HIV Patients Research Articles

A critical assessment of male HIV/AIDS patients' satisfaction with antiretroviral therapy and its implications for sustainable development in Sub-Saharan Africa.

The emergence of unique and destructive viruses, such as COVID-19, has claimed lives, disrupted health systems and diverted resources from addressing the needs of male HIV/AIDS patients in the context of antiretroviral therapy and other HIV/AIDS-related issues. This study aims to assess male HIV/AIDS patients' satisfaction with antiretroviral therapy and its implications for sustainable development in Sub-Saharan Africa. Satisfaction, word-of-mouth, trust and revisit intention were the variables in the research model. A quantitative method was utilized. