bluuebunny/crossref_metadata_2025_split huggingface dataset:
1500. Chest Computed Tomography in Respiratory Asymptomatic HIV patients
Authors: Muñeton Gerardo A , Perdomo-Fonseca Juan Pablo , Guevara-Plata Laura Lucia , Murcia Mariana Espinosa , Saenz Angie Tatiana , Lopez Santiago , Rueda Melissa , Vergara Hernan 
Published: November 2023

Abstract

Background
New HIV infections in Colombia are diagnosed in AIDS stage in 39% of cases. Some pulmonary infections are not diagnosed on time because of the absence of clinical findings, worsening the prognosis of patients. In this study we evaluate the usefulness of chest computed tomography in asymptomatic patients with HIV diagnosed with a CD4 count off less than 200cell/uL.

Methods
This was an analytical cross-sectional study in 2 third-level hospitals. We included patients diagnosed with HIV without respiratory symptoms and a CD4 count of less than 200 cell/uL, who where study with a chest computed tomography. We determined the proportion of anormal chest tomography, the percentage of patients going on additional tests and treatments and the definitive diagnostics found. The association between clinical and epidemiological findings with pathological alterations found in the chest CT scan was also explored.

Results
34 individuals were included. Abnormal CT scans findings were found in 18 of 34 (53%) patients. Two (5.8%) were classified as micronodular, 8 (23.5%) as nodular, 3 (5.8%) as consolidation, 2 (5.8%) as masses, 3 (8.8%) as ground glass opacities and 1 (3%) as pleural effusion. All of the patients with abnormal chest CT scan required one or more additional diagnostic tests or procedures. 8 (24%) patients received new treatments after CT scan findings and results of the additional diagnostic tests. In 6 (18%) of the patients a definitive diagnosis was possible, 2 cases of tuberculosis, 1 case of non hodgkin lymphoma, 1 case of Kaposi sarcoma and 2 cases of disseminated histoplasmosis. An association between clinical manifestations and specific chest tomography results was not found.

Conclusion
All HIV respiratory asymptomatic patient with CD4 count less than 200 cells/uL should be considered for chest computerized tomography scan, taking into account that at least 50% will have abnormal findings, 30% will require new treatments and 20% will have a definitive diagnosis that could not be possible to find without the chest tomography.

Disclosures
GERARDO A. MUÑETON, Infectious diseases and Internal Medicine Specialist, PFIZER: Advisor/Consultant
1502. Disseminated Mycobacterium-avium complex in People with HIV in México City: a Single-center, 23 year (1999-2022) Retrospective Cohort Study.
Authors: Hernández Alejandro Ortiz , Guerrero-Torres Lorena , Benavides Rodrigo Ville , Ventura Rafael Valdes , Caro-Vega Yanink-Nereid , Crabtree-Ramírez Brenda-Eloisa 
Published: November 2023

Abstract

Background
Despite universal access to combined antiretroviral therapy (ART) in Mexico since 2005, people with HIV (PWH) still present with late-stage complications due to delayed diagnosis and/or entry into care. Among these complications, disseminated Mycobacterium-avium complex infection (DMAC) remains a concerning issue given its high mortality and diagnostic challenges. Therefore, we aimed to describe the clinical and microbiological characteristics and outcomes of PWH with DMAC in a tertiary care center in Mexico City over a period of 23 years.

Methods
In this retrospective study, we reviewed all records of PWH attending our hospital from 1999-2022. We included adult PWH with any positive extra-pulmonary MAC-culture. We developed a standardized case report form and recorded sociodemographic, clinical, and microbiological characteristics. We followed patients until microbiological cure or death.

Results
We included 37 PWH diagnosed with DMAC infection, of whom 34 (92%) were men. Overall, 4 (11%) were diagnosed with DMAC before 2005 and 33 (89%) after 2005. The median age was 34 years (IQR 27-36 years). Following HIV diagnosis, mean time to diagnosis of DMAC was 14.2 months (IQR 1.6-11.3 months). At DMAC diagnosis, 12 (32%) patients were on ART and 25 (68%) were ART naïve. Fever was the most common presenting symptom, affecting 32 patients (86%). Mean time to microbiological diagnosis was 34 days. The most common sites for culture isolation were blood (76%) and bone marrow (70%). Anemia occurred in 34 patients (92%), followed by leukopenia in 23 (62%) and pancytopenia in 9 (24%). All patients required hospitalization, with 32 (86%) receiving DMAC-specific treatment and 5 (14%) dying before treatment initiation. Thirty-four patients (92%) received a clarithromycin-based regimen, 15 (41%) of patients developed IRIS. Overall mortality during follow-up was 51%, with 79% deaths occurring within the first year after DMAC diagnosis.

