bluuebunny/crossref_metadata_2025_split huggingface dataset:
1503. Impact of Sars-Cov-2 (Covid-19) in Patients Living with HIV from United States National Inpatient Sample Database
Authors: Patel Premalkumar M , Acosta Daniel , Vallabhaneni Esha , De Frias Fernando Poli , Singh Yavani , Lopez Christopher , Tuda Claudio 
Published: November 2023

Abstract

Background
The COVID-19 pandemic has raised concerns about the impact on those living with HIV/AIDS due to weakened immune systems. Disruptions to HIV services and medication supplies caused by the pandemic have also raised concerns about increased HIV-related illnesses and deaths. An inpatient sample database was used to investigate the impact of Covid-19 on HIV patients in the US by examining the clinical outcomes of Covid-19 patients with and without HIV in US hospitals.

Methods
The NIS database is a publicly available and extensive database that contains information on millions of hospitalizations in the United States. Using the NIS 2020 database, adult patients who were diagnosed with COVID-19 were identified and categorized based on their HIV status. In order to examine the NIS database, a variety of statistical approaches were employed, such as univariate and multivariate analysis, descriptive statistics, and regression analysis.

Results
A total of 11,080 hospitalized HIV-positive patients were diagnosed with COVID-19. Amongst them, 7,510 were male and 3,570 were female with 23.1% being Caucasian, 50.8% African American, and 19.3% Hispanic. 47% of the patients had a national median household income between 0-25th percentile. Geographically, 27.8% were from the northeast, 19.4% from the midwest, 44.4% from the south, and 8.4% from the west. The most common comorbidities were hypertension at 32.8%, diabetes mellitus with complications at 27.8%, chronic lung disease at 26.7%, obesity at 22.2%, hypothyroidism at 7.6%, drug abuse at 8.6%, and depression at 14.5%. The mean age for patients with HIV who contracted COVID-19 was 56 years with a length of stay (LOS) of 9.7 days and an economic burden of $27,566 in comparison to patients without HIV, who had a mean age of 62 years, LOS of 7.9 days, and cost of $21,553.
Data Analysis : Demographics
Data Analysis: Comorbidities
Data Analysis: Outcomes

Conclusion
In conclusion, hospitalized patients living with HIV, particularly African Americans, face a greater risk for adverse outcomes from COVID-19, which results in increased healthcare utilization. This underscores the need for safeguarding vulnerable populations and monitoring infectious disease spread. Further research is needed to better understand how COVID-19 affects different demographics and how to address their healthcare needs during pandemics.

Disclosures
All Authors: No reported disclosures
1511. Sociodemographic and epidemiological factors related to the acceptability of telemedicine among patients for HIV care in four hospitals in the city of Buenos Aires
Authors: Acosta Maria C , Kierszenowicz Tomas , Acosta Maria Cecilia , Rolon Maria Jose , Cabrini Mercedes , Cecchini Diego , Rodriguez Claudia Gabriela , Scapellato Pablo , Bottaro Edgardo Gabriel , Losso Marcelo H 
Published: November 2023

Abstract

Background
In October 2020, a research consortium by four HIV and infectious diseases units of general acute public hospitals of Buenos Aires city began an implementation study aimed to analyze obstacles and facilitators of telemedicine (TM) in the care of people living with HIV(PLHIV). TM visits were conducted through phone or videocalls

Methods
This research aims to assess the association of sociodemographic and epidemiological factors and the willingness of HIV patients to continue with TM after the sequelae of COVID-19. We prospectively collected quantitative data from medical records and distributed an anonymous semi-structured survey to participants after their first TM visit, collecting data on willingness to continue with this strategy and sociodemographic characteristics. We included all the participants who answered the survey. The data was stored in the Redcap® platform. Continuous data are shown as medians with interquartile range (IQR) and were compared using the Wilcoxon test. Categorical data are described as percentages and compared using the chi-square test. We use R® software

Results
The survey was delivered to 4118 patients who had their first remote visit between October 2020 and October 2022. 1.871 patients (45%) responded the survey. 1.085 (58%) were cisgender men. The median age was 47 years (IQR: 37-54). 1.221 (65%) would like to continue with this strategy, while 618 (33%) would not. 32 (2%) did not respond. 1102 (90%) patients willing to continue TM had wireless access at home and 544 (88%) unwilling to continue had wireless access. Among those who were willing to continue using TM, the proportion of people with viral suppression was 88.6%, while among those who were not willing to continue using TM, the proportion was 87.1%. The median CD4 count was 639 (IQR: 442.5-907) for those who wanted to continue and 657 (423-917) for those who did not

