bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-446. Outcomes of Hospitalization due to Cryptococcal Meningitis in a High-Resource Setting, 2015-2022
Authors: Fetters Kirk B , Ziegenbein James C , Chow Erica , Hatlen Timothy 
Published: January 2025

Abstract

Background
There is a paucity of outcome data in high-resource settings for cryptococcal meningitis (CM) in persons living with HIV (PWH). Novel induction regimens, such as the first-line recommended regimen from the World Health Organization, may reduce the duration of hospitalization and drug-associated adverse events with similar treatment outcomes. However, these regimens were not compared to the standard of care used in high-resource countries, leading to a reluctance to change current practice. Randomized controlled trials to compare these strategies would be cost-prohibitive in high-resource settings. To work towards quality observational data on this subject, we sought to describe medication-related adverse effects (AE) and mortality of PWH hospitalized with CM at our institution.Table 1:Patient Characteristics

Methods
We retrospectively obtained all electronic medical records associated with inpatient encounters and an HIV diagnosis occurring between 2015-2022 at Harbor-UCLA Medical Center in Los Angeles County, California. We screened for discharge diagnoses of CM or the immune reconstitution inflammatory syndrome due to CM (CM-IRIS). We abstracted demographic, diagnostic, therapeutic, and outcome data from these patient records.Table 2:Diagnostics and Patient Outcomes

Results
Thirty-one PWH were hospitalized with CM and/or CM-IRIS for a total of 51 admissions. Of these, 26 (83.9%) were cisgender men, 3 (9.7%) were cisgender women, and 2 (6.5%) were transgender women. The median age was 36 years old (IQR 30-46), and 21 (67.7%) were of self-identified Hispanic ethnicity. The median time since diagnosis of HIV was &lt; 1 year (IQR 0-5.5). All patients were prescribed liposomal amphotericin B at 3-4mg/kg/day and flucytosine (5-FU) 100mg/kg/day for initial treatment. Fifteen (48.4%) patients failed to complete the 2-week induction, 10 (32.3%) due to AE. In-hospital mortality occurred in 4 (12.9%) patients, and 1-year mortality was documented for 7 patients (22.6%). Five patients (16.1%) had unknown status at 1 year.

Conclusion
We report a 1-year mortality of 22% in PWH hospitalized for CM in a high-resource setting compared to about 30-40% reported globally. However, 48% of patients were unable to complete induction, 32% due to adverse drug effects, emphasizing the importance of investigating the effectiveness of novel approaches to therapy.

Disclosures
All Authors: No reported disclosures
P-447. Anal Pap Smear Trends in Patients Living with HIV and History of Malignancy in a Single-Center Retrospective Observational Study
Authors: Rybolt Lauren E , Velez Ana , Shah Shivan , Pasikhova Yanina , Pardo Shylah Moore , Coghill Anna , Islam Jessica , Greene John 
Published: January 2025

Abstract

Background
The elevated rates of squamous cell carcinoma of the anus (SCCA) in persons living with HIV (PLWH) have led to greater awareness for screening with anal Pap cytology. While there is a premise that higher states of immunosuppression carry a greater risk of developing SCCA, no current studies describe this in the setting of PLWH with a history of solid or hematologic malignancy. The objective of this study is to review outcomes of anal Pap screenings in PLWH and a history of either solid or hematologic malignancies. With this study, we aim to outline potential risk factors associated with anal dysplasia in PLWH and a history of cancer.

Methods
This single-center retrospective cohort study included patients ≥ 18 years of age with a history of solid or hematologic malignancy who were followed at a cancer center clinic for HIV care between 2020-2024 and underwent anal Pap screening during this period. Demographics, pathology results, and clinical characteristics were obtained by chart review.

Results
The study identified 12 patients to date, with a mean age of 51 and male-to-female ratio of 5:1. Abnormal cytology on anal Pap was present in 83.3% (n=10) of patients with 50% (n=5) of these abnormal screenings resulting in either high-grade squamous intraepithelial lesion (HSIL) or atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion (ASC-H). Most with abnormal cytology on anal Pap underwent high-resolution anoscopy (HRA) (n=7/10). High-grade cytology was present on biopsy in 57.1% of patients (n=4/7). Invasive SCCA was found during HRA in 1 patient who had ASC-H on anal Pap screening. Table 1 outlines demographic information and clinical characteristics. Figure 1 demonstrates cytology results.

