bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-438. T-cell Immune Exhaustion and the Atherogenic Index of Plasma in People Living with HIV on Antiretroviral Therapy
Authors: Francisco Christian , Padua Ana Joy 
Published: January 2025

Abstract

Background
The atherogenic index of plasma (AIP), an index that correlates with atherosclerosis, has been reported to be abnormal among people with human immunodeficiency virus (PWH). Few subclinical markers of atherosclerosis were linked to T-cell immune exhaustion. However, no study has explored the relationship of AIP to the different immune exhaustion markers. We compared the AIP and immunologic parameters of PWH on antiretroviral therapy (ART) to that of people without HIV (PWoH). Correlation of different clinical, laboratory and immunologic parameters with AIP in PWH were investigated.Table 1.Demographic and clinical characteristics of study participants (N=100)

Methods
This is a cross-sectional study conducted from March 2018 to February 2019 in a treatment hub in Manila, Philippines. We recruited 50 virally suppressed PWH on ART and 50 age- and sex- matched PWoH. Demographic and clinical data were recorded. Fasting blood samples were collected for complete blood count, blood glucose, and lipid profile. Peripheral blood monocytes were isolated and analyzed for immune exhaustion markers in T-cells and monocytes (LAG-3, PD-1, TIGIT+, TIM-3) via flow cytometry. AIP was computed as log (trigylyceride/high density lipoprotein-c). Abnormal AIP was defined as values in the medium (0.1-0.24) and high-risk ( &gt;0.24) categories. Pearson correlation was performed to determine linear correlation between clinical, laboratory and immunologic factors and AIP.Table 2.Laboratory and immunologic parameters of study participants (N=100)

Results
Majority of the participants were male (96%) with mean age of 31. Among PWH, the mean recent CD4+ count is at 515 cells/mm3. Median ART exposure is 4 years. Majority were on efavirenz based ART (41, 82%). Few were on protease inhibitors (6, 12%). All PWH had abnormal AIP. There is no difference in AIP between PWH and PWoH (0.5; 0.3 vs 0.62; 0.3, p 0.5). Recent CD4+ (R 0.32, p 0.02), nadir Cd4+ (R 0.31, p 0.03) and zenith CD4+ (R 0.30, p 0.04) were positively correlated with AIP in PWH. Only dual expression of PD-1 TIGIT+ CD8+ T-cells showed positive correlation with AIP (R 0.20, p 0.04).Figure 1.Correlation of AIP levels with CD4+ count

Conclusion
AIP in PWH is comparable to that of PWoH. The correlation of AIP to PD-1 TIGIT+ CD8+ T-cells supports the role of T-cell immune exhaustion in the pathogenesis of dyslipidemia and atherosclerosis. Strategies to decrease immune exhaustion can possibly prevent or delay metabolic complications in PWH.
Correlation of AIP levels with frequency expression of PD-1 TIGIT+ on CD8+ T-cells

Disclosures
All Authors: No reported disclosures
P-439. Breast Cancer (BC) and Colorectal Cancer (CRC) Screenings among Persons with HIV (PWH): The Role of Individual and System-Level Factors on Screening Completion
Authors: Bredehoeft Cole T , Peng Jing , Lipps Ashley , Sobhanie Mohammad Mahdee , Malvestutto Carlos , Koletar Susan L , Patel Yesha 
Published: January 2025

Abstract

Background
Non-AIDS-defining cancers (NADCs) are a leading cause of morbidity and mortality among PWH. With healthcare digitization and evolving HIV care models, equitable access to preventative care is crucial. We investigated individual and system-level factors associated with completion of BC and CRC screenings.

Methods
This was a single-center, retrospective cohort study from 7/1/2022 to 7/1/2023. Established PWH (≥ 3 appointments between 7/1/2020-7/1/2023 with ≥ 1 within the study period) aged 40-75 were included. The primary outcome was ordering and completion of BC and CRC screenings. Demographics were summarized using frequency and percentage for groups with differing screening statuses. Chi-Square or Fisher’s exact test were used to evaluate associations between factors and outcomes. Descriptive statistics and p values were considered for evaluating associations between characteristics and screening status.

