bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-551. The Effects of Antiretroviral Therapy on Immune Activation, Inflammation, Cellular Changes and Clinical Outcomes in Elite Controllers
Authors: Chan Elizabeth , Zhou Lei , Emu Brinda , Paintsil Elijah , Barakat Lydia A 
Published: January 2025

Abstract

Background
Elite controllers are people living with HIV (PLWH) who maintain their HIV viral load (VL) &lt; 50 copies/mL without antiretroviral therapy (ART). Viremic controllers are persons who have HIV who are able to keep their VL &lt; 2000 copies/mL without ART. Current published data does not clearly define the benefits of ART nor the adverse effects of ART in elite controllers. Evaluation of the effects of ART on immune activation, inflammatory markers, mitochondrial and cellular function in elite controllers can better inform utilization of ART in this group.

Methods
Four PLWH—3 elite controllers and 1 viremic controller— were enrolled from our HIV academic center clinic. Participants were women aged 45 to 60 years old who were diagnosed with HIV for 5 to 35 years. After shared decision making with their primary care provider, 2 of the 4 participants were started on ART, one on Triumeq and the other on Cabenuva. Participants were followed from 0 to 12 months. At each visit, routine standard of care labs, as well as inflammatory lab markers IL-6 and CRP were drawn. We assessed their mitochondrial function measuring mitochondrial membrane potential, mitochondrial DNA (mtDNA) deletions, apoptosis, and reactive oxygen species (ROS) production.

Results
Compared to baseline levels, inflammatory markers IL-6 and CRP both decreased at 12-months in participants started on ART (E2 and E3), whereas these markers increased in controls (E1 and E4) (Figure 1). All participants have increased apoptosis and ROS production at 12-months compared to baseline (Figure 2). At the 12-months visit, participants in the ART group (E2 and E3) showed elevated levels of mtDNA deletion, apoptosis, ROS production, and a reduction in mitochondrial membrane potential (Figure 2).

Conclusion
From our small cohort, the observed IL-6 and CRP decrease suggest decreased inflammation at one year after elite controllers start ART. However, decreased mitochondrial function was also noted in those on ART, which suggests possible early signs of ART toxicity. This preliminary data emphasizes the need for further studies to better understand the risk-benefit of initiating ART in elite controllers, including markers for cellular inflammatory markers.

Disclosures
Brinda Emu, MD, Genentech/Roche: Advisor/Consultant|Theratechologies: Advisor/Consultant
P-552. Viral load non-suppression among adults living with HIV on antiretroviral treatment in Sughd Region, Tajikistan, 2013-2022
Authors: Qurbonov Emomali , Nabirova Dilyara , Horth Roberta , Kubatova Aisuluu 
Published: January 2025

Abstract

Background
Unlike many other regions, Central Asia has an increasing incidence of HIV. Viral load suppression among people living with HIV (PLHIV) is a key strategy for reducing HIV transmission. We conducted a study to identify factors associated with viral load non-suppression among PLHIV on antiretroviral treatment (ART).

Methods
We conducted a retrospective study of adults (≥18 years old) newly diagnosed with HIV from 2013 to 2022 who received ART for 6+ months in the Sughd region. Data were abstracted from the national electronic registry of PLHIV and cross-checked with paper medical and laboratory records. Viral load non-suppression was defined as anyone with &gt;1000 copies per ml after being on 6+ months of treatment. Descriptive statistics were performed to summarize the characteristics of the study participants. Bivariable and multivariable logistic regression was used to identify factors associated with viral load non-suppression. We present adjusted odds ratios (aOR) and 95% confidence intervals (95%CI).Table 2.Factors associated with non-viral load suppression among adults with HIV who received antiretroviral treatment (n=1871), Sughd, Tajikistan, 2013-2022

Results
Of 1,871 people who were on ART for at least 6 months from 2013 to 2022, 11% did not achieve viral suppression. Of people on ART, 57% were male, 38% were migrants, and 68% lived in a rural area. The mean age was 31 years (range: 18-74) and 8% had a history of TB. One-third (32%) had late HIV diagnosis (23% in stage 3 and 9% in stage 4). The majority (94%) were on tenofovir lamivudine/dolutegravir (TDF/3TC/DTG) (Table 1). People diagnosed with stage 4 disease vs stage 1 (aOR=2.4, 95%CI=1.5–3.8; p&lt; 0.01), males vs females (aOR=1.5, 95%CI=1.1-2.0; p=0.03), people who migrated after HIV diagnosis vs non-migrants (aOR=1.4, 95%CI=1.1-2.0; p=0.02), or were not married (single) vs married (aOR = 2.0, 95%CI=1.3–3.2; p=&lt; 0.01) had increased odds of viral load non-suppression. People diagnosed in 2019-2022 had lower odds of viral load non-suppression compared to people diagnosed in 2013-2018 (aOR=0.5, 95%CI=0.4-0.7; p&lt; 0.01) (Table 2).

