bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-532. Pediatric Perspectives of PrEP
Authors: Rosencrance Alex , Rosebush Julia , Mannheim Jonathan 
Published: January 2025

Abstract

Background
Thousands of teens are diagnosed annually with HIV-1 in the U.S. despite the 2018 approval of PrEP for adolescents by the FDA, highlighting the need for research on pediatric PrEP prescribing practices. Research in this area is scant and chiefly focuses on patient barriers to accessing PrEP. Our study explores barriers to prescribing for pediatric providers.Table 1:Characteristics of Provider Respondents

Methods
We performed an online survey of medical providers from pediatrics, family medicine (FM) and internal medicine/pediatrics. A 5-point Likert scale (0-4) assessed comfort in providing adolescent sexual health care, including discussions around sexual activity, gender identity, sexual orientation, STIs, and PrEP. Potential barriers to PrEP prescription were explored. Unweighted proportions of responses were compared by provider characteristics, and logistic regression described the association between provider characteristics and the likelihood of having prescribed PrEP. Correlation matrix analysis identified strong relationships between item measure responses, identifying provider characteristics which associated with one another.Table 2:Comparing Comfort and Familiarity in Different Aspects of Sexual Health Care Between Pediatrics and Family Medicine

Results
158 providers responded. Comparison of pediatric and FM providers found large differences in comfort with sexual health care. FM providers were more familiar with PrEP overall (3.42 to 1.53, 76.4% difference) and prescribing PrEP (3.37 to 0.70, 131.2%). FM providers were also more comfortable discussing sexual orientation (3.45 to 3.01, 13.62%), gender identity (3.32 to 2.72, 19.87%) and providing treatment for STIs (3.72 to 3.19, 15.34%). Logistic regression found that FM providers were 32 times more likely to prescribe PrEP than pediatric providers. Correlation analysis revealed that parental knowledge of a provider-patient conversation about sex decreased provider comfort in discussing sexual orientation and gender identity.Table 3:Multivariable Associations Between Provider Characteristics and Likelihood of Having Prescribed PrEP

Conclusion
Pediatric providers were less comfortable than FM providers in matters related to sexual health, sexual identity, and gender identity, including PrEP. FM providers, who routinely see adults, were significantly more likely to prescribe PrEP than pediatric providers. Parental knowledge of patient-provider discussions of sex may decrease provider comfort with discussions about sexual orientation and gender identity.Table 4:Correlation Stratified by Parental Knowledge of Patient-Provider Conversation About Sex

Disclosures
All Authors: No reported disclosures
P-544. Whole Food Plant-Based Diet for HIV-Associated Reduction in Cardiovascular Risk: A Pilot Randomized Clinical Trial (PLANT-HART)
Authors: Martinez-Loya Carolina , Favela Ortiz Ruth Selene , Vargas-Castañeda Alejandra , Seijas-Vasquez Mariana , Perez-Castilla Jesus 
Published: January 2025

Abstract

Background
Globally, 39 million people are affected by HIV, most of whom are on antiretroviral therapy (ART), which increases cardiovascular risks. Guidelines lack specific dietary recommendations for this population, though plant-based diets may reduce these risks. This pilot study (NCT05796882), to our knowledge, is the first to explore the effects of a plant-based diet on cardiovascular risk in HIV-positive individuals.Table 1.Differences in variables for both groups combined and their statistical significance. Paired sample analysis.

Methods
This randomized controlled pilot clinical trial, conducted in Mexico, involved HIV-positive adults on stable ART, aged 30-60, with a body mass index &gt; 25 and ≥ 1 cardiovascular risk factor. Exclusion criteria included: acquired immunodeficiency syndrome, major cardiovascular events, substance abuse, and ART non-adherence. Of 150 invited, 21 consented and 10 completed the 8-week intervention. Outcomes were analyzed using non-parametric tests (Wilcoxon Sign-rank and Mann-Whitney U). The ethics committee approved; all participants provided informed consent.

