bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-1412. HIV Retention in Care and Viral Suppression among Transgender Women in a Large Ryan White Clinic
Authors: Gilbert Danielle L , Moise Hope Oddo , Richey Lauren 
Published: January 2025

Abstract

Background
Transgender women (TW) are disproportionately affected by HIV with 1 in 5 TW in the United States living with HIV. TW with HIV (TWH) have lower rates of retention and viral suppression than cisgender women and cisgender men, resulting in worse health outcomes and increased HIV transmission. The aim of this quality improvement initiative was to identify TWH at a large urban Ryan White clinic in New Orleans to guide future quality improvement efforts to improve retention and viral suppression of TWH.Table 1.Characteristics of Transgender Clinic Patients Reviewed

Methods
A list of established clinic patients with a gender identity of transgender was generated to create a database with basic demographic information, viral suppression, retention in care, and potential barriers to viral suppression or retention from April 1, 2023-March 31, 2024. Insurance status, mental health or substance use disorder, and prescription of gender affirming hormone therapy (GAHT) were documented for each patient. Patients were further subdivided into three categories “In Care and Virally Suppressed,” “Out of Care,” and “Not Virally Suppressed” for further analysis.

Results
Out of 1393 established clinic patients, 28 patients were identified as transgender (2%). 27/28 of these patients are black/African American, 1 is Hispanic/Latino. 64% were retained in care, compared to 81% of all clinic patients. 75% were virally suppressed, compared to 84% of all clinic patients. Detailed characteristics are displayed in Table 1. Patients who were out of care or not virally suppressed were younger and had higher rates of mental health diagnoses. 70% of patients who were out of care carried a mental health diagnosis. There was no correlation between GAHT, substance use, or insurance status and retention in care or viral suppression.

Conclusion
As suggested by previous studies, a significantly lower percentage of TWH were retained in care and virally suppressed when compared to the total clinic population, thus highlighting the need to focus on this disproportionately affected group. This TWH database will be used to track retention in care and viral suppression, and data regarding potential barriers will be used to guide quality improvement efforts among TWH, with a plan to focus on mental health services.

Disclosures
All Authors: No reported disclosures
P-1419. Vaccine failure of the live-attenuated vaccine after liver transplantation depends on the vaccine strain
Authors: Furuichi Munehiro , Ohnishi Takuma , Yaginuma Mizuki , Yamada Yohei , Hoshino Ken , Nakayama Tetsuo , Shinjoh Masayoshi 
Published: January 2025

Abstract

Background
A recent conditional recommendation suggests considering live-attenuated vaccines for solid organ transplant recipients, yet the conditions of their safe and effective administration remain unclear.

Primary vaccine failures after the first dose of live-attenuated vaccines (measles, rubella, and mumps) were significantly different between the vaccine strains.

Methods
This prospective study, conducted at Keio University Hospital from 2002 to August 2023, gave live-attenuated vaccines to liver transplant (LT) recipients fulfilling the criteria for live-attenuated vaccines, including humoral and cell-mediated immunity. Patient background information, immunization date, vaccine strain, immunosuppressive agents at the time of vaccination, and antibody titers were collected. Factors related to primary and secondary vaccine failure were evaluated to enhance the effectiveness of the live-attenuated vaccine program after LT.

Kaplan–Meier curves for the proportion of remaining positive antibody titer after the first dose of indicated live-attenuated vaccine for post-liver transplant recipients.

Results
Among 67 LT recipients, 54, 55, 47, or 55 received at least one dose of live-attenuated vaccine for measles, rubella, varicella, or mumps, respectively. Measles vaccine with the AIK-C strain exhibited significantly lower primary failure rates than the CAM-70 strain (1/38 vs. 4/16, odds ratio: 0.08, 95% confidence interval [CI]: 0.01–0.80, p = 0.02) (Table 1). No primary failures were observed with the TO-336 strain of rubella, whereas 4 of 10 LT recipients with the Matsuura strain of rubella did not seroconvert. For mumps, the Hoshino strain showed lower primary failure rates than the Torii strain (15/52 vs. 3/3, p = 0.03). Among seroconverted LT recipients after the first dose of live-attenuated vaccine, the proportion of remaining positive antibody titer is shown by Kaplan–Meier curves (Figure 1). In the years following the first doses of measles, varicella, and mumps vaccines, the proportion of remaining positive antibody titers decreased gradually. Furthermore, the AIK-C strain exhibited a significantly lower risk of secondary vaccine failure compared to the CAM-70 strain (hazard ratio: 0.29, 95% CI: 0.12–0.72, p = 0.01) (Figure 2).