Results
178 PWH eligible for BC screening were included. 113 (63.5%) were of Black/African American race, 151 (84.8%) had a primary care physician (PCP), and 138 (77.5%) were enrolled in an electronic medical record application (MyChart®). 52.7% were up to date on BC screening. Demographics and BC screening statuses are listed in Table 1. We observed a statistically significant association between having a PCP (90.2% vs 75.8%; p=0.018) and ordering of BC screening. Moreover, patients who completed BC screening are less likely to have obesity (39.4% vs 56.0%; p=0.039) (Table 2).
739 PWH eligible for CRC screening were included. 591 (80%) were assigned male sex at birth, 634 (85.8%) had a PCP, and 601 (81.3%) were enrolled in MyChart®. 349 (47.2%) were up to date on CRC screening. Demographics and CRC screening statuses are listed in Table 3. Significant associations were noted between having a PCP (90.8% vs 81.3%; p &lt; 0.001), higher median income (79.6% vs 69.9%; p=0.003), and MyChart® enrollment (88.0% vs 75.4%; p &lt; 0.001) and CRC screening completion. Other notable variables are listed in Table 4.

Conclusion
BC and CRC screening is essential in reducing morbidity, mortality, and disparities of BC and CRC among PWH. Our findings provide insight on target populations for interventions and highlight opportunities to utilize digital technologies to improve cancer screening rates.

Disclosures
Carlos Malvestutto, MD MPH, Gilead Sciences: Advisor/Consultant|Viiv Healhcare: Advisor/Consultant
P-442. Quantification of TTV in Saliva and Plasma of People Living With HIV
Authors: Gore Edmund , Groenewegen Hester , Lambeck Annechien , Niesters Bert , Bierman Wouter , Van Leer Buter Coretta 
Published: January 2025

Abstract

Background
Torque tenovirus (TTV) viral load in blood is now accepted as a marker of immunocompetence in immunocompromised patients such as transplantation recipients and people living with HIV (PLWH). TTV has been shown to predominantly infect T cells, which are vital for the control of TTV. In PLWH the level of TTV has been shown to correlate with the CD4 count. Recently, TTV has also been detected in saliva of PLWH. However, at this time it is not known if salivary TTV can be used as a non-invasive alternative to blood TTV, or as an alternative to a CD4 count. In this study, we explore the relationship between TTV in blood and in saliva with T cell subsets, including CD4+ T cells, to determine the clinical potential for this novel marker in PLWH.

Methods
80 PLWH visiting the outpatient clinic of our center were recruited. Inclusion criteria were age ≥ 18 years, use of combination antiretroviral therapy for ≥ 6 months and &lt; 40 copies/mL in the last two viral load measurements. The CE-marked TTV R-Gene® kit (bioMérieux, Lyon, France) was used to detect and quantify TTV in plasma and saliva. Results are expressed in log copies/ml, with a cut off of 2.4 log copies. Absolute numbers of CD4+ T cells were measured using the MultiTest TruCount method (Becton Dickinson). HIV viral load was performed on EDTA plasma samples using the Abbott Real-Time HIV-1 assay.
Plasma TTV correlates with salivary TTV, R2 0.89, p&lt;0.01.

Results
Individuals were predominantly male (86%), had a mean age of 51. The mean CD4+ count was 670 (447-844) and 25% had a low detectable HIV load (Table 1). TTV was detectable in 24% of plasma and 20% of saliva samples with an average of 3.86 log copies/ml and 4.01 log copies/ml respectively. Plasma TTV and saliva TTV correlate well (R2 0.89, p&lt; 0.01) (figure 1). There is no relationship between plasma TTV (R2 0.004, p = 0.58), (figure 2) or saliva TTV and the CD4+ count (R2 0.004, p = 0.58) (figure 3).
Plasma TTV does not correlate with CD4 count, R2 0.004, p = 0.58.

Conclusion
Whilst neither salivary nor plasma levels of TTV correlate with the CD4 count of HIV patients in our study, salivary TTV correlates with TTV detected in blood. With the increasing interest in TTV in transplantation as a marker for immunosuppression, the fact that measurements of TTV can be performed on the saliva, preventing or reducing the need to draw blood from patients deserves further exploration.
Salivary TTV does not correlate with CD4 count, R2 0.004, p = 0.58.