Conclusion
Level of viral load suppression among people on ART in Sughd region of Tajikistan is below the global target of 95%. Increasing early detection and providing treatment support for groups with higher odds of non-suppression, especially males, migrants and people in later stages of the disease, can help with achieving global targets.

Disclosures
All Authors: No reported disclosures
P-555. Use of Long-Acting Cabotegravir/Rilpivirine in People Living with HIV with Renal Transplantation
Authors: Bchech George , Oehler Cassandra , Ma Qing , Carpenter Jennifer , Sureshkumar Kalathil , Rothman Ryan , Tives Debra , hsiao Chiu-bin 
Published: January 2025

Abstract

Background
Cabotegravir/Rilpivirine (CAB/RPV) represents a novel combination of long-acting injectable antiretroviral therapy (LAIART). Although the unique benefits of LAIART have been demonstrated in large clinical trials among people with HIV, including a favorable safety profile, few drug-drug interactions, and viral control without a daily oral pill requirement, evidence of LAIART use among PWH diagnosed with end-stage chronic kidney disease (CKD) and during kidney transplantation (KT) remains sparse.

Detailed timeline of all 3 patients in the study.

Methods
A phase IV clinical trial CAPRI (NCT05601128) was designed to evaluate the pharmacokinetics and safety of long-acting CAB/RPV among PWH with CKD &gt;= stage 4 or ongoing hemodialysis. Three enrolled participants were included, in this analysis because of their KT status, of them, one KT before the trial and two KT during the trial. The peri- and post-operative effects of CAB/RPV LA were evaluated focusing on viral load, CD4+ counts, and potential drug interactions. According to protocol, CAB/RPV PK samples were obtained and planned to be measured and analyzed.

Results
All three participants have been virally suppressed (&lt; 50 copies/ml) by CAB/RPV LA with stable CD4+ counts while maintaining appropriate graft function during 12months of study period. The timeline for each participant was depicted in the Figure and details were summarized in terms of virologic and immunologic outcomes as well as renal function at different study periods. CAB/RPV LA was well tolerated, without major related adverse events noted. The renal function was significantly improved, dialysis free, in two participants receiving KT during the trial whereas it remained stable, dialysis free, in the participant with prior KT. The reported tacrolimus trough concentrations were maintained within the therapeutic range to protect the graft function.

Conclusion
The safety and efficacy of CAB/RPV LA have been observed in these participants, supporting its potential use among those with severe renal impairment and kidney transplantation. Additional advantages including lack of adherence barriers and low drug interaction potential are likely to increase viral suppression and improve overall quality of life in this special population.

Disclosures
Chiu-bin hsiao, MD, Viiv, Gilead: Grant/Research Support
P-558. Long-acting Injectable Cabotegravir/Rilpivirine Plus Subcutaneous Lenacapavir Effective in People with HIV with Viremia and Cabotegravir or Rilpivirine Resistance-Associated Mutations
Authors: Brock James B , Denson Racolesha , Herrington Peyton , Hickman Melissa , King Heather , McIntosh Regan , Musa Sirna , Sanders Courtney , Walker Holly , Hickman Aubri 
Published: January 2025

Abstract

Background
Long-acting antiretroviral regimens have the potential to achieve virologic suppression in people unable to maintain adherence to daily oral antiretroviral therapy (ART). Long-acting injectable cabotegravir/rilpivirine (LAI CAB/RPV) is currently the only complete long-acting regimen and is recommended by IAS-USA for select patients with viremia. However, resistance-associated mutations (RAMs) among treatment-experienced people with HIV are common, precluding use of LAI CAB/RPV. LAI CAB/RPV plus subcutaneous lenacapavir (LEN) may provide therapeutic options for people with poor long-term adherence and cabotegravir or rilpivirine RAMs.Table 1.NNRTI Mutations by Patient

Methods
Patients at UMMC’s Adult Special Care Clinic were selected for LAI CAB/RPV plus LEN by a multidisciplinary panel. Criteria for selection included recurrent viremia despite intensive case management strategies, presence of historical or current RAMs to CAB or RPV, and partially- or fully-active cabotegravir based on mutation scores. Patients began therapy with LEN and LAI CAB/RPV on the same day. The prescribed regimen consisted of CAB/RPV 600/900 mg intramuscular at months 0 and 1 followed by every 2 months and LEN 600 mg oral daily x 2 days and 927 mg subcutaneous every six months. No oral lead-in of CAB/RPV was administered, and oral LEN was administered via directly-observed therapy.