Results
Ten male participants (mean age 40.3 ± 8.2) were divided into a plant-based diet (PBD, n=4) and a nutritional standard care (NSC, n=6) group. After 8 weeks, reductions in cardiovascular risk were observed; the NSC group experienced a -0.9% in Framingham Hard Coronary Risk (p=0.2) and the PBD group a -0.1% (p=0.1). Blood pressure decreased significantly in both groups: systolic blood pressure decreased by 15.2 mmHg (p=0.01) and diastolic blood pressure by -7.3 mmHg (p=0.02) (Table 1). The PBD group also showed reductions in weight (-700g, p=0.7), body fat percentage (-0.9%, p=1.0), tricipital fold (-3mm, p=0.06), total cholesterol (-32.0 mg/dL, p=0.1) and LDL cholesterol (-39.7 mg/dL, p=0.2), though not statistically significant.

Conclusion
This pilot study suggests that a plant-based diet may reduce cardiovascular risks in HIV-positive individuals. Both groups were significant for reducing systolic and diastolic blood pressure. The plant-based diet can potentially be beneficial for weight and cholesterol management. Despite a small sample size and adherence challenges, regular follow-ups and dietary self-reports enhanced compliance, underscoring the need for larger, comprehensive studies to confirm these findings.

Disclosures
All Authors: No reported disclosures
P-546. Eligibility and Factors Associated with Long-Acting Injectable Cabotegravir – Rilpivirine Initiation in a South Side Chicago HIV Clinic
Authors: Liegeon Geoffroy , Kaperak Christopher , Friedman Eleanor , Djuricich Paul S , Dawdani Alicia , Plotkin Sophie , Schmitt Jessica , Hazra Aniruddha , Christopoulos Katerina , Schneider John , McNulty Moira 
Published: January 2025

Abstract

Background
We evaluated eligibility for long-acting injectable (LAI) cabotegravir (CAB) and rilpivirine (RPV) treatment among PWH in a Ryan White-funded HIV clinic and assessed factors associated with initiation to identify potential disparities in uptake.

Methods
We conducted a retrospective cohort analysis among PWH who attended the University of Chicago HIV clinic from January 1, 2021 to May 31, 2023. PWH were considered eligible for LAI-CAB/RPV if they had HIV-1 RNA &lt; 50 copies/mL for ≥3 months, no active hepatitis B virus infection, no resistance to rilpivirine or cabotegravir on historical genotypes, and/or no history of treatment failure on integrase inhibitors or non-nucleoside reverse transcriptase inhibitors. We used a logistic regression model to identify socio-demographic and clinical factors associated with treatment initiation among eligible PWH.

Results
Of the 655 PWH, 413 (63%) were eligible for LAI-CAB/RPV. Median age was 45 years, median time from HIV diagnosis was 9 years, 33% were women, 84% Black, 70% had permanent housing, 52% were employed, 56% had Medicaid insurance, 9% had active substance use, 26% had an active mental illness, 69% were taking other daily oral medications, 13% were receiving another ongoing injectable treatment, 48% had no historical genotype available, and 6% had a CD4 count &lt; 200/mm3. Of the 413 eligible PWH, 64 (15%) initiated LAI-CAB/RPV. PWH who initiated LAI-CAB/RPV were significantly younger (34 vs. 48 years, P&lt; 0.001), diagnosed with HIV more recently (6 vs. 11 years, P=0.002), had a higher employment rate (67% vs 50%, P=0.03), and tended to have no mental health issues (19% vs. 28%, P=0.14). They were also less likely to take other daily pills (48% vs 73%, P&lt; 0.001) but more likely to be receiving another injectable treatment (17% vs 12%, P=0.002). In multivariate analysis, younger age (P&lt; 0.001) and not taking other daily pills (P=0.048) were associated with LAI CAB/RPV initiation.

Conclusion
Younger age and not taking other daily pills were associated with LAI-CAB/RPV initiation. More work is needed to understand the reach of LAI-CAB/RPV for those eligible and interested in receiving it.

Disclosures
Eleanor Friedman, PhD, Gilead health sciences: Grant/Research Support Aniruddha Hazra, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|ViiV Healthcare: Advisor/Consultant Katerina Christopoulos, MD, MPH, Janssen: Honoraria Moira McNulty, MD, Gilead Sciences, Inc.: Advisor/Consultant
P-549. Early Results from a Community-Based HIV Rapid Start Initiative, Memphis TN
Authors: Closs David 
Published: January 2025

Abstract

Background
In 2023, Memphis ranked second in the US for the highest rates of new HIV infections. Friends for All (FFA) is a community-based organization located in Memphis whose aim is to prevent the spread of HIV and improve health outcomes of those living with HIV through a holistic and client-centered approach. To improve health outcomes for people diagnosed with HIV and prevent further transmission, FFA launched a rapid test and treat HIV initiative with the primary aim of increasing viral suppression and retention in care.