Disclosures
All Authors: No reported disclosures
P-456. Reduction in the incidence of chronic hepatitis C, liver cancer, and related healthcare burden following the introduction of interferon-free direct-acting antiviral therapy in Japan: a national claims database study
Authors: Kanda Naoki , Yamashita Sinnpei , Hashimoto Hideki , Yoshimoto Hiromasa , Goda Kazuo , Mitsutakke Naohiro , Hatakeyama Shuji 
Published: January 2025

Abstract

Background
The World Health Organization aims to eliminate hepatitis C virus (HCV) infections by 2030. Interferon-free direct-acting antiviral (DAA) therapy, available in Japan since 2014, has demonstrated high hepatitis C cure rates and reduced hepatitis C-related hepatocellular carcinoma (HCC). However, DAA therapeutic efficacy on a national scale remains underexplored. In this study, we investigated national trends in HCV prevalence and complications, including liver cancer, during the era of interferon-free DAAs, with particular focus on the impact of coexisting human immunodeficiency virus (HIV) infection.

Methods
We used the National Database of Health Insurance Claims, covering &gt;98% of the population in Japan, to extract claims data on patients with chronic hepatitis C between 2013 and 2022. We identified patients with chronic hepatitis C annually based on the presence of corresponding diagnostic codes and relevant tests (abdominal ultrasound or HCC tumor markers) within each fiscal year. Next, we analyzed the trends in the prevalence of chronic hepatitis C (stratified by HIV status), DAA therapy, HCC incidence and treatment, and healthcare costs.

Results
Between 2014 and 2022, 333,020 patients underwent interferon-free DAA therapy in Japan. The number of patients with chronic hepatitis C decreased from 690,336 in 2013 to 414,708 in 2022, representing a 40% prevalence reduction (95% confidence interval: 40%–40%). However, among people living with HIV (PLWH), we observed a 16% decline (10%–20%). Newly diagnosed HCC incidence among patients with chronic hepatitis C declined by 69% (68%–70%) over the 10 years. HCC treatment numbers also declined, with 50%, 80%, and 82% reductions in hepatectomies, radiofrequency ablation, and transarterial chemoembolization therapy, respectively. The total annual healthcare cost of HCV-infected individuals peaked in 2015 (1.1 trillion yen), coinciding with the widespread use of DAAs, and decreased to 65% of the 2013 expenses by 2022.

Conclusion
The introduction of DAAs significantly reduced the HCV infection-related healthcare burden in Japan. Extensive screening and treatment, particularly in PLWH, are crucial for successful HCV eradication.

Disclosures
All Authors: No reported disclosures
P-459. Length Of Hospital Stay, In-patient Mortality And Factors Associated With Mortality Among HIV-Cryptococcal Meningitis Patients Receiving Liposomal Amphotericin B At Tertiary Hospitals in Uganda
Authors: Namuju Olivie Carolyne , Kwizera Richard , Tugume Lillian , Boulware David R , Meya David 
Published: January 2025

Abstract

Background
Cryptococcal meningitis (CM) remains the second lethal opportunistic infection among People Living with HIV (PLWHIV) in sub-Saharan Africa. Currently, the patients are managed on single high-dose liposomal amphotericin B and flucytosine. However, there is no sufficient data on whether the new treatment regimen has an effect on reducing inpatient mortality and length of hospital stay in the real-world setting.
We aimed to investigate the proportion of inpatient mortality, length of hospital stay (LOS), and factors associated with mortality among patients with HIV-associated CM receiving liposomal amphotericin B-flucytosine regimen.

Methods
This was a cross-sectional study conducted to review medical records of patients admitted between December 2022 and May 2023 at 11 tertiary hospitals in Uganda. Medical records of 173 HIV-CM patients were reviewed. Univariate descriptive statistics were used to summarize the background characteristics. Modified Poisson regression was used to ascertain factors associated with mortality at bivariable and multivariable levels. Associations were presented through adjusted prevalence ratios with their 95% confidence intervals. Data were analyzed using STATA v15.

Results
Of the 173 patients’ medical records reviewed, 58.4% were males with a median age of 38 years (IQR= 30, 48) and over 55.5% were married. Patients with altered mental status (GCS&lt; 15) were 40%. Overall, inpatient mortality for liposomal amphotericin B was 35.8% and this varied by health facility. The median LOS was 7 days (IQR = 3, 12). Factors associated with mortality were convulsion [APR, 1.86, 95%CI (1.21-2.86), p-value=0.005)], altered mental status [APR; 1.66, 95%CI (1.07-2.57), p-value=0.023], and a comorbid condition [APR, 2.26 95%CI (1.44-3.53), p-value=0.006]. Therapeutic lumbar punctures were significantly associated with reduced mortality [APR; 0.47, 95%CI (0.29-0.73), p-value=0.001].