Conclusion
In this adult cohort of PLHIV receiving TM care in public facilities in the city of Buenos Aires, two-thirds of those who answered the survey were willing to continue with this strategy after the COVID-19 crisis. When comparing participants willing or unwilling to continue TM in the future, both groups were similar in terms of age, gender, proportion of participants with wireless access at home, CD4 count and viral suppression

Disclosures
All Authors: No reported disclosures
1520. Exploring the factors linked to prior HIV testing and schistosomiasis treatment in Malawi.
Authors: Kangogo Geoffrey K 
Published: November 2023

Abstract

Background
Fishing exposes fishermen to schistosomiasis-infested fresh water and concurrently through precarious livelihoods to risky sexual behaviour, rendering these two infections occupational hazards for fishermen. This study aimed to characterize the knowledge of the two conditions to obtain necessary data for a subsequent cluster randomized trial designed to investigate demand creation strategies for joint HIV-schistosomiasis service provision in fishing villages on the shores of southern Lake Malawi.

Methods
Enumeration of all resident fishermen was carried out from 2019 to 2020. The fishermen reported their knowledge, attitudes and practices in the uptake of HIV and schistosomiasis services. Knowledge of HIV status, previous receipt of praziquantel and willingness to attend a beach clinic were modelled using random effects binomial regression, accounting for clustering.

Results
A total of 6,297 fishermen were surveyed from the 45 clusters with harmonic mean number of fishermen per cluster of 112 (95% CI: 97; 134). The mean age was 31.7y (SD: 11.9) and nearly 40% (2,474/6,297) could not read or write. Overall, 1,334/6,293 (21.2%) had never tested for HIV, with 64.4% (3,191/4,956) having tested in the last 12 months, and 5.9% (373/6290) taking antiretroviral therapy (ART). Only 40% (1,733/4,465) had received praziquantel in the last 12 months. Every additional year of age was associated with 1% decreased likelihood of having taken praziquantel (aRR: 0.99, 95% CI: 0.98-0.99, p&lt; 0.001). However, recent HIV testing increased the likelihood of taking praziquantel (aRR 2.24, 95% CI: 1.93-2.62, p&lt; 0.001).

Conclusion
In a setting with an underlying high prevalence of both HIV and schistosomiasis, we found low knowledge of HIV status and low utilization of free schistosomiasis treatment. Among fishermen who accessed HIV services, there was a very high likelihood of taking praziquantel suggesting that integrated service delivery may lead to good coverage.

Disclosures
All Authors: No reported disclosures
1522. Predictors of Weight Gain in People Living with HIV
Authors: Pedersen Karen B H , Poulsen Susanne Dam , Benfield Thomas 
Published: November 2023

Abstract

Background
Highly effective antiretroviral therapy (ART) and longer life expectancy in people living with HIV (PLWH) has led to increased incidence of lifestyle associated risk factors including overweight and obesity. ART is considered to play an important role in this tendency. Excess weight gain has been reported in PLWH treated with and integrase strand transfer inhibitors (INSTI). For nucleoside/nucleotid reverse transcriptase inhibitor (NRTI) backbone components tenofoviralafenamid (TAF) is associated with higher weight gain compared to tenofovir disoproxil (TDF) and abacavir (ABC). This study aims to investigate ART as predictors of weight gain in a prospective cohort using a target trial emulation.

Methods
The protocol for the target trial was established to evaluate the impact of baseline backbone treatment and various third components on weight gain over a 2-year follow-up period using the Copenhagen Co-Morbidity in HIV Infection Study (COCOMO) cohort. Data was collected from March 2015 to December 2016 in the Capital Region of Denmark. Adult PLWH were included. Subjects were divided into four different treatment groups according to their backbone components: Lamivudine/emtricitabin (XTC)/TDF, XTC/ABC, XTC/TAF or “other”. Regression standardization was applied to the linear regression outcome adjusted for relevant confounders.