Conclusion
Despite universal ART access, DMAC remains a high-mortality AIDS-defining illness in Mexico City. Efforts must be made to promote HIV testing, early diagnosis, and entry into care.

Disclosures
All Authors: No reported disclosures
1504. Weight Gain and Weight Loss Attempts among People with HIV(PWH) in Louisiana
Authors: Richey Lauren , Schroeder Jonathan , Mistretta Kyle , Lin Hui-Yi , Arnold Connie , Welsh David , Apolzan John 
Published: November 2023

Abstract

Background
Weight gain is common among PWH. The Louisiana Translational Collaborative on Health Behaviors [LATCH] is a multi-center workgroup created to study modifiable health behaviors in PWH in Louisiana with participating HIV clinics in three cities: New Orleans, Baton Rouge, and Shreveport. We set out to characterize the BMI, weight gain, and weight loss attempts within this population.

Methods
PWH aged ≥ 18 y were recruited from three HIV clinics during regular appointments from 2019 to 2023. Participants completed standardized surveys that assessed weight gain/loss and methods used. Participants were divided into two groups: BMI &lt; 30 and BMI 30 and greater for analysis.

Results
106 PWH were enrolled as of Jan 2023. The average age was 51 y, most were African-American (81%), men (55%), and had a BMI &gt;25 (74%). Fifty-eight (55%) participants had a BMI &lt; 30, mean BMI and weight were 25 kg/m2 (range 17.9 to 29.8) and 75.6 kg, respectively. In the 48 people with obesity (45%), the mean was BMI and body weight was 38 kg/m2 (range 30 to 54) and 116 kg, respectively. Among the participants with a BMI &lt; 30, 45% reported weight gain in the last 12 months, 7% reported trying to lose weight, but 31% lost weight, with a mean weight loss of 12.5 pounds. Exercise, medical illness, and diet were the most common contributing factors in the weight loss for this group. Among participants trying to lose weight, the average weight loss was 14 pounds. Among participants with a BMI of &gt;30, 62% reported weight gain in the last 12 months, 27% reported trying to lose weight, but 40% lost weight, with an average of 23.7 pounds lost. Exercise and diet were the most common contributing factors in the weight loss for this group. Among participants trying to lose weight, the average weight loss was 26.7 pounds. No patients in either group reported weight loss surgery as a contributing factor in their weight loss.

Conclusion
In this study, most people with HIV in Louisiana had a BMI &gt;25 and reported weight gain in the past year. In the group with obesity, over a quarter reported trying to lose weight and those who tried had success. People with HIV and overweight or with obesity show encouraging outcomes when attempting weight loss, which may be critical in addressing the weight gain associated with first line HIV regimens.

Disclosures
John Apolzan, PhD, WW(Weight Watchers) Inc: Grant/Research Support
1505. Clinical characterization of TB/HIV naive coinfection patients enrolled in a TB program in Cali - Colombia.
Authors: Muñoz-Lombo Jenny Patricia , Llanos-Torres Julio , Rebellon-Sanchez David E , Montes-Tello Sofía Alexandra , García-Goez José Fernando , Rosso Fernando 
Published: November 2023

Abstract

Background
Although antiretroviral therapy (ART) is beneficial for patients with TB/HIV coinfection, there are issues associated with concomitant therapy administration such as overlapping drug toxicity profiles, drug interactions, and the possibility of developing immune reconstitution inflammatory syndrome (IRIS). The clinical experience in managing patients with TB who develop de novo HIV is poorly described in Colombia and the prevalence of IRIS in our context is unknown. This study aims to describe the clinical characteristics of patients with TB who develop de novo HIV coinfection and determine the prevalence of IRIS following treatment initiation.

Methods
Retrospective, observational study. Patients in the TB program whit de novo HIV coinfection were included.

Results
A total of 39 patients were included. Most of the patients were male (64%) and of mixed race (58%) with an urban origin (92%). Smoking was documented in 24% of the patients and the Bacille Calmette-Guérin (BCG) TB vaccine was recorded in 48% of the patients. Pulmonary TB occurred in 74% of the patients, while miliary TB and lymph node involvement occurred in 26%. Meningeal TB and CNS TB were present in 15% of the patients, peritoneal TB in 18%, and pleural TB in 5.1%. More than 70% of the patients experienced weight loss and dyspnea (74% and 76%, respectively). Antiretroviral treatment was administered to 46% of the patients with EFV-AZT/3TC, to 21% with LPV/R+ABC/3TC, and to 14% with EFV+TDF/FTC. Individualized tuberculosis treatment was administered to 38.48% of the patients. Of the patients, 19% (5/27) developed IRIS, of which three developed TB-IRIS. The mortality rate was 2.6%, while the cure rate was 18%.