Conclusion
Over 75% screened had abnormal cytology, emphasizing the high incidence of anal dysplasia in this set of PLWH and a history of malignancy. The percentages of abnormal cytology in this population with a history of malignancy appeared to be higher than in other studies, implying chronic ongoing immune activation, although future work to expand the cohort is needed for robust estimation. These results should prompt further investigation to understand the potential interplay of HIV and malignancy history on the risk for developing anal dysplasia.

Disclosures
All Authors: No reported disclosures
P-452. Factors Associated with Liver Fibrosis Development in HIV-Monoinfected Patients Within the Modern ART Era
Authors: Endreson Morgan L , Hsieh Hsing-Chuan , Joya Christie , Colombo Rhonda E , Schofield Christina , Lalani Tahaniyat , Larson Derek , Yabes Joseph , O’Connell Robert , Blaylock Jason , Agan Brian , Ganesan Anuradha 
Published: January 2025

Abstract

Background
Liver fibrosis (LF) is a significant contributor to morbidity and mortality in people living with HIV (PLWH). Using data from the US Military HIV Natural History Study (NHS), we examined prevalence and risk factors of LF in the era of fixed dose combination antiretroviral therapy (ART).Table 1.Pertinent Participant Characteristics Categorized by the Presence or Absence of Liver Fibrosis:

Methods
The NHS is comprised of military beneficiaries with HIV, who are often diagnosed and treated early due to mandatory screening and guideline-based initiation of ART. We included ART-treated NHS participants, diagnosed after 2006, without active hepatitis B or C infection. LF was defined as a FIB-4 Index &gt;2.67, a validated, non-proprietary, readily available marker of LF based on age, platelets, and liver-associated enzymes. Risk factors examined included demographic, HIV-specific, and other recognized associations with LF, see Table 1 footnote for details. Participants characteristics were analyzed with either the Kruskal Wallis or Chi2 test. Cox proportional hazard models, adjusted for baseline and time-updated variables, were used to assess risk factors for developing LF.Table 2.Unadjusted and adjusted HR on liver fibrosis

Results
Among 1209 participants, followed for a median of 5.4 years, 60 (5.0%) met the criteria for LF. Overall, the median time to ART initiation was 2.4 months. The median time to LF was 2.5 years. At LF diagnosis the median age, CD4 count and viral load were 36 years, 526 cells/uL and 20 copies/mL respectively. Those with LF were older, had lower CD4 count and high VL at HIV diagnosis and more likely to initiate NNRTI based ART, table 1. In an adjusted model, LF was associated with female gender, hypertension, obesity, at risk drinking, and higher VL, while African American race, integrase strand transfer inhibitor (INSTI) use, and higher CD4 counts were protective, table 2.

Conclusion
In the contemporary ART era, in this young and promptly treated cohort, the prevalence of LF was 5%, suggesting liver-related morbidity remains an important concern. Our results underscore the protective effect of immune preservation (by timely initiation and continuation of ART) against LF; however, the observed protective association with INSTI-based regimens will need further study to determine long-term benefit. As observed previously, hypertension, at risk drinking, and obesity are modifiable risk factors that should be addressed.

Disclosures
All Authors: No reported disclosures
P-579. Putting our Heads Together: Multidisciplinary Approach to Persons Living with HIV with Unsuppressed Viral Load
Authors: Rothman Ryan , Oehler Cassandra , Bchech George , Moore Jasmine , hsiao Chiu-bin 
Published: January 2025

Abstract

Background
Advances in antiretroviral therapy such as the use of single tablet regimens, improvements in tolerability, medications with low resistance, and availability of long-acting injectable antiretroviral regimens have made HIV viral control an achievable goal for persons living with HIV (PWHIV), leading to a longer healthy life and significantly reduced risk of HIV transmission. However, there is a subset of patients (5-10% of PWHIV prescribed antiretroviral therapy) who have a persistently elevated viral load. We aimed to target these individuals for better HIV viral control.Figure 1:Barriers to HIV VL controlThe most common barriers encountered among the 38 patients discussed

Methods
We identified patients from 2019 to 2024 in our Ryan White funded clinic with uncontrolled HIV, defined as a viral load (VL) greater than 200 copies/mL. Patients were placed in three categories: high risk (persistent VL &gt; 200), vulnerable (inconsistent VL &lt; 200), or stable (consistent VL &lt; 200 for less than 2 years). We held weekly multidisciplinary meetings to discuss high risk and vulnerable patients and form an individualized plan of action. This plan was then discussed and enacted for each patient.Figure 2:Interventions geared to overcome the barriersThe most common interventions used among the 38 patients discussed to help overcome their unique barriers