Results
In total 704 subject were included in the analysis. Overall median weight gain in the 2-years follow up period was 0.7 IQR[-22.4, 26.0] with the largest weight gain in subjects with XTC/TDF at baseline (median 1.0 IQR[-12.6, 26.0]). Regression standardization of the adjusted linear regression model showed no significant difference in weight gain between backbone groups. In the third-component analysis including subjects with XTC/TDF or XTC/ABC backbone, subjects receiving an integrase inhibitor based regimen at baseline tended to have a 0.75 kg higher weight gain compared to NNRTI- and PI-based regimens, but this was not significant S.E. 0.474, (0.17;1.67 95%CI).

Conclusion
The results suggest that while antiretroviral therapy may contribute to weight gain, the choice of backbone components may not be a significant predictor. Further studies are needed to confirm these findings.

Disclosures
All Authors: No reported disclosures
1528. Retrospective cohort study of factors associated with non-initiation of antiretroviral therapy among adults newly diagnosed with HIV in Andijan, Uzbekistan, 2018-2021
Authors: Usmanov Shokhruh , Horth Roberta , Denebayeva Alfiya , Gazezova Saya , Zikriyarova Sanam , Kurbanov Botirjon , Nasirova Feruza , Nabirova Dilyara 
Published: November 2023

Abstract

Background
Immediate uptake of antiretroviral therapy (ART) by people newly diagnosed with HIV reduces morbidity and viral transmission. Since 2018, in Uzbekistan people newly diagnosed with HIV are immediately offered ARVs, but just over half of people living with HIV are estimated to be on ART. To reach global targets, we assessed factors associated with ART non-initiation.

Methods
We conducted a retrospective cohort study using secondary data from Andijan Region Republican AIDS Center. Our study included all people 18 years of age and older newly diagnosed with HIV between January 1, 2018, and June 31, 2021. We analyzed sociodemographic and behavioral factors associated with non-initiation of ART, defined as not having initiated ART by December 31, 2021. Using multivariable analysis, we calculated risk ratios (RR) and 95% confidence intervals (CI).

Results
From 2018 to 2021 in Andijan Province, 1,098 people were newly diagnosed with HIV, of which 113 (10.3%) did not initiate ART. Participants were mostly 30-49 years old (49%), male (56%), married (46%), and with secondary education (74%). Also, 39% and 31% had HIV clinical stage I and II, respectively. Risk for non-initiation was higher among people with secondary education (RR=8.6 [CI: 1.2–60.9]) compared to higher education, with multiple partners (RR=2.7 [1.5-5.0]), with disease stage I (RR=3.3 [2.0–5.2]) and stage II (RR=4.4 [2.8–7.0]). People with sexual partners living with HIV had higher risk of non-initiation (RR=1.8 [1.2–2.9]) than people with partners that did not have HIV. Being single was associated with reduced risk of non-initiation (RR=0.1 [0.03–0.3]).
Factors associated wtih initiation of ARV treatment among people newly diagnosed with HIV, Uzbekistan

Conclusion
People with multiple partners and with partners living with HIV should be prioritized for ART initiation support. Increased risk of non-initiation among people in non-symptomatic or mild disease stages earlier disease stages points to the need for interventions to increase awareness of test-and-start among providers.

Disclosures
All Authors: No reported disclosures
1554. Facilitators and Barriers to Engaging in PrEP and Gender Affirming Therapy for Black and Latina Transgender Women in South Florida
Authors: Silvey Rebe , Rosas Yesenia , Ellick Kecia L , Johnson Ariana , Craker Lacey , Lewis Susanne Doblecki , Cunningham Suzanne Randolph , Rehman Aliya F , Kanamori Mariano , Beauchamps Laura 
Published: November 2023

Abstract

Background
Black and Latina transgender women (BLTW) have the highest HIV rates among transgender women (Black: 62%, Latinx: 35%). PrEP-GAT is an EHE grant which evaluated barriers and facilitators to engagement in PrEP and gender affirming therapy (GAT) services and the use of friendship networks to promote these interventions.

Methods
Participants were recruited through the University of Miami’s GenWell Service, which provides bundled PrEP and GAT. This study has two components: qualitative and social networks. Qualitative component: 20 in-depth interviews focused on barriers and facilitators to PrEP and GAT services using Consolidated Framework for Implementation Research (CFIR) constructs. Data was analyzed using thematic analysis. Social network component: 27 social network-based interviews identified friendship dynamics that could promote conversations and encouragement to engage with PrEP and GAT. Analysis included multilevel logistic regression using R and network visualizations using UCINET.