Methods
We offered free HIV testing at our sexual health clinic and pop-up community testing sites. Individuals that tested positive for HIV and had no prior HIV diagnosis were offered rapid start HIV treatment, defined as treatment initiation within 72 hours. Staff administered an assessment of barriers to linkage and scheduled the appointment.

Results
Between July 2023 and March 2024, FFA tested 2131 clients for HIV. Of the 125 who tested positive, 14 met rapid start criteria. We successfully initiated treatment inside the 72-hour window for 12 (83%) of the 14 eligible. Ninety days post rapid start, 10 (83%) achieved viral suppression and 10 (83%) attended at least 3 medical appointments. The two clients who did not initiate rapid start treatment were identified at pop-up events outside of normal clinic hours, and it was not possible to schedule an appointment within 72 hours. Both of these clients did, however, initiate treatment within 7 days of diagnosis.

Conclusion
While linkage to rapid start ART has been successful in the clinical setting, barriers remain at the patient and organizational level that prevent similar outcomes in the outreach setting. Patients reported barriers to appointment attendance, including food insecurity and transportation. At the organizational level, limited access to ART outside of clinic hours and prescriber requirements for in-person care prevent successful linkage from outreach settings. We are investigating the use of a mobile unit to initiate rapid start treatment in outreach settings and telehealth options for ongoing HIV care. To address patient level barriers, FFA will continue to provide transportation and food services to those living with HIV.

Disclosures
David Closs, MPH, Gilead Sciences: Grant/Research Support
P-556. Efficacy and Safety of Bictegravir/Emtricitabine/TenofovirAlafenamide in Females Living With HIV: 96 Weeks Real Life Analysis
Authors: De Vito Andrea , Ceccarelli Manuela , Colpani Agnese , Venanzi Rullo Emmanuele , Spampinato Serena , Sofia Sonia Agata , Pantò Grazia , Albanese Antonio , Frasca maria Chiara , Paternò Raddusa Michele Salvatore , Campanella Antonio Edoardo , Santoro Laura , Russotto Ylenia , todaro laura , Coco Mariagiovanna , Micali Cristina , Pulvirenti Sarah , calì claudia , Di Rosolini Maria Antonietta , moi Giulia , conti giuseppe , Marino Andrea , Pellicanò Giovanni Francesco , Iacobello Carmelo , Montineri Arturo , Santi Cacopardo Bruno , angioni goffredo , Madeddu Giordano , Nunnari Giuseppe 
Published: January 2025

Abstract

Background
Females with HIV (FWH) are underrepresented in HIV trials. Pooled data from 5 trials at 48 weeks demonstrated the virological efficacy and safety of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF). We evaluated the safety and efficacy of B/F/TAF in a cohort of 99 FWH, in a real-life setting, at 48 and 96 weeks from the switch.

Methods
We conducted a multicentric cohort study that included all experienced FWH starting B/F/TAF treatment in the Shine&Shic cohort across six Infectious Disease Centers in Italy. We collected demographic, epidemiological, clinical, and laboratory data at the time of the switch and at 48 and 96 weeks. Informed consent was obtained from all participants.
Data were reported as numbers (%), or using median and interquartile range (IQR), as appropriate. We assessed differences between baseline, 48 weeks, and 96 weeks using the Mann-Whitney test. A p-value of less than 0.05 was considered significant.