Kaplan–Meier curves for the proportion of remaining positive antibody titer after the first dose of measles vaccine for post-liver transplant recipients with Log-rank test for the vaccine strains.

Conclusion
Vaccine strains are the most critical factor influencing primary and secondary vaccine failure in post-transplant live-attenuated vaccination.

Disclosures
Masayoshi Shinjoh, MD, PhD, Meiji Seika Pharma Co., Ltd: Honoraria|Mitsubishi Tanabe Pharma Corporation: Honoraria|MSD K.K.: Honoraria|Pfizer Japan Inc: Advisor/Consultant|Shionogi & Co., Ltd: Honoraria
P-1441. Demographic and Clinical Characteristics of New Migrant Patients with HIV in a New York City Open Access HIV Primary Care Clinic
Authors: Parkinson Melissa , Saylor Maureen , Villarreal Jason , Chaudhuri Shaoli , Gunaratne Shauna , Olender Susan 
Published: January 2025

Abstract

Background
Since 2022, New York City has seen an influx of migrants, many seeking asylum due to political strife or discrimination. This study assessed the clinical characteristics of new migrant patients with HIV who sought care at an academic, open access clinic.

Methods
This is a retrospective chart review study of new clinic patients January 2022–March 2023. Patients were included in the study if they were ≥18 years of age, living with HIV, and had migrated to the United States within one year of first clinic visit.

Results
From January 2022 through March 2023, we identified 58 patients who met study criteria. 53 patients (91.4%) identified as male, and the mean age was 33 years (SD 8.8), see Table 1. Most patients were from South America, with just over half from Venezuela alone. 48.3% of patients were walk-ins and 43.1% were connected through an open access line, with a majority referred from community-based organizations. 37 patients (63.8%) were on ART (antiretroviral therapy) at first visit, see Table 2. 67% of patients had an HIV viral load of 200 copies/ml or less. 29.8% of patients had a reactive RPR (rapid plasma reagin) consistent with a current diagnosis of syphilis. 11.8% of patients screened had a positive IGRA (interferon gamma release assay), none with active tuberculosis. 17.9% and 10% of eligible patients were screened for Strongyloides and Schistosoma antibodies, respectively. Only 4 of 56 eligible patients received empiric treatment for helminthic infection. 46.6% of patients reported history of STI (sexually transmitted infection), see Table 3. Nearly all patients (93.1%) were linked to a care coordinator prior to or at first visit. 25 patients were identified as having a possible mental health disorder or history of trauma, and 44% were seen by a licensed social worker same day, see Figure 1.

Conclusion
Most new migrant patients were from South America, identified as male, and had suppressed HIV. There were missed opportunities to screen for and treat helminthic infections. There was a high burden of STIs and mental health disorders. Many patients utilized our open access line or walked into clinic and nearly all were connected to a care coordinator at or prior to first visit. Continued research is needed to better understand the needs of this vulnerable and growing patient population.

Disclosures
All Authors: No reported disclosures
P-1444. Impacts of LGBT Equality Index and 2016 UN Resolution Vote on AIDS-Related Mortality
Authors: Modi Neil , Ikuta Kevin 
Published: January 2025

Abstract

Background
Stigma surrounding HIV has been well-described as a barrier to HIV care engagement. Much of this arises from a belief that only certain groups of people can get HIV as well as public opinion and government policies toward LGBT people. Recognizing the effects of discriminatory laws against individuals based on sexual orientation and gender identity, the United Nations Human Rights Council adopted resolution A/HRC/RES/32/2 in 2016, deploring acts of violence and discrimination based on these traits. Our study had two aims: first, to assess if a country’s AIDS-related mortality differed based on how the country voted on the 2016 resolution and, second, to describe whether greater legal protection of LGBT rights was associated with reduced AIDS-related mortality.

