bluuebunny/crossref_metadata_2025_split huggingface dataset:
1498. Geographic differences in weight change on dolutegravir: a prospective cohort study
Authors: Chen Geoffrey , Migisha Richard , Muyindike Winnie R , Aung Taing N , Nanfuka Victoria , Komukama Nimusiima , Chandiwana Nomathemba , Shazi Gugulethu , Moosa Mahomed-Yunus S , Gupta Ravindra K , Pillay Deenan , Marconi Vincent , Hedt-Gauthier Bethany , Francois Venter W D , Siedner Mark J , McCluskey Suzanne M , Manne-Goehler Jennifer 
Published: November 2023

Abstract

Background
People with HIV (PWH) on integrase inhibitors may be at increased risk of excess weight gain, but it is unclear if this risk is consistent across settings. Our study objective was to compare weight change over 48 weeks among PWH in Uganda and South Africa.Figure 1.Mean weight change (kg) over 48 weeks among DISCO participants overall (A), among men (B), and among women (C).

Methods
The Population Effectiveness of Dolutegravir Implementation in Sub-Saharan Africa (DISCO) study is a prospective observational cohort of PWH in routine clinical care at public-sector HIV clinics in Uganda and South Africa. Inclusion criteria were as follows: PWH &gt;18 years old, on NNRTI-based first-line ART for &gt;6 months, and switched to tenofovir disoproxil fumarate, lamivudine, and dolutegravir) by clinic staff. We measured the primary outcomes of weight (in kilograms [kg]) and waist circumference (WC, in centimeters [cm]) at enrollment, 24 weeks, and 48 weeks after switch. The primary outcomes were (1) weight change (kg) and (2) change in WC (cm). We used a linear mixed-effect regression model, adjusted for age, sex, education, duration on ART, and the interaction of study site and visit, to estimate weight.

Results
428 individuals in Uganda and 387 in South Africa had data available. The mean weight change over 48 weeks was 0.6 kg [95% CI: 0.1-1.0] in Uganda compared to 2.9 kg [2.4-3.4] in South Africa (p&lt; 0.001); men had significantly smaller mean weight changes than women did in both countries (Figure 1). After adjustment, PWH in South Africa gained significantly more weight than those in Uganda. In participants with available waist data (277 in Uganda and 402 in South Africa), the mean change in WC was significantly greater among those in South Africa (2.3 cm [1.4-3.2]) than those in Uganda (0.8 cm [0.0-1.5]) (p&lt; 0.017).

Conclusion
PWH in South Africa experienced greater weight gain than in Uganda, suggesting substantial heterogeneity in this risk across settings. Strategies to address obesity risk in PWH should account for regionality.

Disclosures
W D Francois Venter, MD, FCP, PhD, Gilead Sciences: Grant/Research Support|South African Medical Research Council: Grant/Research Support|Unitaid: Grant/Research Support|USAID: Grant/Research Support|ViiV Healthcare: Grant/Research Support Mark J Siedner, MD, MPH, Viiv Healthcare: Grant/Research Support
1499. Tesamorelin Reduces Visceral Adipose Tissue and Liver Fat in INSTI-Treated Persons with HIV
Authors: McLaughlin Taryn , Grinspoon Steven K , Stanley Takara , Fourman Lindsay 
Published: November 2023

Abstract

Background
Significant attention surrounds the recent observation of weight gain in persons with HIV (PWH) initiating integrase inhibitors (INSTIs). Given the finding that visceral adipose tissue (VAT) is a critical component of this weight gain, the clinical implications of this weight gain are a growing concern, since VAT has been associated with downstream comorbidities including non-alcoholic fatty liver disease (NAFLD). Tesamorelin, a growth hormone releasing hormone analogue, has been shown to reduce VAT by over 15% in 6 months in PWH with lipohypertrophy. Therefore, we sought to investigate if tesamorelin could reduce VAT and liver fat in PWH on INSTI-containing regimens.

Methods
To do this, we leveraged data from a previous placebo-controlled trial of 61 participants with HIV-associated NAFLD. Measurements of body composition and hepatic fat fraction (HFF) were taken at baseline and after 12 months of treatment. Post-hoc analyses were performed to evaluate changes in body composition amongst individuals receiving INSTIs.

Results
Amongst participants, 39 (64%) were on INSTI containing regimens, the most common of which was dolutegravir (41%). These individuals were largely similar at baseline to those on regimens without INSTIs. Interestingly, although anthropometric measurements at baseline did not differ between the two groups, at 12 months, there were marked changes in VAT amongst the INSTI group. After 12 months, there was a significant difference in VAT change between the placebo and tesamorelin treated groups (p=0.0034). The placebo group had an increase in VAT of 10.8% whereas the Tesamorelin treated group had an overall reduction in VAT of 8.3%. Furthermore, the tesamorelin treated group saw a 31% relative reduction in HFF compared to baseline (p=0.006) which was significantly higher than in the placebo treated group (T:-4.9%, P:-0.1% absolute change p=0.015).

Conclusion
These data reinforce the impact of INSTIs on VAT, body composition, and concomitant organs in PWH. It also demonstrates the potential for tesamorelin as a strategy to reduce VAT and HFF amongst individuals with INSTI-associated VAT accumulation.

Disclosures
Taryn McLaughlin, PhD, Theratechnologies, Inc: Employee Steven K. Grinspoon, MD, Theratechnologies: Grant/Research Support Takara Stanley, MD, Pfizer, Inc: Grant/Research Support Lindsay Fourman, MD, Amryt Pharmaceuticals: Advisor/Consultant|Amryt Pharmaceuticals: Grant/Research Support
1507. The Yield and Correlates of Mandated Annual Screening for Chlamydia Trachomatis and Neisseria Gonorrhea in People Living With HIV in a Large Federally-Funded Clinical Cohort
Authors: Suryadevara Madhu , Bishburg Eliahu , Hogan Dennis 
Published: November 2023

Abstract

Background
Gonorrhea (GC) and Chlamydia (CT) screening is part of the requirement for grantees of the Ryan White funding of HIV clinics. Tests are required to be done at least once yearly. Testing is required to all patients regardless of age or sexual activity.
Our aim was to assess the yield of GC/CT screening in patients living with HIV (PLWH) in an inner-city HIV clinic.

Methods
Retrospective Chart Review over a 10-year period (2013-2023). Data was collected for demographics, sexual history, HIV Viral Load (VL), CD4 count, syphilis serology, GC/CT urine probe results using nucleic acid amplification testing (Amplicor PCR and Aptima TMA), treatment when infection was diagnosed and outcome.

Results
1120 unique patients were identified, a total of 5050 GC/CT tests were analyzed. Median age of GC/CT (-) pts. was 53.6 yrs. with a range of 21-90 yrs. Positive GC/CT tests was found in 43 pts of whom 28/43 (65%) males, 42/43 (97.6%) were African American. These 43 patients had 56 tests with a positivity rate of 56/5050 (0.01%). Median age of GC/CT (+) pts. was 33.7 yrs. Age range of positive pts. was 21-65 yrs. GC (+) only tests in 13/56 (23%), CT (+) only tests in 43/56 (76.7%). Both GC (+) and CT (+) co-infection in 3/43 (6.9%). Positive syphilis serology concomitant with GC/ CT(+) in 5/43 (11.6%). In the GC/CT (+) group, median VL 43.5 copies/mL and median CD4 534.5 cells µL. 30/43 pts. had undetectable VL. All GC+/CT+ pts. were successfully treated with post treatment negative test documented in all but 1 non adherent patient. All patients were sexually active. 7/43 with prior Sexually Transmitted Disease (STD).

Conclusion
Yield of screening for GC/CT in our clinic was very low. Younger patients had higher positivity rates compared to the elderly. Routine screening for these infections should be targeted at younger patient who are sexually active and/or symptomatic.

Disclosures
All Authors: No reported disclosures
1508. The effects of the COVID-19 pandemic on depression severity and viral load non-suppression among people with HIV accessing care in an urban infectious disease clinic in Baltimore, MD
Authors: Verinumbe Tarfa , Lesko Catherine , Moore Richard , Fojo Anthony , Keruly Jeanne , Snow LaQuita N , Pytell Jarratt , Falade-Nwulia Oluwaseun 
Published: November 2023

Abstract

Background
The COVID-19 pandemic heightened concerns about people experiencing more depressive symptoms. Among people with HIV (PWH), who have higher rates of depression, these symptoms may lead to adverse HIV-related outcomes. This study sought to characterize the effects of the COVID-19 pandemic on depression severity and to investigate the association between depression trajectories and viral load (VL) non-suppression among PWH enrolled in HIV care.