Results
73 patients were identified who fit into one of the three categories, including 39 high risk, 15 vulnerable, and 19 stable. Thus far, weekly meetings have been held for 38 of them. Figure 1 portrays the most common barriers to VL control, with many patients having multiple barriers. Each patient’s barriers were then addressed, with the most common interventions illustrated in Figure 2. Thus far, 11 patients have moved from the high risk group to the stable group, and 3 patients have moved from the vulnerable group to the stable group. VL trend from these 14 patients are shown in Figure 3.Figure 3:Viral load over time for 14 patients with improved HIV viral controlLogarithmic graph of the viral loads over time for 14 patients who have moved from high risk or vulnerable to stable

Conclusion
By identifying patients who were unable to bring their HIV VL under control and holding weekly multidisciplinary meetings to discuss specific barriers, we have been able to bring many high risk patients down to VL &lt; 200. The most common barriers were related to mental health, substance use, and difficulty adhering to daily medications. The most common interventions were offering long-acting injectable regimens, increasing clinic visit frequency, and offering mental health support. We believe this multidisciplinary approach shows promise in decreasing the prevalence of unsuppressed HIV in clinical practice.

Disclosures
Chiu-bin hsiao, MD, Viiv, Gilead: Grant/Research Support
P-586. Weight Gain in Treatment Naïve Patients with HIV Prescribed with Integrase Strand Transfer Inhibitor (INSTI)
Authors: Ludden Thomas , Thomas Jeremy , Vaught Brianne , Meardon Douglas 
Published: January 2025

Abstract

Background
Advances in care for patients with human-immunodeficiency virus (HIV) have progressed significantly over the past few decades. Integrase strand transfer inhibitors (INSTI) are recommended as initial therapy for HIV treatment-naive patients due to virologic efficacy, tolerability, toxicity profile, and ease of dosing. Current guidelines suggest consideration of weight gain as a possible side effect. As with overall US population trends of increased incidence of obesity, this same trend is being seen in the rate of overweight/obese patients with a new diagnosis of HIV. In recent years, there has been increasing concern regarding weight gain specifically associated with antiretroviral therapy (ART). Prior studies have found that individuals who start or switch to a regimen containing certain integrase inhibitors or tenofovir alafenamide (TAF), especially in combination, are more likely to gain weight. Here we examine the treatment of naïve patients with INSTI by BMI classes (underweight/normal, overweight, and obese).

Methods
Baseline BMI and weight were collected for treatment naïve patients with HIV who were prescribed an INSTI. Patients taking medications considered to be beneficial for weight loss were excluded. Weight one year later (+/- 2 months) was collected and paired with the patient's baseline weight. Average weight change was summarized for all patients and patients in underweight/normal, overweight, and obese BMI categories.

Results
Overall, 220 patients who were prescribed INSTI began with an average weight of 83.9 kgs at baseline and increased to 86.8 kgs 1 year later with an average of 2.93 kgs ([95%] CI 1.385 – 4.484), P&lt; 0.001). For the 86 patients with underweight/normal BMI, weight increased by 3.12 kgs ([95%] CI 1.754 – 4.484), P&lt; 0.001). For the 72 patients with overweight BMI, weight increased by 2.30 kgs ([95%] CI 0.076 – 4.515), P=0.043). For the 62 patients with baseline BMI classified as obese, weight increased by 3.42 kgs ([95%] CI -1.17 – 8.016), P=0.141).

Conclusion
Treatment naïve patients with HIV prescribed with INSTI have statistically significant weight gain. These increases were also significant for patients with normal and overweight BMI at baseline but not for patients with a BMI classified as obese.

Disclosures
All Authors: No reported disclosures
P-608. Clinical Profile of GSK's Pentavalent Meningococcal ABCWY Vaccine: An Overview
Authors: Toneatto Daniela , Lattanzi Maria , Ypma Ellen , O’Brien Karen , Rubin Steven , Tomasi Cont Laura , Pedotti Paola , Sohn Woo-Yun 
Published: January 2025

Abstract

Background
GSK’s MenABCWY vaccine was developed to provide broad protection against invasive meningococcal disease by combining the antigenic components of the licensed 4-component meningococcal serogroup B vaccine (MenB-4C) and serogroups A,C,W,Y vaccine (MenACWY-CRM).

Methods
An overview of the MenABCWY vaccine’s profile was derived from its clinical development program of 12 controlled studies,1-10 which enrolled over 7000 adolescents and adults in 13 countries.