Methods
We used HIV prevalence and mortality estimates in men aged 15-49 from the Global Burden of Disease 2019 to determine the case fatality rate for men aged 15-49 living with HIV by country. To estimate the legal protection of LGBT rights, we utilized the Equaldex Equality Index, a publicly available rating from 0 to 100 describing LGBT legal protections and public opinion by country, with higher values reflecting greater equality. We then performed multivariate log-linear regression to describe the relationship between a country’s AIDS-related mortality among men 15-49 and that country’s Equality Index and vote on the 2016 resolution, adjusted for WHO region.

Results
AIDS-related fatality rate was available for 204 countries/territories, an Equality Index was available for 196 countries, and 47 countries voted. In the countries that voted in favor, there was a 65% (95% CI 43-79%, p&lt; .001) relative risk reduction in AIDS-related fatality rate. When adjusted for WHO region, the relative risk reduction was 72% (95% CI 35-88%, p&lt; .06). Assessing the impact of the Equality Index, multivariate log-linear analysis adjusting for region showed that for every 1 point increase there was a 1.6% (CI 1.2-2.0%, p&lt; 0.001) relative risk reduction in AIDS-related fatality rate.

Conclusion
The results of this study support the hypothesis that increasing LGBT legal protection can improve HIV care engagement. It also highlights the significant impact public opinion and government policies toward LGBT people has on AIDS-related mortality.

Disclosures
All Authors: No reported disclosures
P-1448. Targeting Smoking Among People with HIV (PWH): Does Intensive Group Therapy Reduce Mortality?
Authors: Goyal Rohan , Kahan Abner A , Shuter Jonathan 
Published: January 2025

Abstract

Background
PWH in the United States smoke cigarettes at rates 2-3 times higher than the general population. Between 2014 and 2017 we conducted a randomized controlled trial (RCT) comparing Positively Smoke Free (PSF), an 8-session intensive group therapy intervention targeting HIV+ smokers, to brief advice to quit. Findings suggested that PSF conditioned participants had higher quit rates at both early and late (approximately 3-year) follow-up. In the present study, we sought to determine whether PSF conditioned participants had a significant difference in mortality compared to controls 7-10 years after study enrollment.Table 1.Baseline Characteristics of Study Participants.

Methods
Participants of the Bronx cohort of the original RCT (n=247) were chart reviewed for vital status. Participants were classified as “alive” if review indicated contact with the patient within six months of review. If no records were available within the prior six months, an attempt was made to contact the patient, pharmacy, or emergency contact as listed either in the medical chart or original study records. Dates of death were recorded for deceased participants. Data were analyzed using R 4.4.0. All identifying patient information was secured in a password-protected spreadsheet only accessible to study authors.Figure 1.Vital Status of Study Participants.

Results
There were no significant differences in baseline characteristics between treatment and control groups (Table 1). 14.2% of all participants were confirmed deceased at the time of data collection; vital status of 25.5% of participants could not be determined (Figure 1). Kaplan-Meier analysis was performed (Figure 2); log-rank test was significant for survival difference favoring the PSF vs control group (p = 0.03). Univariate Cox-proportional analysis showed a hazards ratio of 0.46 (0.23 - 0.94, p = 0.034).Figure 2.Kaplan-Meier Survival Analysis.

Conclusion
Follow-up analysis of Bronx participants in the original RCT suggests that there is a significant mortality benefit over 7-10 years for HIV+ smokers who received PSF intensive group therapy.

Disclosures
All Authors: No reported disclosures
P-1450. Impact of Multi-morbidities on Quality of Life Among People Living with HIV at a tertiary care center in India: A cross-sectional study
Authors: Ramachandran Sai Prasad , Manam Abhigna 
Published: January 2025

Abstract

Background
India is home to an estimated 2.4 million People Living with HIV (PLHIV). The term "multi-morbidity" refers to the simultaneous presence of 2 or more chronic medical conditions in an individual, the prevalence of which is rising. The aim of our study is to assess the impact of multi-morbidities on Quality of Life (QoL) in PLHIV attending the Antiretroviral Therapy (ART) center at a tertiary care hospital in Western Maharashtra, India.