Conclusion
Liposomal amphotericin B regimen has lower mortality than deoxycholate in the real-world setting. Patients on average spend more than a week in hospital. Male sex, convulsion, altered mental status, and comorbid conditions were independently associated with mortality. Therapeutic LPs significantly reduced inpatient mortality.

Disclosures
All Authors: No reported disclosures
P-478. Assessing HIV Transmitted Drug Resistance and cluster detection among Antiretroviral-Naïve individuals in Hispaniola
Authors: Lora Hector J , Sanchez Martha , Novitsky Vladimir , Hague Joel , McCarthy Meghan , DeLong Allison , Mendoza Diego , Ruiz Ingrid , Jabier Maridania , Paulino-Ramírez Robert , Kantor Rami 
Published: January 2025

Abstract

Background
The use of antiretroviral therapy (ART) has surged globally, heralding an era of life-saving treatment for millions. However, with this widespread adoption of ART, a concerning trend has emerged: the escalation of antiretroviral resistance. Within the confines of La Hispaniola, encompassing the Dominican Republic (DO) and Haiti(HT), the prevalence of HIV stands among the highest in the Caribbean region. Our main objective is to identify and characterize the extent of transmitted drug resistance (TDR) of HIV among treatment naïve participants, its demographic and the clinical associations in the DO and the transmission networks.
Phylogenetic relationships between DRII PRRT sequences and NNRTI SDRMs

Methods
During May 2021-June 2022, we enrolled 148 newly HIV-diagnosed ART naïve adults at Centro de Orientacion e Investigación (COIN) in DO. Demographic and clinical were collected, and blood samples obtained for partial pol genotyping using NGS. Subtyping and resistance interpretation were performed with Stanford Database tools. Maximum likelihood phylogenies were inferred by RAxML and clusters were defined as clades with bootstrap support of ≥0.8. Extended phylogenetic analyses included ∼1,500 publicly available Caribbean sequences including prior data set from our group. Fisher Exact tests and logistic regression were used to test associations of those in clusters.
Phylogenetic relationships of DRI and DRII PRRT sequences

Results
Among participants the mean age was 30 years, 52% male, 48% were Dominican and 52% Haitian, 74% heterosexual. Among those with genotype, 8% (10 out of 127) had NNRTI SDRMs (Figure 1). A minority SDRMs, range of 1% to 20%, were found in the PI, NRTI and NNRTI. At the relaxed criteria, 17% of participants were in 8 clusters, ranging from 2 to 5 members. Those within clusters were less likely to be older, p=0.026 and more likely to be male, p=0029. Combination of current and prior dataset from the DO revealed 21 clusters, ranging from 2 to 6 members per cluster (Figure 2).

Conclusion
In the DO, NNRTI-associated TDR is increasing, aligning with the continued use of Efavirenz as first-line ART highlighting the need for an update in the national guidelines. Identification of minority mutations suggests need for TDR surveillance. Detection and response to clusters is a novel, effective modality to understand HIV transmission networks and address care gaps at individual and systems level.

Disclosures
All Authors: No reported disclosures
P-479. The Impact of the COVID-19 Pandemic on HIV Testing in Peru: An Interrupted Time Series Analysis from 2014 to 2022
Authors: Yrene-Cubas Robinson A , Perez-Castilla Jesus , Reynaga-Cottle Daniel E , Bringas-Queirolo Maria J , Soriano-Moreno David , Fernandez-Guzman Daniel , Gonzales-Zamora Jose A 
Published: January 2025

Abstract

Background
HIV testing is crucial for early treatment and mortality reduction. In Latin America and the Caribbean, 18% of individuals are unaware of their HIV status, which leads to a late diagnosis. Furthermore, COVID-19 lockdowns had a negative impact on HIV testing rates. This study focused on comparing pre-pandemic (January 2014-February 2020) and post-lockdown (August 2020-December 2022) testing rates to support effective HIV screening and public health strategies.Figure 1.Interrupted time series analysis for the frequency of HIV testing per quarter.