Results
Qualitative Component. Barriers to accessing PrEP and GAT services included cost, need for Spanish-language materials, bias, stigma, and discrimination. Facilitators included access to telehealth, mobile services, pharmacists, and co-located PrEP-GAT services. BLTW were not comfortable disclosing their HIV status due to HIV stigma. “HIV clinics” discouraged individuals from seeking services. Social network component: most participants were using GAT (75%), and more than half reported lifetime PrEP use (56%). Bivariate analysis: having a Latinx friend, a friend who shared GAT status, and higher emotional closeness were associated with future conversations about PrEP and GAT (p&lt; 0.05). Multilevel model: emotional closeness was associated with future conversations about PrEP and GAT (p=0.02).

Conclusion
Mental health, legal, employment and housing services are needed to meet BLTW access to PrEP. Social network approaches can identify key individuals in BLTW friendship networks to promote and disseminate information about PrEP and GAT.
Future Directions: Future research will determine whether bundled PrEP-GAT, social network support, and telehealth is effective to increase BLTW’s engagement in these services.

Disclosures
Susanne Doblecki Lewis, MD, MSPH, FIDSA, Gilead Sciences: Grant/Research Support|Janssen: Grant/Research Support|Merck: Grant/Research Support
1589. Real-World Outcomes with Cabotegravir/Rilpivirine: Does Duration of Pre-treatment Viral Suppression Matter?
Authors: Mesa Daniel , Neha Pandit , Ryscavage Patrick , Schmalzle Sarah 
Published: November 2023

Abstract

Background
The efficacy and safety of long-acting injectable, cabotegravir/rilpivirine (CAB/RPV), was established in people with HIV (PHIV) on a stable oral antiretroviral (ART) regimen with viral suppression ≥ 6 months prior to CAB/RPV initiation and with no history of treatment failure. Given the design of the CAB/RPV clinical studies, there have been varying recommendations for its initiation in real-world settings due to the lack of data in patients with either incomplete, or shorter duration of pre-treatment viral suppression. The objective of this study was to describe virologic outcomes among patients on CAB/RPV based on duration of pre-treatment viral suppression.

Methods
This was a single-center, retrospective, observational study of PHIV initiated on CAB/RPV at an HIV clinic in Baltimore, MD, between Jan 2021-Dec 2022. Patients were stratified by duration of viral suppression prior to CAB/RPV initiation. Viral suppression was evaluated at weeks 8-24 post CAB/RPV initiation and stratified by body mass index (BMI), baseline drug resistance, and CAB/RPV dosing frequency.

Results
A total of 78 patients were included in this study. The mean age was 47 years, 41% were female at birth, and 92% were Black/African American. At weeks 8-24, 62 patients had HIV RNAs available with 87% (54/62) having achieved viral suppression (&lt; 50 copies/ml). Viral suppression was achieved in 94% (n=33/35), 67% (2/3), and 78% (18/23) of patients who had been virologically suppressed for &gt; 12 months, 6-12 months, and 0-6 months, respectively. Of the 8 patients that did not achieve viral suppression, 6 were able to suppress on CAB/RPV between 125-364 days, 1 had no subsequent HIV RNA result available, and 1 discontinued treatment due to increase in HIV RNA but had been durably suppressed for over 12 months prior to CAB/RPV initiation. We found no differences between viral suppression on CAB/RPV and BMI, baseline mutations, and dosing frequency.

Conclusion
Virologic outcomes did not differ based on duration of viral suppression prior to initiation of CAB/RPV. Though larger studies should be completed, long-acting CAB/RPV has remained effective in patients with variable durations of pre-treatment viral suppression and in patients who did not have viral suppression prior to switch.

Disclosures
All Authors: No reported disclosures
1609. Engagement in Care, Awareness, and Interest in Long-Acting Injectable Anti-Retroviral Therapy
Authors: Stout Jacob , Allamong Maxwell , Hung Frances , Link Katherine , Chan Cliburn , Muiruri Charles , Sauceda John , McKellar Mehri 
Published: November 2023

Abstract

Background
Long Acting Injectable (LAI) therapy to treat HIV is now a viable alternative to daily oral medications. The success of early roll-out of LAI to eligible patients requires a better understanding of patients’ awareness and interest in this novel therapy.