Results
For serogroup B (MenB), non-inferiority of MenABCWY (2 doses, 6 months apart) to MenB-4C (2 doses, 2 months apart) was demonstrated in a phase 3 study9 in terms of vaccine-induced bactericidal immune responses measured by endogenous complement human serum bactericidal antibody (enc-hSBA) assay. The enc-hSBA assay uses each vaccinee’s serum as source of complement and tests a panel of 110 MenB strains representing 95% of disease-causing isolates in the US and ∼89% of global circulating strains,11 and is thereby used to assess immunological vaccine effectiveness (iVE) in clinical studies, in conditions close to real-world settings. MenABCWY iVE was 78% (95% CI: 77–79) against the panel of 110 MenB strains; serum from 84% of participants killed ≥ 70% of strains.9 For serogroups A,C,W,Y, non-inferiority of MenABCWY (2 doses, 6 months apart) to MenACWY-CRM (1 dose) was demonstrated in phase 3 studies in MenACWY-primed10 and -naïve9 participants, with robust immune responses against each serogroup.9,10 Phase 2 data for all 5 serogroups show 2-year and 4-year antibody persistence5,8 and anamnestic booster responses2,5,8 at 2 years after primary MenABCWY vaccination, and similar immune responses with MenABCWY 0-6 and 0-11 months schedules.8 In phase 3, 1 MenABCWY dose was non-inferior to 1 MenACWY-CRM dose as booster in participants primed with MenACWY ≥ 4 years previously.10 The safety and reactogenicity profile of MenABCWY was favorable overall and consistent with that of MenB-4C.1-3,8,9

Conclusion
GSK’s combined MenABCWY vaccine is immunogenic, with demonstrated non-inferiority to MenB-4C and MenACWY-CRM vaccines, and a safety profile similar to that of MenB-4C.
FUNDING: GSK

Disclosures
Daniela Toneatto, MD, GSK: Employee|GSK: Stocks/Bonds (Public Company) Maria Lattanzi, MD, PhD, GSK: Employee|GSK: Stocks/Bonds (Private Company) Ellen Ypma, Msc, GSK: Employee Karen O’Brien, PhD, GSK: Employee Steven Rubin, PhD, GSK: Employee Laura Tomasi Cont, PhD, GSK: Employee|GSK: Stocks/Bonds (Private Company) Paola Pedotti, PhD, GSK: Employee|GSK: Stocks/Bonds (Private Company) Woo-Yun Sohn, MD, GSK: Employed by GSK|GSK: Stocks/Bonds (Private Company)
P-615. Knowledge, attitudes and practice towards routine vaccination among medical students, Kazakhstan, 2023
Authors: Balmagambetov Arystan , Zhuman Balaussa , Horth Roberta , Nabirova Dilyara 
Published: January 2025

Abstract

Background
In Kazakhstan, coverage for childhood immunizations has decreased in recent years. Healthcare workers have the ability to increase vaccine coverage if they are sufficiently trained and have correct knowledge, attitudes and practices (KAP) related to routine immunizations. To assess whether interventions are needed in pre-service medical training, we needed to understand current vaccine KAP in medical students.Table 1.Participant characteristics

Methods
We conducted a cross-sectional study among senior medical students in 3 universities in Karaganda, Astana and Almaty, from March to May 2023. We used multivariable logistic regression to test association with adequate knowledge, attitudes, and practices (KAP); threshold for adequate scores for questions in each domain was 70%. Adjusted odds ratios (OR) and 95% confidence intervals (CI) are reported.Figure 1.Factors associated with vaccine practice among medical students in Kazakhstan

Results
We interviewed 3,956 students: 1,716 (43%) in Astana, 1,313 (33%) in Almaty, and 927 (24%) in Karaganda. Of these, 74% were female, and 65% were 21-23 years old. Additionally, 89% were studying general medicine, 8% pediatrics, and 3% public health. Fewer than half (38%) reported having received training on vaccination. Adequate KAP scores were 11% for knowledge, 55% for attitudes, and 17% for practices. Most (74%) believed common myths about routine vaccinations, including 62% believing that the flu vaccine causes flu. Knowledge scores &lt; 70% were associated with attitude scores &lt; 70% (OR: 1.72; CI=1.37–2.17) and practice scores &lt; 70% (OR: 1.66; CI=1.30–2.11). Attitude scores &lt; 70% were associated with being male vs female (OR: 1.25; CI=1.07–1.47), living with anyone &lt; 18 years old vs not (OR: 1.37; CI=1.08–1.73), and living in Astana vs Karaganda (OR: 1.69 CI=1.41–2.03). Practice scores &lt; 70% were associated with living with anyone &gt;65 years old vs not (OR: 1.32; CI=1.03–1.72), Islam religion vs no religion (OR: 2.03; CI=1.65–2.50) and having attitude score &lt; 70% vs ≥70% (OR: 2.99; CI=2.45–3.66).