Methods
This was a cross-sectional study, over 2 months with 285 patients recruited. After ethical clearance was obtained, patients were interviewed to gather comprehensive sociodemographic history, with information on treatment and comorbidities obtained from patient charts. The QoL was measured using the WHOQOL-HIV BREF questionnaire which evaluates QoL across six domains: Physical, Psychological, Independence, Social, Environment, and Spiritual.

Results
The cohort exhibited an average of 2.2 comorbidities (SD = 1.4), with a notable prevalence of cardiovascular diseases and diabetes. Participants with 3 or more comorbidities demonstrated significantly lower QoL scores in the Physical (mean = 10.4, SD = 1.8, p &lt; 0.01) and Psychological (mean = 11.9, SD = 1.5, p &lt; 0.05) domains compared to those with fewer comorbidities. A longer duration of ART correlated positively with higher scores in the Independence domain (r = 0.26, p &lt; 0.05). Elevated CD4 counts were linked with improvements in the Environmental and Psychological health domains. (p &lt; 0.05) Participants from higher socioeconomic backgrounds reported significantly better scores in the Environmental and Spiritual domains (p &lt; 0.05). Younger patients (&lt; 40 years) reported better Social and Spiritual QoL scores compared to older individuals Gender-specific analysis indicated that females reported higher scores in the Social and Environmental domains. (p &lt; 0.01).

Conclusion
There is a pressing need for effective management strategies that encompass comprehensive care approaches to address the complex health needs of this population. Enhancing routine screening for comorbidities and educating patients about the implications of multi-morbidities can empower PLHIV to improve QoL.

Disclosures
All Authors: No reported disclosures
P-1452. Exploration of Associations Between Social Determinants of Health and Treatment Failure in People with HIV
Authors: Gudipati Smitha , Warzocha Victoria , Brar Indira , Baxa Dwayne , Homayouni Ramin , Markowitz Norman 
Published: January 2025

Abstract

Background
Addressing Social Determinants of Health (SDOH) and health disparities is at the core of “Ending the HIV Epidemic.” To address SDOH, there is a funded HIV Care Coordination Program (CCP) at Henry Ford Health (HFH), with support to surmount SDOH in people with HIV (PWH). In this pilot study, we explore associations between SDOH and treatment failure (TF) in this program.

Methods
A retrospective study was conducted on PWH in our CCP at HFH from 2022 to 2023. Variables were extracted from data monitoring. CCP enrollment required referral by HIV providers. PWH were surveyed on SDOH related to ART challenges, and these SDOH were assessed throughout the course of one year. HIV genotypes were obtained upon enrollment, and HIV-1 viral load (VL) was collected every 3 months for one year. Significant differences between PWH with or without TF (defined as VL &gt; 200 copies/mL at 1 year) were determined using Chi-Square test for categorical variables and Kruskal-Wallis for continuous variables. Multivariable logistic regression was used to find associations between independent variables and TF.

Results
A total of 144 PWH were included in this study and divided into with (n=26) and without (n=118) TF (Table 1). There were no statistically significant differences in age, gender, risk factors and mean years living with HIV between the two groups. TF PWH had significantly lower incidence of insurance issues and need for financial assistance. Using linear regression analysis while adjusting for age, race, gender, genotype and other SDOH factors, there was no significant association between insurance issues or financial assistance. Although drug resistant mutations (DRMs) were not linked to specific demographics or SDOH, TF PWH had a significantly higher number of DRMs at baseline (p&lt; 0.0176, OR 3.45, 95% CI 1.24-9.60) and a trend towards increased low frequency (&lt; 10%) DRMs.

Conclusion
TF occurred in 18% of PWH with adverse SDOH at enrollment into CCP. While we were unable to identify an association of specific SDOH with TF, the TF rate was elevated in these PWH. Overcoming SDOH is essential to achieve viral suppression. DRMs at CCP entry were significantly associated with TF, and were present in all those with TF. Our study is ongoing, and with larger numbers, we aim to assess the impact of SDOH in TF PWH in future studies.