Methods
The study sample was PWH in the Johns Hopkins HIV Clinical Cohort who reported depression symptoms on the Patient Health Questionnaire 8 (PHQ-8) via a self-administered survey pre-pandemic (Mar. 1, 2018 - Feb. 28, 2020) and during the COVID-era (Sept. 1, 2020 - Feb. 28, 2022). Depression severity was categorized using standard PHQ-8 cutoffs ranging from normal (0-4) to severe (20-24). Depression severity categories pre-pandemic (last survey) and COVID-era (earliest survey) were compared, and trajectories were classified as: 1) remained depressed (PHQ-8 &gt; 4 and no change in severity category) or worsened (change to a higher severity category) and 2) remained non-depressed (PHQ-8 ≤ 4 and no change in severity category) or improved (change to a lower severity category). The association between depression trajectories and VL non-suppression (HIV RNA &gt; 200 copies/ml on the first measurement after a COVID-era survey) was assessed using logistic regression adjusting for age, gender, pre-pandemic VL, clinical diagnosis of mood and substance use disorders.

Results
Among 793 PWH in this study, 60% were male, 88% were Black and the mean age was 56 years. Approximately 24% of PWH remained depressed (9%) or worsened (15%), while 76% remained non-depressed (60%) or improved (16%). PWH who remained depressed or worsened were more likely to be virally unsuppressed (adjusted odds ratio:2.45, 95% confidence interval: 1.19 – 5.06) compared to those who remained non-depressed or improved.

Conclusion
In our cohort of PWH, a quarter either remained consistently depressed or experienced worsening depression in the COVID-era. Depression was significantly associated with VL non-suppression during the pandemic. Our findings suggest that strategies to monitor and address depression symptoms among PWH may contribute to reduced risk of VL non-suppression.

Disclosures
Oluwaseun Falade-Nwulia, MBBS ,MPH, Abbvie Inc: Grant/Research Support|Gilead Sciences: Advisor/Consultant
1517. Sexual Network Characteristics of MSM with Detectable Viremia Living with HIV in Lima, Peru
Authors: Harris Carlyn L , Segura Eddy , Gutierrez Jessica , Lake Jordan , Blair Cherie , Clark Jesse 
Published: November 2023

Abstract

Background
In Lima, Peru, the HIV epidemic is concentrated among men who have sex with men (MSM) and transgender women (TW). Few data exist on the sexual network characteristics of MSM with detectable HIV-1 viremia, yet these networks have important implications to control transmission. We report data on frequency of sero-discordant, condomless anal intercourse (CAI) among MSM in Lima with detectable viremia.

Methods
This cross-sectional secondary analysis includes MSM screened for a STI trial in Lima, Peru between June 2022 and January 2023. Participants completed questionnaires on demographics, sexual identity and role, and sexual network characteristics. Participants were screened for HIV infection and those who tested positive were included and HIV-1 RNA was measured. Descriptive and comparative statistics are reported for those with detectable and undetectable viremia.

Results
665 MSM with HIV were included. 153 (23%) had detectable ( &gt;200 copies/mL) viremia. Among those with detectable viremia, the median (IQR) age was 29 (25, 35) years. 70% identified as homosexual and 57% identified their sexual role during intercourse as “moderno” or “versatil”. The median (IQR) number of sexual partners in the last 3 months was 15 (5,20). 55/153 (35.6%) of the detectable group were aware of their HIV diagnosis, 33/55 (60%) reported being on anti-retroviral therapy (ART) and 15/32 (47%) believed they were virally suppressed. Among all participants living with HIV, 499/662 (75%) were aware of their HIV status, 469/499 (94%) reported to be on ART and 436/469 (93%) were virally suppressed. 147/153 (96%) of men with detectable viremia reported sero-discordant CAI with at least one of their last three sexual partners, and 106/144 (74%) reported this with all three of their last partners. In the undetectable group, 302/489 (62%) reported sero-discordant CAI with all three of their last partners (p &lt; 0.01).

Conclusion
In this sample of MSM living with HIV in Lima, Peru, almost all men with detectable HIV-1 viremia reported sero-discordant CAI, more often than those with undetectable viremia. The primary gap in the HIV care cascade was participant awareness of their HIV status, suggesting that broader HIV testing and improved access to resources for secondary HIV prevention are key objectives in Peru.

Disclosures
Jordan Lake, MD, Gilead Sciences: Grant/Research Support|Theratechnologies: Advisor/Consultant
1519. Prevalence and factors associated with HIV testing among sexually experienced high school students in the U.S.A.
Authors: Kangogo Geoffrey K 
Published: November 2023

Abstract

Background
HIV testing is a critical strategy for the prevention of HIV/AIDS yet testing among sexually experienced adolescents remains low. This study examined the prevalence of HIV testing and its influential factors among high school students in the USA.