Conclusion
our study sheds light on the clinical characteristics of patients with TB who develop de novo HIV coinfection in Colombia. The high prevalence of smoking and low prevalence of BCG vaccination among these patients are notable findings. Additionally, our study highlights the importance of individualized treatment for TB and the need for careful management of patients receiving ART to minimize the risk of developing IRIS. Further research is warranted to explore the prevalence of IRIS in our context and to develop strategies to reduce its incidence.

Disclosures
All Authors: No reported disclosures
1506. Prevalence of Histoplasma Antigenuria among an outpatient Advanced HIV cohort in Kampala,Uganda
Authors: Sekar Preethiya , Nalintya Elizabeth , Kwizera Richard , Mukashyaka Claudine , Niyonzima Godfrey , Namakula Olive Loryndah , Nerima Patricia , Fieberg Ann , Dai Biyue , Bahr Nathan C , Ellis Jayne , Meya David , Boulware David R , Rajasingham Radha 
Published: November 2023

Abstract

Background
Histoplasmosis is a major cause of mortality in persons with advanced HIV disease (CD4&lt; 200 cells/mcL) and areas of endemicity are evolving. Presenting symptoms of histoplasmosis may overlap with that of tuberculosis (TB). The true burden of histoplasmosis remains unknown in persons with advanced HIV disease, in part due to poor diagnostic capacity. We sought to evaluate the prevalence of Histoplasma antigenuria among outpatients with advanced HIV disease in Kampala, Uganda.

Methods
This prospective cohort study of outpatients with advanced HIV in Kampala, Uganda was nested within the ongoing ENCORE trial evaluating preemptive therapy and prophylaxis among outpatients with advanced HIV disease. Urine samples were obtained from participants at the time of enrollment and a Histoplasma galactomannan enzyme immunoassay (EIA) (Immy, Norman OK) was run on urine per manufacturer’s instructions. We obtained baseline characteristics and laboratory values, a statistical comparison by antigen status was not done due to a low number of positives. We calculated the prevalence of histoplasmosis in our cohort using EIA results. We obtained information on symptoms, TB diagnostics, and TB treatment for those with Histoplasma antigenuria.

Results
We tested 388 urine samples among participants with advanced HIV disease. Four samples were positive for Histoplasma antigen (1%). Baseline characteristics of participants are summarized in Table 1. Histoplasma antigen prevalence among participants with CD4&lt; 100 cells/mcL was 2.5% (4/158). Of those that tested positive for histoplasmosis, the median CD4 count was 39 cells/mcL (interquartile range (IQR): 16–54), and median CRP was elevated at 29 (IQR 14-46). All four participants with Histoplasma antigenuria had a positive TB urine lipoarabinomannan (LAM, AlereLAM, Abbott, Palatine, IL, USA), though only two of four participants reported symptoms of cough, weight loss, and/or physical weakness. Three of four participants with positive Histoplasma antigen were started on anti-TB treatment. Patient symptoms resolved with no intervention.

Conclusion
Among outpatients with severe advanced HIV disease with CD4&lt; 100 cells/mcL in Kampala, Uganda Histoplasma antigen prevalence was 2.5%.

Disclosures
All Authors: No reported disclosures
1513. Evaluating the Incremental Accuracy of HIV Self-Test Together with an App-Based Solution: A Secondary Data Analysis of Trial Data
Authors: Beecroft Ashlyn M , Duchaine Thomas , Engel Nora , Liang Chen , Esmail Aliasgar , Dheda Keertan , Pai Nitika 
Published: November 2023

Abstract

Background
According to the United Nations Programme on HIV/AIDS (UNAIDS), in 2019, two out of every seven new human immunodeficiency virus (HIV) infections, globally, were among young people aged 15 to 24 years old. HIV self-testing (HIVST) is a convenient strategy that helps increase knowledge of HIV serostatus in the young. In 2012, the Food and Drug Administration (FDA) approved the OraQuick In-Home HIV Test with a reported sensitivity of 92%. Digital supports such as applications (Apps) and websites, in conjunction with oral self-tests, have demonstrated a high feasibility, acceptability, and impact, yet data on accuracy with digital supports remain largely unexplored.