Methods
We administered an electronic survey to patients attending an urban HIV clinic in the US South (Duke University). Eligible participants were 18+ years old with a most recent HIV-1 viral load &lt; 200 copies/ml, without any evidence of genotypic resistance to LAI components or chronic hepatitis B. Survey recipients were asked questions on their current treatment, their awareness and interest in LAI, and were asked to rate common benefits and concerns associated with LAI. After probing awareness of LAI, patients were provided further details on LAI for consideration for the rest of the survey. The survey also included the 3-item Brief Index of Engagement in HIV Care, a patient-reported measure of engagement in HIV care that has predicted future retention in care outcomes.

Results
Between January-April 2023, 480 patients were screened; 319 were found to be eligible, and 159 (50%) completed the survey. 73% were male; 44% Black, 7% Latinx; mean age was 49. The majority (119, 76%) were aware of injectable treatments, and 87 (56%) were interested in LAI. Among proposed benefits of injectables, ease of travel without pills, fewer medication interactions, and lack of daily pill-taking were most appealing. Among proposed concerns with injectables, out of pocket cost and insurance coverage of the new medicine were most worrisome. Black patients were more likely to be interested in LAI, and interested patients tended to be younger, single, and more recently diagnosed with HIV. Overall, patients surveyed were highly engaged in care (Mean 4.5/5, SD: 0.5)., but engagement was not predictive of awareness or interest in LAI.
This table summarizes and compares the key patient characteristics between the patients who rated themselves interested or not interested in LAI

Conclusion
As we roll out LAI in real world settings, it will be helpful to characterize which patients are most interested in order to optimize uptake and benefit. Ease of travel without pills, not having to remember daily doses, and fewer medication interactions were the most appealing reasons, while concerns about both insurance coverage and out of pocket cost will need to be addressed.

Disclosures
Mehri McKellar, MD, Gilead Sciences, Inc: Grant/Research Support
1623. Assessing Clinical Evaluation and Patterns of Treatment in Nationally Reported Cases of Congenital Syphilis in Liveborn Infants – United States, 2016–2021
Authors: O’Callaghan Kevin P , Jones Michelle L Johnson , Jackson David A , Torrone Elizabeth 
Published: November 2023

Abstract

Background
Congenital syphilis (CS) rates have increased in the United States since 2013. Management of infants exposed to syphilis during pregnancy entails a detailed clinical evaluation, followed by stratified work-up and treatment.

Methods
During 2016─2021, 9,827 surveillance cases of CS were notified to the National Notifiable Diseases Surveillance System. Using the clinical framework described in the 2015 CDC Sexually Transmitted Diseases Treatment Guidelines, we assigned a clinical scenario (Proven or Highly Probable CS, Possible CS, CS Less Likely, and CS Unlikely) to 8,280 liveborn cases which had sufficient data for case classification (Figure 1). Based on data documented in the case report, we described the elements of evaluation and therapy provided to neonates, assessing whether they met, were in excess of, or were less extensive than recommendations, and stratified these findings by race, ethnicity, and geography.

Results
Of the 8,280 surveillance cases which were assigned a clinical scenario, the majority (80.9%) were classified as Possible CS, of whom 60.7% received an appropriate evaluation, while 68.4% received appropriate treatment. Of those assigned to Proven or Highly Probable CS, 46.0% received an appropriate evaluation, while 82.3% received appropriate treatment.
By U.S. census region, infants born in the Northeast were most likely to receive evaluation (75.7%) and treatment (87.3%) at or above recommendations for their case scenario, while infants born in the South were least likely to receive at or above recommended evaluation (49.5%) and treatment (59.3%). Infants born to a birth parent reporting non-Hispanic Native Hawaiian/Pacific Islander race were most likely to report less than recommended evaluation (36.7%), while infants of a non-Hispanic Black birth parent were most likely to experience less than recommended treatment (32.2%).

Conclusion
This analysis of CS clinical scenarios underscores disparities in evaluation and therapy across geographic, racial, and ethnic lines. Further research is needed to understand factors involved in the evaluation and treatment of infants affected by CS, particularly for those born in the South and to birthing parents reporting minority racial and ethnic backgrounds.

Disclosures
All Authors: No reported disclosures