Methods
We analyzed cross-sectional data from the 2019 National Youth Risk Behavior Survey. Analysis was limited to 3123 complete cases of sexually experienced high school students as measured by ever having sex. Chi-square and binary logistic regression analyses involved three models comprising predisposing, enabling and need factors were conducted to study lifetime HIV testing.

Results
The prevalence of lifetime HIV testing was 18.8% with females getting tested more than males. Female gender (OR:1.55; p&lt; 0.001), being Black (OR:1.42; p=0.008), and sexual debut below 13 years (OR:1.67; p=0.013) were positively associated with lifetime HIV testing. Further, we observed that having multiple sexual partners (OR:3.09; p&lt; 0.001) and mild physical activity (OR:1.28; p=0.025) were significantly associated with HIV testing. Lastly, we noted that Hispanics/Latinos (OR:0.67; p=0.025) and those using condoms (OR:0.77; p=0.015) were less likely to have reported ever having an HIV test.

Conclusion
Our study revealed that HIV testing among sexually experienced high school students remains low and sexual risk behaviors that impede testing among students need to be addressed to effectively scale up testing for this vulnerable population. The implication of this study to the relevant stakeholders responsible for creating a healthier nation is to strengthen the current efforts targeting sexually experienced high school students to encourage HIV tests and linkage to care.

Disclosures
All Authors: No reported disclosures
1523. Impact of Antiretroviral Therapy (ART) on All-Cause Mortality in HIV from 1999 to 2020 in the United States
Authors: Prince Monique A , Tan Min-Choon , Tan Min-Xuan , Prince E’ebony , Nicholas Rick , Shaaban Hamid , Slim Jihad 
Published: November 2023

Abstract

Background
Over the last two decades, Antiretroviral Therapy (ART) has evolved dramatically in the United States (U.S.) from multi-tablet regimens (MTR) to single tablet regimens (STR) and from Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) and Protease Inhibitor (PI) based regimens to integrase inhibitor (INI) based ART. This study sought to determine the trends in all-cause mortality over time as ART trends changed.

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 all-cause mortality with comorbid HIV from 1999 to 2020. HIV diseases (ICD-10 B20-B24, O98.7, R75) were listed as the contributing cause of death. We calculated age-adjusted mortality rates (AAMR) per 1,000,000 individuals. Additional analyses were performed to categorize the underlying causes of death by organ systems. The study period was further stratified into three groups when specific drug regimens were more prevalent: 1999-2007 (MTR), 2008-2014 (STR) and 2015-2020 (INI).

Results
In the 22-year study period, 251,759 all-cause mortalities with comorbid HIV in the United States were identified. The most common cause of death was infectious diseases (84.0%, N=211,438), followed by neoplasms (5.3%, N=13,264) and diseases of the cardiovascular system (3.9%, N=9,797). The AAMR in HIV was also highest in infectious diseases at 3.12 per 1,000,000 individuals, followed by neoplasms (0.18 per 1,000,000 individuals), diseases of cardiovascular system (0.12 per 1,000,000 individuals), diseases of respiratory system (0.05 per 1,000,000 individuals) and diseases of gastrointestinal system (0.04 per 1,000,000 individuals). Further analysis of infectious related causes showed significantly decreased mortality trends from 134,726 (MTR) to 69,450 (STR) and 47,583 (INI).Figure 1Demonstrates all-cause mortalities with comorbid HIV in the United States from 1999-2020

Conclusion
More than 80% of deaths in HIV occurred because of infectious disease over the past two decades. A decreasing trend was also seen in infectious related mortality in three different time periods. This reflects the improved tolerability and efficacy of ART over time.

Disclosures
Jihad Slim, MD, FACP, ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support
1527. Assessment of Human Immunodeficiency Virus Testing in Underinsured Persons
Authors: Skinner Andrew M 
Published: November 2023

Abstract

Background
Among those living with HIV, nearly 13% are unaware of their diagnosis and approximately 40% of new HIV infections are transmitted from those lacking a formal diagnosis. Thus, determination of populations at high risk of not having HIV testing completed are essential to reduce transmissions. A barrier to obtaining an HIV test within low-income individuals that do not qualify for Medicaid, or underinsured persons, is the rising cost of healthcare in the US. Thus, it is essential to determine if further resources should be dedicated to underinsured populations with the aim of increasing access to HIV testing.