Results
Nine patients were treated with LAI CAB/RPV plus LEN at UMMC. Mean baseline viral load was 36 251 copies/mL. All patients had RPV RAMs. One patient had CAB RAMs (N155H, T977A) conferring low-level resistance to CAB. The follow-up period ranged from 24-36 weeks. All patients maintained viral loads &lt; 200 copies/mL during follow-up. Patients with baseline CD4 &lt; 200 cells/µL demonstrated 208% increase in absolute CD4 count. No treatment-emergent resistance has occurred to date.

Conclusion
LAI CAB/RPV plus LEN achieved virologic suppression for up to 36 weeks of follow-up in PWH with incomplete adherence to oral ART and mutations to CAB or RPV. Further follow-up and larger sample size will be needed to determine long-term durability of this combination. Additional combinations of long-acting ART are vitally needed to achieve virologic suppression for all.

Disclosures
All Authors: No reported disclosures
P-561. Long-Acting Cabotegravir and Rilpivirine in HIV Individuals Over 60 years: a Real-World Study (RELATIVITY Cohort)
Authors: Troya Jesús , Bernal Enrique , Morano Luis , Montes Marisa , Galindo María José , Crusells María José , Torralba Miguel , Santacreu Mireia , Losa Juan Emilio , de Zárraga Miguel , Aguilera María , Cabello Noemí , Martín Patricia , Masiá Mar , Cabello Alfonso , Sepúlveda María Antonia , Carmen Fariñas Maria del , Santiago Alberto Diaz-De , Vivancos María Jesús , Llenas Jara , Carmen Montero María del , de la Calle Beatriz , Calderón Ruth , Mar García María del , Cecilio Álvaro , Pedrero Tomé Roberto , Buzón-Martín Luis 
Published: January 2025

Abstract

Background
The switching strategy to long-acting cabotegravir and rilpivirine (CAB+RPV) has emerged as a standard approach for people living with HIV (PLWH), offering high efficacy, safety, and convenience rates. Nevertheless, there is a scarcity of data regarding older PLWH, an important and growing population with physiological differences and arising comorbidities.

Methods
We conducted a multicenter, non-controlled, retrospective study on HIV virologically suppressed individuals who switched to long-acting CAB+RPV. We evaluated demographic and clinical factors associated with this switch in individuals over 60 years of age.

Results
The study included 154 individuals from 27 hospitals in Spain, representing 12.8% of the Relativity cohort, which comprised 1204 individuals. The median age was 63 years (range: 61 to 68), with 77.9% being men. 89.5% were Spaniards, followed by South Americans (6.5%). HIV transmission ocurred via HSH in 42.6% of cases and heterosexual in 27.7%. Comorbidities were present in 70.1% of individuals, with 17.5% having three and 3.9% having four. The most prevalent comorbidities were dyslipidemia (45.5%), high blood pressure (32.5%), and osteoporosis (19.5%).
The HIV infection median time was 22 years (range: 13 to 31), the antiretroviral therapy median time was 18 years (range: 11 to 24), and the median time of viral suppression was 12 years (range: 8 to 17). 24.5% were in CDC stage C3. The nadir CD4+ cell count was 240 (range: 111 to 374) cells/mm³, and 5.8% had previous virological failure with resistance mutations in 100% (NRTI, PIs or both). ART before switching included DTG/3TC (31.8%), DTG/RPV (28.6%), BIC/FTC/TAF (16.2%), DRV/c/FTC/TAF (5.2%), and EFV/FTC/TDF (1.9%). The main reasons for switching were patient request (43.5%), improvement in quality of life (35.7%), and simplification (23.4%). The efficacy rate at week 28 was 100%, with no discontinuations.

Conclusion
In a real-life setting, switching to long-acting CAB+RPV proves to be a viable option for individuals over 60 years old, with long-standing HIV infection and a high burden of baseline comorbidities, demonstrating sustained virological control over the initial 28 weeks of this treatment. Therefore, it should also be offered to older patients, even if they have multiple treated comorbidities.