Methods
We performed a secondary data analysis of a quasi-randomized trial of oral HIVST with HIVSmart! conducted in South African township populations (2017-2019). We hypothesized that HIVSmart! guided interpretation increased test accuracy. We evaluated the diagnostic accuracy of the HIVSmart! guided interpretation of an oral self-test result against the reference standard (dual Elisa and HIV RNA). Stored picture of a self-test result was uploaded by the participants.

Results
Accuracy data from (n=1489) HIVST participants versus reference standard (2 rapid tests and HIV RNA) demonstrated:
Sensitivity: 95.52% (95% CI: 94.48%-96.56%)
Specificity: 99.93% (95% CI: 99.79%-100.00%)
Positive Predictive Value: 99.22% (95% CI: 98.78%-99.67%)
Negative Predictive Value: 99.57% (95% CI: 99.24%-99.90%)

Conclusion
With the App, we noticed an improved sensitivity to 95.5% (from 92% with self-tests without the use of the App), specificity high at 99%, together with high positive and negative predictive values. Findings demonstrate that Smart-App based digital interpretation removed subjectivity and increased accuracy of test result interpretation, together with recording and storage of data for monitoring purposes. Findings suggest that Smart-App based readers could be useful adjuncts to improve the accuracy estimations of self-tests, translating to increased trust and confidence in self-tests.

Disclosures
All Authors: No reported disclosures
1524. Racial and Gender Disparities in HIV Mortality: A population-based Retrospective Study in the United States from 1999 to 2020
Authors: Prince Monique A , Tan Min-Choon , Tan Min-Xuan , Prince E’ebony , Nicholas Rick , Shaaban Hamid , Slim Jihad 
Published: November 2023

Abstract

Background
Human Immunodeficiency Virus (HIV) has been historically associated with high mortality however, rates have declined with expanded access to antiretroviral therapy. It is important to identify and dissect inequities that contribute to mortality rates in individuals with HIV, which may help inform targeted interventions to improve treatment access in future decades. This study sought to determine the longitudinal trends in mortality attributed to HIV disease by race and sex.

Methods
We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database and performed serial cross-sectional analyses of national death certificate data for HIV-related mortality. HIV diseases (ICD-10 B20-B24, O98.7, R75) were listed as the underlying cause of death. We calculated age-adjusted mortality rates (AAMR) per 1,000,000 individuals and determined the trends over time by using the Joinpoint Regression Program. Subgroup analyses were performed by sex and race.Figure 1Demonstrates Age-Adjusted HIV Mortality Rate per 100,000

Results
In the 22-year study period, 210 921 HIV-related mortality in the United States were identified between 1999 and 2020. The AAMR from HIV-related mortality decreased significantly from 5.32 per 1,000,000 individuals in 1999 to 1.40 per 1,000,000 individuals in 2020 (p&lt; 0.01). Overall, men recorded a higher AAMR compared to women (4.66 vs. 1.65 per 1,000,000 individuals, p&lt; 0.01). African American individuals had the highest AAMRs (13.46 per 1,000,000 individuals) compared to White, American Indian, and Asian individuals (1.70 vs 1.65 vs 0.47 per 1,000,000 individuals). Similar decreasing trends were seen in all racial groups: African American men from 36.12 to 8.11 per 1,000,000 individuals, African American women from 13.13 to 3.54 per 1,000,000 individuals, White men from 4.91 to 1.36 per 1,000,000 individuals, and White women from 1.00 to 0.27 per 1,000,000 individuals.

Conclusion
The AAMR from HIV-related mortality has decreased significantly over the last two decades with significant racial and gender disparities. Men and African American individuals have higher AAMR from HIV-related mortality. This highlights the effectiveness of antiretroviral medications and emphasizes the need to improve the healthcare access among those underserved population.

Disclosures
Jihad Slim, MD, FACP, ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support
1525. Evolving Trends in HIV Transmitted Drug Resistance in Eastern North Carolina
Authors: Reddy Srinivas , Pierce Jacob , Bian Hui , Lebron Dora 
Published: November 2023

Abstract

Background
The impact of HIV/AIDS worldwide is an important public health challenge. One factor that contributes to increased HIV transmission is HIV drug resistance. This occurs from the intrinsic nature of HIV to mutate and eventually replicate in the presence of antiretroviral therapy. The effects of this are development of treatment failure and further transmission amongst cohorts in a given population. The problem of propagated drug resistance is further compounded in populations that present with problems of adherence. A previous study conducted at our institution demonstrated no association with race and transmitted drug resistance.