Methods
We performed an interrupted time series analysis with cross-sectional data from Peru's National Demographic and Health Survey (ENDES), covering 2014 to 2022. ENDES follows a complex, three-stage sampling method: proportional cluster selection, random household selection within clusters, and individual selection aged 15 or older for the health survey. A segmented regression analysis adjusted for age and gender evaluated changes in testing rates, with an ARIMA model providing counterfactual predictions against actual pandemic-period rates.Figure 2.Interrupted time series analysis for HIV testing.

Results
The study included 211,359 participants aged 15 to 49 years. There was a significant drop in HIV testing by 8.33% (95% CI: -10.73% to -5.93%, p&lt; 0.001) post-lockdown. Before the lockdown, HIV testing rates trend was increasing by 0.30% per quarter (95% CI: 0.21% to 0.40%, p&lt; 0.001); however, after the lockdown, they declined by -0.24% per quarter (95% CI: -0.56% to 0.09%, p=0.125) (Figure 1), with the most pronounced decrease among adolescents (15-17 years), the economically disadvantaged, those who lived in rural areas, and non-capital residents. The ARIMA model indicated a potential non-pandemic decline of -9.20% in testing proportions (95% CI: -13.70% to -4.80%) in comparison with the forecasted values (Figure 2).

Conclusion
COVID-19 lockdown policies markedly decreased HIV testing in Peru, especially affecting high-risk groups. Although limited by potential recall bias and self-reporting, this research, focusing primarily on individuals aged 15 to 49, provides essential data for targeted interventions to restore and ensure HIV testing accessibility post-pandemic.

Disclosures
All Authors: No reported disclosures
P-530. Clinician Utilization of CDC-aligned HIV PrEP Panels
Authors: Walworth Charles M , Gillim Laura , Alfego David , Aikins Ato 
Published: January 2025

Abstract

Background
In Dec 2021, the CDC issued updated guidelines for HIV PrEP. Diagnostic panels were developed to facilitate the baseline evaluation and monitoring of patients for HIV, STIs, HBV, and HCV among PrEP users.

Methods
Retrospective analysis of results reported for HIV PrEP panels ordered between Feb 2023 and Mar 2024. The panels were developed to capture HIV PrEP testing for baseline (BL) evaluation and for monitoring of oral and injectable agents in males and females. Tests were aligned with those recommended by the 2021 updated guidelines and included panels with and without HIV-1 RNA PCR. Standalone testing was also available. Testing intervals were assessed.

Results
31,347 unique patients had PrEP-related testing. Of those, 25,373 had one or more tests with 146 (0.6%) testing positive for HIV at baseline. 14,480 unique patients had two or more HIV PrEP tests on different dates. 98% were male with a median age of 36 years. 20 of those patients tested positive for HIV (0.14%). Of those, 15 tested positive for HIV Ag/Ab, but 14 were negative for HIV RNA. 5 patients were positive for HIV-1 RNA, but tested negative for HIV Ag/Ab. The HIV false positive rate was 0.25%. There were 5 HIV RNA positive tests out of 52,050 negative HIV Ag/Ab tests (0.001%). Testing closely adhered to recommended intervals for both oral and injectable agents. 15,041 out of 25,227 patients (59.6%) had an STI test during the analysis. 2,876 out of 15,041 patients had at least one STI during PrEP treatment (19.1%). Chlamydia was diagnosed in 5.8% and gonorrhea in 9.2%. 6.7% of patients were positive for treponemal antibodies with 5.1% RPR reactive. STI co-infections were also seen. Those with active HBV and HCV infections while on PrEP were each 0.3%.

Conclusion
In this large laboratory cohort of patients utilizing HIV PrEP testing, HIV infections were rare, supporting the low rates seen in HIV PrEP trials. Infections were mainly found at BL screening. False positive HIV Ag/Ab results were consistent with published reports. STI rates are significant with approximately 1/5 of patients testing positive, although active HBV and HCV infections were very low for those utilizing PrEP.

Disclosures
Charles M. Walworth, MD, Labcorp: Employee|Labcorp: Employee|Labcorp: Stocks/Bonds (Public Company) Laura Gillim, PhD, Labcorp: Employee|Labcorp: Stocks/Bonds (Public Company) David Alfego, PhD, Labcorp: Employee|Labcorp: Stocks/Bonds (Public Company) Ato Aikins, PhD, Labcorp: Employee