Results
We included 99 females with HIV (FWH) in the study, with a median age of 51.9 years (IQR 43.1-57.8) and a duration of HIV infection of 15.1 years (IQR 5.1-24.7). During follow-up, we observed an increase in the percentage of FWH with an undetectable viral load (Figure 1).
We noted a significant increase in CD4 cells/mL and in CD4/CD8 ratio at 48 and 96 weeks and no differences in CD8 cell counts (Table 2).
Of importance, we observed a significant reductions in total cholesterol and low-density lipoprotein (LDL) at both 48 and 96 weeks. No significant changes were observed in transaminase levels, glucose levels, high-density lipoprotein (HDL), or triglycerides (Table 2). Regarding safety, there was a significant increase in creatinine at 48 and 96 weeks.
We registered 9 interruptions of B/F/TAF: 3 due to loss to follow-up, 1 death, 1 switch to long-acting treatment, 1 due to adverse events, and in 3 cases, due to patient’s choice.

Conclusion
The number of FWH on B/F/TAF under virological suppression increased at 48 and 96 weeks. Furthermore, CD4 T-cell and CD4/CD8 ratio also augmented, underlining an amelioration of the immunological and inflammatory profile. Of note, LDL cholesterol levels significantly decreased overtime. B/F/TAF is virologically and immunologically effective in FWH, in a real-life setting, at 96 weeks from the switch.

Disclosures
All Authors: No reported disclosures
P-564. Long Term Follow Up of Rapid or Same-day Start of Antiretroviral Therapy (ART) in Patients Living With HIV (PWH) in the Midwestern US
Authors: Duggan Joan , Sahloff Eric G 
Published: January 2025

Abstract

Background
Current DHHS guidelines recommend starting ART in PWH immediately or as soon as possible after HIV diagnosis to improve ART uptake, linkages to care and virologic suppression (VS). But there is little data measuring the longitudinal impact of rapidly starting ART. We previously showed that rapidly starting ART significantly decreased time to VS. This study compares the longitudinal effects of rapid ART start versus delayed ART initiation on retention in care and VS in a previously defined cohort of PWH.

Methods
IRB-approved follow up study of a single-center, retrospective cohort. The original cohort included all newly diagnosed, antiretroviral-naïve adult patients seen in the Ryan White Clinic (RWC) at a single site for their initial visit between 1/1/15-12/31/15 (delayed ART) and 1/1/17-12/31/17 (rapid ART): Table 1 and Table 2. In the original cohort, primary outcome of time from HIV diagnosis to VS [VL &lt; 200 copies/ml (cp/ml)] was compared between groups. For the current study, the primary outcomes of VS (VL &lt; 50 cp/ml) and retention in care (documented visit at study site or documented transition of care) were measured in the original cohort participants from 1/1/23-12/31/23. Reasons for lack of retention in care were death and loss to follow up.

Results
In the original cohort, 72 patients were screened and 60 met inclusion criteria; (24 delayed ART, 36 rapid ART). The long-term outcomes for VS and retention in care are shown in Table 3. 11/24 (delayed) and 23/36 (rapid) remained engaged in care at the study institution (p=.193). 9/11 (82%) and 22/23 (96%) maintained VS (p=.239), in the delayed ART and rapid ART, respectively. Participants were more likely to be retained in care (at study site or with documented transition in care) in the rapid ART group (11/22 delayed ART vs. 31/35 rapid ART, p=.002) If not retained in care at the study site, delayed ART participants were more likely to be lost to follow up versus having a documented transition in care or death [11/13 delayed ART vs 4/13 rapid ART, (p=.015)].

Conclusion
A previous study showed a shortened time to VS with rapid start of ART. Long-term retention in care may be significantly improved with rapid start of ART and requires further study. Rapid start may also demonstrate a trend towards increased VS.

Disclosures
All Authors: No reported disclosures
P-578. Just “Short of a Cure”: Unique Considerations in Uptake and Use of Long-Acting Injectable Cabotegravir/Rilpivirine Among Long-Term Survivors with HIV
Authors: Pareek Priyasha , Collins Lauren F , Dance Kaylin , Smith Mollie , Dawdani Alicia , Erguera Xavier A , Walker Ryan , Grochowski Janet , Mayorga-Munoz Francis , Hickey Matt , Johnson Mallory , Sauceda John , Gutierrez Jose I , Balter Laurence , McNulty Moira , Koester Kimberly , Christopoulos Katerina , Colasanti Jonathan 
Published: January 2025

Abstract

Background
Understanding perspectives of subgroups of people with HIV (PWH) who have accessed long-acting cabotegravir/rilpivirine (CAB/RPV-LA) is crucial for optimizing implementation; especially among long-term survivors (LTS) who have lived through the trauma of the early epidemic to the innovation of today.