Disclosures
All Authors: No reported disclosures
P-563. Low level viremia is associated with viral non-suppression within 96 weeks among adolescents with perinatally acquired HIV: a prospective cohort study
Authors: Paredes Jose Luis , Bemplidaki Danai , Dzavakwa Nyasha V , Chisenga Molly , Filteau Suzanne , Gregson Celia L , Kasonka Lackson , Kranzer Katharina , Banda-Mabuda Hildah , Mujuru Hilda , Redzo Nicol , Bandason Tsitsi , Rowland-Jones Sarah , Schaible Ulrich E , Simms Victoria , Ferrand Rashida 
Published: January 2025

Abstract

Background
Viral suppression, defined as having a viral load (VL) &lt; 1,000 cop/mL is used as the threshold for antiretroviral treatment (ART) changes in WHO guidelines. It is unclear whether those with low-level viremia (LLV) (VL 60-999 cop/mL) and undetectable (VL&lt; 60) have different HIV-related outcomes. This study investigated factors associated with having viral non-suppression (≥1000 copies/ml) within 96 weeks among adolescents with perinatally-acquired HIV in Zimbabwe and Zambia with viral suppression (&lt; 1000 copies/mL) at baseline.

Methods
Longitudinal analysis of data from a trial using vitamin D and calcium supplementation on adolescents with perinatally-acquired HIV aged 11-19 years established on ART for &gt; 6 months. Participants were enrolled from public-sector HIV-clinics in Harare and Lusaka and VL were measured at baseline, 48 weeks and 96 weeks. Those who completed follow-up until 96 weeks and were virally suppressed at baseline were included in this analysis. Enhanced adherence counselling was provided to those with viral non-suppression at 48 and 96 weeks. Multivariate Poisson regression was used for analysis of the association of viral-non suppression with VL at baseline, adjusting for age and sex a priori.

Results
A total of 656 who had a VL&lt; 1000 at baseline and complete follow-up were included in this analysis. Median age was 15.2 years, 54.6% were female, 90 (13.7%) had viral non-suppression within 96 weeks: 49 (7.5%) at week 48, and 43 (6.6%) at week 96. Viral non-suppression occurred among 18/54 (33.3%) of those who had LLV at baseline in comparison to 72/602 (12.0%) of those that were undetectable at baseline. Adjusting for age and sex, those with LLV were 2.3 times more likely to have viral non-suppression within 96 weeks (adjusted risk ratio 2.32, 95%CI 1.53-3.51) in comparison to those undetectable. In univariate analysis, country, age, sex, being enrolled in school and baseline ART regimen were not associated with having viral non-suppression within 96 weeks of follow up.

Conclusion
Adolescents with LLV are at higher risk of viral non-suppression within 96 weeks than those with undetectable VL, with implications for HIV transmissibility, resistance to ART and HIV-related clinical outcomes.

Disclosures
All Authors: No reported disclosures
P-573. Analysis of Cabotegravir-Rilpivirine Use in HIV Patients at MedStar Washington Hospital Center
Authors: Koutsoupias Panagiotis , Wortmann Glenn , French Kimberly , Navigator Treatment 
Published: January 2025

Abstract

Background
Intramuscular cabotegravir-rilpivirine (CAB-RPV) is a long-acting antiretroviral for the treatment of HIV which can be administered every 1-2 months. Registration trials demonstrated the non-inferiority of CAB-RPV versus oral antiretroviral therapy, but data on the ‘real world’ performance of CAB-RPV is sparse. In addition, these trials required HIV virologic suppression (viral load (VL) &lt; 50 copies/mL) with oral medications before transitioning to CAB-RPV. Small studies have reported success when CAB-RPV was started in patients with detectable viremia, and our study sought to build on those findings.

Methods
Descriptive, retrospective study based on patients who began treatment with CAB-RPV between May 2022-Nov 2023. Virologic undetectability (VL &lt; 50 copies/mL), suppression (VL 51-200 copies/mL) and virologic failure (VL &gt; 201 copies/mL) at last measurement are described among patients with a VL &lt; 50 copies/mL, 51-200 copies/mL or &gt;201 copies/mL at baseline.

Results
42 patients are included in the analysis with a median age of 42 (range 27-80). The cohort was 93% African American, 60% male and 81% received Medicare/Medicaid or both as their primary insurer. Median CD4 count was 861 (range 15-1827) and median viral load was 40 copies/mL (range &lt; 20-294,000). Among 38 patients with a baseline VL of &lt; 50, 34 maintained viral undetectability, 1 become virally suppressed (VL=60) and 3 did not have results available due to recently starting CAB-RPV. One patient with baseline viral suppression (VL=90) became virally undetectable. Two patients with baseline virologic failure (VL 1,210 and 7,200) became virologically undetectable. One patient with baseline virological failure (VL=294,000) developed resistance shortly after starting therapy.

Conclusion
Similar to data in registration trials, CAB-RPV maintained viral suppression in 100% of patients who were at least virally suppressed at baseline. Two patients with virological failure at baseline achieved virological suppression, adding to data that CAB-RPV may be beneficial in patients who are unable to adhere to oral antivirals. One patient with baseline virological failure and high viral load quickly developed resistance after starting therapy, supporting data that CAB-RPV needs to be used carefully in certain populations.

Disclosures
All Authors: No reported disclosures
P-614. Acceptance of vaccination - strategies for populations of Ukrainian children migrating to Poland
Authors: Dzielska Anna , Kleszczewska Dorota , Lewtak Katarzyna , Mazur Joanna 
Published: January 2025

Abstract

Background
The presence of a significant number of refugees from Ukraine in Poland creates a need to understand and improve the immunisation status of children in this population. UNICEF and WHO data indicate potential challenges in maintaining adequate vaccination coverage in the refugee population. In this context, this study aims to identify factors influencing vaccination decisions among parents of Ukrainian children living in Poland. The main objective of this project is to increase vaccination coverage among Ukrainian children (0-5 years) in Poland.

Methods
A pilot study to identify the main barriers and determinants of vaccination decisions among parents of newly arrived war migrants from Ukraine was conducted online and included a group of 187 refugees from Ukraine, most of whom were women. Participants in the study were analysed in terms of their barriers and concerns about vaccinating their children.

Results
Preliminary results of the survey indicate that the main sources of information about vaccination for Ukrainian parents are doctors and the media. The most commonly reported barriers include difficulties in accessing health services, lack of knowledge about vaccination schedules, and language barriers. Concerns about returning to Ukraine and lack of information about the effects of vaccines are also important. Based on the findings, a behaviour change strategy based on the COM-B theoretical model and a systems approach is proposed. The implemented education and outreach activities, supported by media campaigns and psychosocial support, should aim to increase the capability, motivation and opportunity of Ukrainian parents to make informed decisions about vaccination. Between 24.02.2022 and 31.01.2024, 37,315 Ukrainian children aged 0-5 years were vaccinated in Poland.

Conclusion
The effectiveness of interventions should be further investigated; however, the available evidence suggests that a comprehensive approach involving a variety of systems can contribute to improving the immunisation status of children among the Ukrainian refugee population in Poland.

Disclosures
All Authors: No reported disclosures
P-620. High Risk, Low Compliance: Surprising Post-Pandemic Influenza Vaccine Trends in a Children's Hospital
Authors: Leyden Brianna , Gornick Wendi , Tran Martin T , Singh Jasjit 
Published: January 2025

Abstract

Background
Post-pandemic, the CDC reports a decline in influenza vaccinations in children 6 months to 17 years by 6.3% from 2019-2020 to 2022-2023. We describe concerning widespread declines in our institution in inpatient influenza vaccinations, outpatient oncology influenza vaccine rates in those receiving active chemotherapy, and employee vaccinations. We present these trends in the context of local influenza epidemiology, influenza admissions, and reasons for refusal.

Methods
Our institution, a free-standing children’s hospital, collected inpatient influenza vaccinations based on calendar years 2019-2023 and influenza admission rates over winter seasons 2018-2019 to 2022-2023. Additionally, employee vaccination rates, including reasons for refusal, were collected fall/winter 2018-2019 to 2023-2024. Lastly, oncology clinic influenza vaccination rates among the high-risk patients receiving active chemotherapy were collected from Sept-Dec 31 2020-2023.

Results
Although influenza admissions plummeted from 302 in winter 2019-2020 to 0 in winter 2020-2021, these admissions have since rebounded (Fig. 1). While inpatient influenza immunizations have continued to decline to a low of 0.0029 vaccines/patient day, they are now outpaced by influenza admissions at 0.0037 admissions/patient day (Fig. 2). This trend in decreased vaccines is echoed in oncologic patients on active chemotherapy, with non-medical refusals increasing from 5% in 2020 to 16% in 2023, and in employees, with refusals increasing from 1.9% in 2019 to 5.3% in 2024 (Fig. 3). Although employee rates for medical exemption are consistent, non-medical reasons for refusals have increased 6-fold from 2019 to 2024 (Fig. 4).

Conclusion
We saw a decline in influenza vaccine rates for hospitalized patients, immunocompromised outpatient oncology patients on active chemotherapy, and employees, despite increased influenza burden in the community post-pandemic. The latter were almost exclusively due to non-medical reasons for refusal. Further study needs to be done to elucidate post-pandemic vaccine trends and identify missed opportunities for immunization, particularly in high-risk patients and their contacts, with emphasis on bolstering influenza vaccine confidence in not only patients, but staff.

Disclosures
All Authors: No reported disclosures