Methods
This is a retrospective cross-sectional study utilizing the 2021 Behavior Risk Factor Surveillance System conducted by the US CDC to determine if individuals that do not qualify for Medicaid yet live in a household with an income of &gt;138% but ≤200% of the US federal poverty line (FPL) had increased odds of not having an HIV test when compared to individuals that live in a household with an income of ≤138% of the FPL, and thus qualify for Medicaid. A multivariable logistic regression model was created to determine the adjusted odds ratio for not having an HIV test in those who did not qualify for Medicaid.

Results
This study analyzed data from 33,431 respondents that were age 18 – 64, living in a Medicaid expansion state, and had a household income of ≤200% the FPL. Among these persons, 65.1% of respondents qualified for Medicaid. Univariate analysis revealed that non-Medicaid eligible persons were more likely to not have an HIV test when compared to Medicaid eligible persons with 54% and 48.6% not having an HIV test, respectively. After adjusting for the confounding variables, persons who were not eligible for Medicaid had 1.26 (95% CI:1.21 - 1.32) times the odds of not having an HIV test compared to those who were eligible for Medicaid.(Table)

Conclusion
After adjusting for confounding variables, the odds that a person did not have an HIV test were higher among individuals that lived in a household with an income that was &gt;138% but ≤200% of the FPL. These data reveal that underinsured persons are a potential group that may benefit from further resource allocation to bolster HIV screening.

Disclosures
Andrew M. Skinner, MD, Academy for Continued Healthcare Learning: Honoraria|American Society of Healthcare Pharmacists: Honoraria|Ferring Pharmaceuticals: Honoraria|MJH Life Sciences: Honoraria
1538. Is there value in performing yearly screening for latent tuberculosis infection by interferon-gamma release assay among patients living with HIV in non-endemic settings?
Authors: Palacios Carlo Foppiano , Achhra Amit , Barakat Lydia A , Virata Michael , Hao Richie , Baxter John D , Malinis Maricar F 
Published: November 2023

Abstract

Background
People with HIV (PWH) are at increased risk of reactivation of tuberculosis (TB) from latent tuberculosis infection (LTBI). Current guidelines recommend all PWH be initially screened for LTBI with either interferon-gamma release assays (IGRA) or tuberculin skin testing (TST). Also, repeat screening is recommended in either PWH with CD4 count &lt; 200 cells/mm3 after initial negative screen or any PWH with new TB exposure risk. Despite such guideline, there are centers that continue to screen LTBI in all PWH with annual IGRA testing. Our study evaluated the utility of universal yearly LTBI screening by IGRA among PWH in non-endemic settings.

Methods
A retrospective chart review of PWH in care from 2017-2021 at two urban academic medical centers. Demographics and annual IGRA results were collected. Patients were further stratified into three groups based on IGRA seroconversion: those with negative to positive (Group A), indeterminate to positive (Group B), and negative to indeterminate (Group C). Data for 3 groups, included risk factors for TB, chest imaging results, HIV data, and treatment. Descriptive statistics, chi-square, and Welch’s ANOVA were performed.

Results
A total of 2694 PWH were in care, comprised of 66% male, 50% Black, and 23% LatinX. Of the 2694, 2255 (84%) had a negative baseline IGRA. Seventy-two patients (2.7%) had IGRA seroconversion: 39 in Group A, 1 in Group B, and 32 in Group C (Table 1). Group A had lower CD4 counts (p=0.04) and higher HIV viral loads (p=0.03) than Group C.
Only 12 PWH (0.5%) with negative baseline IGRA developed new LTBI, with an incidence 1.1 cases/1000 patient-years. Of these, 8 PWH (67%) had ≥ 1 TB risk factor and none had CD4&lt; 200. Travel to endemic region (33%) was most common risk factor. Among those with new LTBI, N=6/7 had confirmation of LTBI with repeat positive IGRA after initial seroconversion. Nine (75%) patients completed LTBI treatment and none developed tuberculosis.
Features of patients with conversion to a positive or indeterminate QuantiFERON

Conclusion
In two large diverse clinics in non-TB endemic settings, the true incidence of developing LTBI in PWH was rare among those with negative baseline IGRA. Due to low yield of cases with universal annual screening, our findings support the targeted approach recommended by current guidelines.

Disclosures
Michael Virata, MD, Gilead Sciences: Advisor/Consultant|Janssen: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant