evaluate weight change in PLWH who switched to DTG- or BIC-based antiretroviral therapy (ART) compared to those who remained on non-INSTI-based ART during the COVID-19 pandemic.

Methods
This retrospective cohort study included virologically-suppressed PLWH seen at an HIV clinic between January 1st, 2020 to December 31st, 2023. Patients aged &gt; 18 years were included if they switched from RAL- or EVG-based to DTG- or BIC-based regimens (Group 1), from non-INSTI-based to DTG- or BIC-based regimens (Group 2), or remained on non-INSTI-based regimens (Group 3). Pregnant and ART-naïve PLWH were excluded. The primary outcome was absolute weight change from index date to 6 and 12 months. The index date was defined as the switch date in Groups 1 and 2 and was based on the first weight available in the study period in Group 3. Secondary outcomes were absolute change in body mass index (BMI) at 6 and 12 months and in A1c and LDL at 12 months. Mixed linear models, adjusted for sex, age, and baseline BMI, were used to analyze the outcomes.

Results
A total of 200 patients were included (n=45 in Group 1, n=26 in Group 2, and n=129 in Group 3). Baseline characteristics are presented in Table 1. Absolute changes in outcomes are summarized in Table 2. Groups 1 and 2 experienced a median weight increase of 0.9 kg and 0.5 kg, respectively, from index to 12 months, while Group 3 experienced a median weight decrease of 1.1 kg from index to 12 months. Model-generated means for outcome measurements are presented in Tables 3 and 4. Using mixed linear models, there were no significant changes in adjusted mean weight, LDL, and A1c between groups from index to 6 and 12 months (Table 3).

Conclusion
Switching to BIC- or DTG-based ART during the COVID-19 pandemic was not associated with weight gain in treatment-experienced, virologically-suppressed PLWH in this single-center study.

Disclosures
All Authors: No reported disclosures
P-469. Evaluation of the HIV biobehavioral surveillance system for key populations in the Kyrgyz Republic, 2024
Authors: Kubatova Akylai , Kemelbek kyzy Nasyat , Kubatova Aisuluu , Nabirova Dilyara , Horth Roberta , Otorbaeva Dinara 
Published: January 2025

Abstract

Background
New HIV infections are growing in Kyrgyzstan. Key populations (KP), including men who have sex with men (MSM), sex workers (SW), people who inject drugs (PWID), transgender people (TG), and labor migrants (LM) are disproportionately burdened by HIV. Biobehavioral surveillance is essential because routine HIV testing and treatment data in Kyrgyzstan does not adequately capture KP data due to stigma. A surveillance evaluation had not been conducted to identify system gaps and strengths.Table 1.Summary of HIV biobehavioral surveys among key populations in the Kyrgyz Republic

Methods
Using U.S. Centers for Disease Control and Prevention published guidelines for evaluating public health surveillance systems, we conducted an evaluation of Kyrgyzstan’s biobehavioral surveillance system from February to April 2023. We reviewed protocols, survey tools, data and reports from 2003 to 2023.

Results
Biobehavioral surveys are conducted every 3 years. From 2003-2023, 34 studies were completed which included 1,806 MSM in 10 studies, 6331 SW in 11 studies, 8,772 PWID in 11 studies, 56 TG in 1 study and 945 migrants in 1 study. Population size estimations, which are useful for strategic planning, were 16,900 MSM, 7,100 SW, and 25,000 PWID. Protocols and tools were revised and sampling strategies updated before each survey. This helped ensure high quality standards and demonstrates the systems’ flexibility but limits the usefulness of data for comparing trends over time. Recent surveys for each KP failed to reach desired sample size; the TG study reached just 72% of target. Under-sampling, coupled with inherent bias introduced from the quasi-random sampling strategies used, may result in the data not being fully representative. Stability and timeliness were weaknesses; no surveys were conducted 2016-2021 due to funding shortages and the COVID-19 pandemic. Data quality was high. The recent SW survey (n=520) had high completeness of data (91%) and low error measured as invalid/not logical responses to questions (2%).

Conclusion
The biobehavioral surveillance system for key populations in the Kyrgyz Republic is useful, flexible and of high quality. Important gaps in timeliness, stability, and representativeness could be addressed through stable financing for more surveys conducted at regular intervals.