Methods
We analyzed semi-structured interviews collected from 08/2022-05/2023 via a parent study at four Ryan White clinics in Atlanta, Chicago, and San Francisco among early adopters of CAB/RPV-LA (received ≥3 injections or discontinued). Our analysis explored factors impacting CAB/RPV-LA uptake and use in LTS (living with HIV since 2000 or earlier) using a socioecological model of HIV care engagement.

Results
Among 20 LTS, median age was 56 (Q1-Q3 54-60) years and median time living with HIV was 27 (Q1-Q3 25-34) years. Thirteen (65%) identified as racial/ethnic minorities and seven (35%) as cis or trans women. We identified three primary themes: 1) The majority of LTS eagerly awaited CAB/RPV-LA and seemed unconflicted in their choice to switch from oral antiretroviral therapy (ART). Their confidence stemmed from experience using new iterations of oral ART over decades, with some citing CAB/RPV-LA as being a step closer to a cure. 2) Choosing to start CAB/RPV-LA was sometimes facilitated by input from longstanding, trusted relationships with healthcare providers or other PWH. 3) Reflections on the emotional gravity of witnessing loved ones die from AIDS-related illnesses early in the epidemic, and the mental imprisonment of around-the-clock pill taking required for their own survival, influenced use of CAB/RPV-LA. In fact, many reported transforming HIV-related psychological trauma and tragedy into education, support, and advocacy efforts: using CAB/RPV-LA was a unique mechanism to further benefit their community—indeed, it was an obligation to both PWH who have passed as well as PWH to come, who could learn from their experience.

Conclusion
The perspectives of LTS who initiated CAB/RPV-LA during early implementation revealed uptake and use was shaped by the emotional, psychosocial, and physical impact of living with HIV for decades. These data serve as a framework to tailor service delivery of current and future long-acting ART options in this population.

Disclosures
Moira McNulty, MD, Gilead Sciences, Inc.: Advisor/Consultant Katerina Christopoulos, MD, MPH, Janssen: Honoraria
P-585. Improvement in Time to Viral Suppression Pre/Post an Anti-Retroviral Treatment and Access to Services Intervention (ARTAS) for Emergency Department Patients
Authors: Ludden Thomas , Parker Sam , Leonard Michael , Thomas Jeremy , Jefferson Dasia , McLean Jaylyn 
Published: January 2025

Abstract

Background
While the benefits of early entry into medical care are well-documented, more than one-third of people living with HIV and AIDS (PLWHA) who know their serostatus are not linked to medical care. Nearly 39 percent delay entry into care by 12 months, and 32 percent delay entry for more than 2 years. People do not link to medical care following an HIV-positive diagnosis for a variety of reasons. These may include but are not limited to personal barriers such as unemployment, lack of health insurance, fear, stigma, substance use, mental health issues, lack of transportation, homelessness, and/or not having the required forms of identification to receive services. Other system-level barriers include wait lists for services and/or medications and complex, confusing administrative processes. Rarely do people face only one barrier to accessing medical care. Anti-retroviral treatment and Access to Services Intervention (ARTAS) is an individual-level, multi-session, time-limited intervention designed to link individuals who have been recently diagnosed with HIV in the Emergency Department (ED) to medical care.

Methods
African American or Hispanic/Latino male patients who tested positive for HIV for the first time in the emergency department in an urban Southeastern location were included in the analysis. The number of days to viral suppression was calculated from the date of diagnosis to the undetectable viral load test. The average number of days was summarized and compared using the difference in means one year pre/post the implementation of ARTAS in the emergency department.

Results
ARTAS was implemented on March 1, 2022. Eight patients were diagnosed with HIV in the ED one year before this date, with an average of 264 days to viral suppression. 53 patients were diagnosed one year after that date, with the average number of days from diagnosis to viral suppression decreased to 113 with an average difference of 151 days ([95%] CI 54.6150 to 247.3850, P=0.03). From the time of the first visit with an HIV provider to viral suppression was 86 and 85 days, respectively.

Conclusion
An ARTAS implementation in the ED reduced the time from diagnosis to viral suppression by 57%.

Disclosures
All Authors: No reported disclosures