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
P-1453. Disparities in PrEP utilization
Authors: Soomro Ayesha 
Published: January 2025

Abstract

Background
In October 2023, the CDC released data regarding PrEP uptake in the United States. The data indicated that in 2022, for the first time, more than one-third of individuals who could benefit from PrEP had been prescribed it. While this advancement is certainly significant, as PrEP coverage is one of the cornerstones in ending the HIV epidemic, the report also highlighted substantial disparities.
According to the report, while 94% of White individuals who could benefit from PrEP had been prescribed it, only 13% of Black and 24% of Hispanic/Latino individuals who could benefit had received prescriptions for PrEP. Another notable disparity was observed regarding sex at birth, with 40% of males who could benefit from PrEP being prescribed it, compared to only 15% of females.

Methods
We aimed to determine if such a magnitude of disparity existed within our patient population receiving care at the infectious disease clinic. We identified 99 patients who had been prescribed PrEP at the ID clinic. These individuals were categorized based on their self-identified race/ethnicity and sex assigned at birth.

Results
Of the 99 individuals prescribed PrEP, 86 were males, while only 13 were females. Regarding race/ethnicity, there were 65 White or Caucasian patients, 24 Black or African American patients, 5 Hispanic or Latino patients, and 5 others.

Conclusion
Compared to national data published by the CDC, our data shows similar disparities. While the PrEP-to-need ratio would be a better indicator of the true disparity, our data still highlights the trend in racial and sex-based differences among users of PrEP prescriptions.

Disclosures
All Authors: No reported disclosures
P-1462. Utilization of a Point-of-Care Hepatitis C Test to Treat in People Experiencing Homelessness with Street Medicine Outreach
Authors: Mann Yasmeen , Ogbenna Ugonna K , Ishak Angela , Kasmikha Lauren , Numi Mariia , Iyer Hari , Rehman Sheema , Kadouh Ali , Mangal Ruchi , Qasawa Austin , Dehghani Ali , Hasso Muneer , Henry Joanna , Santana-Garcés Maria , Rehman Najibah K , Bryce Richard , Zervos Marcus , Joshi Seema 
Published: January 2025

Abstract

Background
Persons experiencing homelessness (PEH) have disproportionately higher rates of untreated chronic hepatitis C virus (HCV) than the public. Improved community funding and resources are needed to expand HCV rapid point-of-care (POC), confirmatory testing, treatment and follow-up. Given that PEH face competing priorities (unstable housing, food access, addiction, other infections), it is our role as clinicians to reduce barriers to HCV treatment, understand hesitancies for deferring treatment, and design programs to improve accessibility. This is the pilot project of a Street Medicine (SM) based initiative to use POC testing for HCV amongst PEH with linkage of care to a federally qualified health clinic (FQHC).
Hepatitis C Screening and Treatment Protocol
HCV- Hepatitis C Virus
POC- Point of Care
CHASS- Community Health and Social Services
HbsAg- Hepatitis B Surface Antigen
CBC- Complete Blood Count
CMP- Complete Metabolic Panel

Methods
SM provides medical care to PEH outside of a hospital setting. Medical students and residents were recruited to form a HCV outreach team at Henry Ford Hospital and trained in HCV testing via OraQuick rapid antibody (Ab) test. During SM outreach, PEH were provided education on HCV and offered POC testing with a $10.00 grocery gift card. If a patient was identified as HCV Ab positive they were provided free transportation to a FQHC for confirmatory testing. If diagnosis was confirmed, they were evaluated for eligibility for simplified HCV treatment, check-ins to assess adherence and sustained virologic response (Figure 1).

Results
From February-April 2024, 103 PEH were tested using POC HCV testing on SM runs, with 4 positive results. 3 of 4 patients were confirmed for CHASS clinic appointments. 1 patient presented to clinic follow-up but deferred confirmatory testing bloodwork, demonstrating challenges in arranging for HCV clinic follow-up care.

Conclusion
Previous studies have shown that lack of insurance, prior authorization and referral process, active injection drug use or alcohol use, lack of knowledge of HCV treatment, and limited healthcare workforce and infrastructure have all contributed to the low treatment rate in the homeless. Using trusted community organizations with SM, this initiative aims to reduce testing and transportation barriers in order to eliminate HCV in PEH. Larger numbers of positive patients are needed to best assess the feasibility of the program, and if providing all testing and treatment at the point of care is needed to improve compliance.

Disclosures
Marcus Zervos, MD, Johnson and johnson: Grant/Research Support|Moderna: Grant/Research Support Seema Joshi, MD, AbbVie: Grant/Research Support