Disclosures
All Authors: No reported disclosures
P-480. Improving HIV Screening Rates among US Veterans: A Quality Improvement Project
Authors: Shah Khushbu , Martin Matthew , Fisher Lisa , Modi Viraj , Lier Audun J 
Published: January 2025

Abstract

Background
Fifteen percent of the 1.2 million people living with human immunodeficiency virus (HIV) in the United States are unaware of their infection, which increases risk of onward transmission and negative sequalae from untreated HIV. To improve early detection of HIV infection, the US Preventive Services Task Force recommends one-time HIV testing for all adults aged 15 to 65. The goal of this quality improvement project is to understand the rate of HIV testing in US Veterans (USV) who seek care at the Northport Veterans Affairs Medical Center (NVAMC) primary care setting and assess the efficacy of a quality improvement strategy to improve HIV screening rates.Table 1:HIV, HCV, and STI screening rates, and demographic variables identified in Veterans at NVAMC primary care setting.NVAMC, Northport Veterans Affairs Medical Center; HIV, Human Immunodeficiency Virus; HCV, Hepatitis C Virus; STI, Sexually Transmitted Infections; USV, United States Veterans

Methods
We conducted a prospective study of USV aged 15 to 65 from three Primary Care provider panels at NVAMC. Demographics, sexual history, injection drug use (IDU), prior hepatitis C virus (HCV), and sexually transmitted infection (STI) testing rates were obtained from chart review. USV without prior HIV screening were telephoned to obtain informed HIV testing consent and testing was ordered for USV who agreed.

Results
We identified 368 USV, with mean age of 60 years. The majority of this cohort were male (n=366, 99.4%) and White (n=262, 72.3%). Seventy-five (20.4%) USV did not have sexual orientation screening charted, no USV were identified as men who have sex with men (MSM), and 4 (1.1%) USV were identified with IDU history. Two hundred twenty (59.8%) USV had received prior HIV testing. Sixty-eight (18.5%) USV with no prior testing gave consent to obtain an HIV test, 29 (42.6%) USV underwent testing and 29 (100%) tested negative for HIV. Prior HCV testing was common (n=262, 71.2%); 2 (0.8%) USV had prior HCV infection and were treated. Sixty-two (16.8%) USV received testing for gonorrhea, 63 (17.1%) for chlamydia, and 138 (37.5%) for syphilis; one USV was identified with chlamydia infection history. We identified patient barriers to HIV testing (refusal, provider outside VA system) and provider factors (testing not offered).

Conclusion
Implementation of a telephone strategy improved HIV testing rates at NVAMC. HIV screening is cost effective as early identification improves survival due to linkage to care and access to treatment. Consequently, this may prevent forward transmission of HIV.

Disclosures
All Authors: No reported disclosures
P-486. Current Trends in Hospitalization Among People Living with HIV at an Inner City Hospital in Newark, N.J
Authors: Prince Monique A , Owolabi Modupeoluwa , Aiman Wajeeha , Attilus Beatrice , Mbenga Kelly , Slim Jihad 
Published: January 2025

Abstract

Background
As HIV disease is becoming a chronic outpatient condition, we were interested in understanding what is driving high-cost hospitalization in people living with HIV (PLWH) at our inner city hospital in Newark, New Jersey. We sought to examine the trends in admissions over the last two years.Table 1compares the causes of hospitalization between 2022 and 2023 [n = 110]

Methods
A retrospective study was performed on electronic medical records of PLWH &gt;18 years old admitted for at least 24 hours to the medical, intensive care, or psychiatry unit of Saint Michael's Medical Center from 2022-2023. The reason for hospitalization was determined to be the main diagnosis related to the symptoms on admission upon chart review. We calculated the standardized mortality ratios using observed deaths and expected deaths compared to mortality in the general inpatient population. We used R software to compare the causes of hospitalization between the two years using the Welch two-sample t-test.Figure 1demonstrates the breakdown of causes by infectious diseases over the 2 years

Results
We identified 110 HIV-positive adults admitted to the hospital. The mean age was 55.8 +/- 12.7 in 2022 and 53.6 +/- 16.3 in 2023. The causes of hospitalization are illustrated in Table 1, p=0.2438. Infections were the top cause of admissions with the most common infections from the respiratory system over two years as demonstrated in Figure 1. AIDS-defining infections were only 4.5% with a decreasing trend during the study period. Overall inpatient mortality in PLWH was 10% in 2022 and 7.14% in 2023. The mortality rate decreased from 4.06 (95% CI 2.20 - 6.91) in 2022 to 1.91 (95% CI 0.89 - 4.06) in 2023. The length of stay (LOS) among PLWH was 26% shorter than the LOS of the general inpatient population in 2022 (n = 4.475) and the same in 2023 (n = 5.34). The mean LOS in PLWH increased by 19.32% over the two years.

Conclusion
Infections are the most common cause of hospitalization in PLWH with stable trends over the last two years. Average mortality rates and length of stay were lower in PLWH compared to the general hospital admissions.

Disclosures
Jihad Slim, MD, FACP, AbbVie: Grant/Research Support|AbbVie: Honoraria|AbbVie: Speaker Bureau|Gilead Sciences, Inc.: Grant/Research Support|Gilead Sciences, Inc.: Honoraria|Gilead Sciences, Inc.: Speaker Bureau|Merck: Grant/Research Support|Merck: Honoraria|Merck: Speaker Bureau|Theratechnologies: Advisor/Consultant|Theratechnologies: Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support|ViiV Healthcare: Speaker Bureau
P-488. Factors associated with the first-time HIV testing among priority populations in Kentucky
Authors: Soria Jaime , Collins Jana , Wilburn Amanda B , Thacker James , Hoven Ardis , Van Sickels Nicholas , Thornton Alice C 
Published: January 2025

Abstract

Background
The Kentucky Income Reinvestment Program (KIRP), a statewide program funded through the Ryan White HIV/AIDS Program, provides comprehensive early intervention services targeting persons at the highest risk for HIV infection. Conducting first-time HIV testing in high-risk populations represents a crucial and proactive approach to mitigating the impact of HIV/AIDS, plays a pivotal role in reducing onward transmission within communities, and provides critical data for public health planning.

Methods
We conducted a cross-sectional study in Kentucky from January 2022 to March 2024. We compared the demographic characteristics and factors associated with first-time HIV testing in high-risk populations. Study data were collected and managed using a REDCap database. The statistical analyses, including logistic regression, were performed with Stata 17 (College Station, TX: Stata Corp LLC).

Results
In the study period, 27,574 subjects were tested for HIV, and 10,268 (37.2%) of them reported not having had an HIV test before. The median age for the first-time tested was 33 (IQR 13 – 83) years; 4,305 (41.9%) were female, 162 (1.58%) were transgender, and 5,321 (51.8%) lived in Rural Counties. (Table 1) In a multivariate analysis, first-time HIV test was associated significantly with younger age, transgender population, and living in rural counties. (Table 2)

Conclusion
The study underscores the critical importance of reaching high-risk populations for initial HIV testing. Around 40% of the subjects tested did not have a previous HIV test, even though they belonged to a high-risk group. The findings reveal several key demographic factors associated with first-time HIV testing, including the younger population, transgender identity, and rural residents, who were more likely to undergo their initial HIV test through the KIRP interventions to address demographic and geographic disparities.

Disclosures
All Authors: No reported disclosures
P-496. Trajectory of Veterans Aging Cohort Study Index Score in People Living with HIV
Authors: Syue Lingshan , Ko Wen-Chien , Ko Nai-Ying , Li Chung-Yi 
Published: January 2025

Abstract

Background
HIV infection weakens human immunity and also causes chronic inflammation. Effective antiretroviral therapy (ART) restores cellular immunity but its ability to reverse chronic inflammation is limited. The Veterans Aging Cohort Study (VACS) is a longitudinal, prospective observational cohort study and used routinely obtained generic data during clinic follow to generate the VACS index which was correlated with poor outcomes. The present study aims to describe the long-term VACS index trajectory pattern of PLWH and to identify the possible factors associated with the unfavorable trajectory of PLWH.
Trajectories of the VACS index and the confidence intervals over up to 7 years of follow-up (n=1677)

Methods
This was a retrospective cohort study enrolling adult PLWH who received HIV care regularly for more than one year in a single medical center and data were retrieved from the electronic medical system. The VACS index for each patient every half year was calculated during 2016∼2022 and collected for group-based trajectory analysis (GBTA). All these analyses were done using the SAS software (9.4 version, SAS Institute Inc., Cary, NC, USA).
Multivariate odds ratio with 95% confidence intervals of factors associated with unfavorable trajectory in PLWH by the logistic regression method (n=1677)

Results
A total of 1677 PLWH with 13366 VACS index records were analyzed through GBTA and categorized into three trajectories: consistently low VACS index with a median VACS index score of 0 points (40.4%), consistently medium scores (median score, 16) of the VACS index (48.2%), and consistently high scores (median score, 52 ) of the VACS index (11.4%) The medium score distribution of the VACS index in the three groups remained unchanged even though the proportion of ART prescriptions increased during the entire follow-up. Age, HIV exposure other than male-to-male sexual contact, baseline CD4 count, Hb level, renal function, FIB-4, and HCV co-infection were significantly associated with the unfavorable trajectory in the multivariate model.

Conclusion
The present study showed that the VACS index is a relatively stable indicator and could be used as an outcome indicator and also provided physicians with an understanding of the long-term trajectories of the VACS index in PLWH. Physicians could identify the high-risk PLWH quickly by using the VACS index. For the PLWH with the consistently high VACS index, physicians need to consider more evaluations or interventions to assure drug adherence to address HIV control.

Disclosures
All Authors: No reported disclosures
P-504. Disparities in PrEP Coverage by Sex Among Individuals Diagnosed with Bacterial STIs in a Large Municipal Healthcare System
Authors: Kaplan-Lewis Emma , Casey Eunice , Gala Kruti , Li Zeyu , Dai Xingyu , Cohen Gabriel 
Published: January 2025

Abstract

Background
Nationally almost 20% of new HIV diagnosis are in females. Females carry 53% of sexually transmitted infection (STI) disease burden in the US, yet nationally represent only 10% of individuals on Pre-Exposure Prophylaxis (PrEP). The US Preventive Services Task Force and CDC include females diagnosed with bacterial STIs as one of the populations to be considered for PrEP. However, females are often not the focus of HIV PrEP campaigns, resulting in knowledge gaps, bias and stigma that further challenge PrEP access for women. As part of efforts to improve sexual health services and access within NYC's municipal healthcare system, we designed a sexual health dashboard (SHD) that included a “PrEP Eligible” metric focused on federal PrEP guidelines related to bacterial STIs.

Methods
All alive patients aged 13-75 years old with a primary care or women’s health clinic visit within a NYC Health and Hospitals facility during April 2023-March 2024 were included in the SHD. The SHD displays testing and positivity rates for Chlamydia, Gonorrhea, and Syphilis, in addition to PrEP eligibility and PrEP active status. PrEP eligibility is based on high frequency of HIV or STI tests (3+ in 1 year), an abnormal STI lab or STI diagnosis and ‘PrEP Active’ is defined as an active prescription for PrEP within the preceding 6-months.

Results
Females represented 82% of PrEP eligible patients but only 13.2% (162) of PrEP Active patients (1,223). Among all people with Chlamydia, 0.2% of females were PrEP Active compared to 16% of males. For Gonorrhea, 2.6% of females were PrEP Active compared to 44.3% of males. For Syphilis, 1.9% of females were PrEP Active compared to 18.6% of males (Figure 1).

Conclusion
According to the CDC, 6% of sexually acquired HIV can be attributed to bacterial STIs, however PrEP usage remains low among eligible females within a municipal healthcare system in NYC. Dedicated efforts are being made within NYC Health and Hospitals to expand PrEP to primary care and women’s health, with the hopes that diversifying care settings for PrEP will reach populations not currently accessing PrEP services. Lack of recognition of the connection between HIV risk and STIs may disproportionately impact females and contribute to underutilization of PrEP.

Disclosures
Emma Kaplan-Lewis, MD, Gilead Pharmaceuticals: Grant/Research Support