Methods
This is a retrospective study that evaluated treatment-naive HIV patients with genotype results from 2016-2020 at East Carolina University infectious disease clinic in Greenville, NC. We collected data on age, race, sex, HIV risk factor, and genotype. A logistic regression model was fit for transmitted HIV resistance with the following covariates: age, gender, race, year, and men who have sex with men (MSM) status. Individual comparisons were made by chi-squared testing for categorical variables or Wilcox ranked sum test for non-normally distributed continuous variables. All observations are presumed to be independent. All data analysis was performed in SAS (SAS Institute Inc., SAS 9.4, Cary, NC: SAS Institute Inc., 2002-2023).

Results
Of 305 charts reviewed, 245 were included in the analysis. Twenty-six (13.7% African-Americans) versus 14 (25.9% of other races) were found with transmitted drug resistance. Twenty four (16.4%) were MSM. The years with higher transmitted drug resistance detected were 2017-2019 (18.7%, 16.5%, 17.1%, respectively). African American race was found to be protective against transmitted resistance (OR 0.46, 95% CI 0.22-0.98, p = 0.04) when adjusting for MSM status, Sex, Age, and Year. The result was also significant in the unadjusted analysis (χ2 = 4.60, p = 0.03). Non-African Americans were 2.17 times more likely to have transmitted resistance than African Americans.Table 1:Patient Characteristics. Patient characteristics presented as proportion and percentage for categorical variables and median and standard deviation for continuous variables.Table 2:Adjusted logistic regression for variable effect on transmitted antiviral resistance

Conclusion
African American race was found to be protective against transmitted resistance (OR 0.46, 95% CI 0.22-0.98, p = 0.04) when adjusting for MSM status, sex, age, and year. This is a change from the results of our previous study.

Disclosures
All Authors: No reported disclosures
1526. Hospitalized Patients with HIV – Defining the Population and the Impact of Barriers to Care
Authors: Hatlen Timothy , Reynoso Giselle A , Fetters Kirk B 
Published: November 2023

Abstract

Background
Hospitalized people living with HIV (PLWH) with active viremia present a unique opportunity for addressing barriers to care (BTC) and optimizing 1-year outcomes. Large-scale interventions have had limited long-term success. We aimed to evaluate the role of pre-specified BTC to viral suppression at one year to guide local interventions.

Methods
We performed a retrospective cohort study at a safety-net hospital in Los Angeles County evaluating encounters of adult PLWH admitted between 2015 - 2020. We collected demographics, clinical characteristics, and 1-year outcomes based off baseline virologic status.

Results
A total of 361 encounters involving 234 patients were reviewed. Patients viremic at baseline (n=70) were more often Black, cis-men, severely immunocompromised and 73% reported at least one BTC (Table 1, Fig 1). At 1-year follow up, patients with baseline viremia or reporting multiple BTC regardless of baseline viral status were more likely to be viremic or lost to follow up (Table 2, Fig. 2).
Population characteristics based off insurance status and baseline virologic status
Data are n (%) or median (range). Categories may not add to 100% in cases of missing data. a – Based off first encounter; b - Encounters of patients with insurance though Department of Health Services or self-pay that have ability to follow up in the safety-net system included only; c – includes data for all patient encounters; d – other diagnoses include, but not limited to, chest pain, acute coronary syndrome, heart failure, diabetes with hyperglycemia, cerebrovascular event; c – excluding patients that died or discharged on hospice care; Suppressed – HIV-1 RNA &lt; 200 copies, ART – antiretroviral therapy; dx - diagnosis
One Year Outcomes based off Baseline Viral Status in the Insurance Linked Population
a – Encounters of patients with insurance though Department of Health Services or self-pay that have ability to follow up in the safety-net system included only; b – Chi Square suppressed versus viremic baseline; LTFU – lost to follow up; Suppressed – HIV-1 RNA &lt; 200 copies/mm3. Viremic – HIV-1 RNA &gt; 200 copies/mm3
Prevalence of barriers to care amongst PLWH suppressed or viremic at baseline

Conclusion
Hospitalized PLWH experiencing multiple barriers to care, regardless of baseline virologic control, are at higher risk for being viremic at 1-year and lost to follow up. These data can inform local interventions, i.e. enhanced post-discharge follow-up or social work involvement, and advocacy in this population.

LTFU – lost to follow up; 1yr – 1-year; #V – cumulative number of prespecified barriers to care. Suppressed Baseline defined as HIV-1 RNA &lt; 200 copies/mm3

Disclosures
All Authors: No reported disclosures