Conclusion
Our study revealed markedly low levels of correct KAP related to routine immunizations. These results demonstrate the need to increase training on vaccination among medical students, especially among pediatric and general medicine students who will be involved in immunizations. Trainings should address common myths about routine immunizations.

Disclosures
All Authors: No reported disclosures
P-616. Sociodemographic and Clinical Factors Affecting Vaccination after Pediatric Solid Organ Transplantation at Duke University
Authors: Blatt Adam , Chang Yeh-Chung , Wang Yunfei , Heston Sarah M 
Published: January 2025

Abstract

Background
Pediatric solid organ transplant (SOT) recipients are at increased risk for vaccine preventable illnesses (VPI). They frequently receive vaccines after transplantation when immunosuppressive medications and cytopenias may impact their immune response to routine childhood vaccines. Current guidelines recommend monitoring vaccine-specific serologies to ensure optimal vaccine responses and to guide the need for repeat doses.

Methods
In this single-center retrospective cohort study, a multivariate logistic regression model was used to determine the sociodemographic and clinical factors associated with delays in starting post-transplant vaccines and adherence to post-vaccine serologic monitoring among 199 pediatric patients who received a SOT at Duke University between 2014-2023. The prevalence of cytopenias at the time of post-transplant vaccination was also described.

Results
Out of 150 children eligible for post-transplant vaccines (Table1), 48 (32%) failed to start catch-up vaccines within 2 years of transplantation. Older children (OR=0.877, 0.83-0.927) and children with private insurance (OR=0.458, 0.211-0.993) had significantly decreased odds of early catch-up vaccines (Table 2). Hepatitis B serologies were obtained in 23% of patients after post-transplant vaccination, but titers against the remaining non-live childhood vaccines were only obtained in 1-8% of children (Table 3). Approximately 53% of all children had neutropenia or lymphopenia (less than 1500 x 10^6 cells/L) at the time of post-transplant vaccination, with heart and intestinal/multi-visceral transplant recipients having the highest rates at ∼75% (Table 4).

Conclusion
These findings identify pediatric SOT recipients most at risk for delayed post-transplant vaccines. The associations between vaccine delay and private insurance and older age warrant further investigation. The extremely low rates of vaccine-specific serologic monitoring and the high prevalence of cytopenias at the time of vaccination raise concerns that pediatric SOT recipients are insufficiently protected from VPI. Future work will determine the impact of cytopenias on vaccine response and will address inequities in vaccination among pediatric SOT recipients.

Disclosures
All Authors: No reported disclosures
P-618. Investigating the Relationship Between COVID-19 Vaccine Accessibility and Coverage in Seattle and King County
Authors: Bemanian Amin , Mosser Jonathan F 
Published: January 2025

Abstract

Background
The COVID-19 pandemic presented unique challenges for public health and healthcare organizations delivering novel vaccines. For pediatric patients, it was further complicated by a rolling timeline for authorization and differences in products based on the patient’s age. Previous research has shown that spatial accessibility can affect health service utilization. There has been limited literature regarding COVID-19 vaccine accessibility, especially in pediatrics. For this project, we calculated the spatial accessibility of the pediatric COVID-19 vaccine in King County, WA, USA and then investigated the relationship between COVID-19 vaccine accessibility with rates of vaccine uptake/coverage.

Methods
The study was a cross-sectional ecological analysis with data from July 2022. Publicly available data was used to identify locations of vaccine sites in King County, WA and find ZIP code tabulation area (ZCTA) level vaccination coverage rates. Spatial accessibility was calculated using an enhanced two step floating catchment area (E2SFCA) technique. Spatial regression analyses were done to measure the relationship between vaccine accessibility, coverage, and other socioeconomic and demographic variables.

Results
Higher rates of vaccine accessibility and vaccine coverage were found in adolescents (12-17-year-old) relative to school age children (5 to 11-year-old). Vaccine accessibility scores were higher in ZCTAs with higher rates of adult educational attainment. Vaccine accessibility was positively associated with coverage in the univariable analysis, and this relationship was found to be modified by ZCTA educational attainment in the multivariable models and stratified analysis.

Conclusion
This study demonstrates how COVID-19 vaccine accessibility can be calculated in a region. Additionally, this study showed the relationship between vaccine accessibility and coverage was affected by educational attainment and other socioeconomic factors. These findings may be helpful in planning distribution of future vaccines.

Disclosures
All Authors: No reported disclosures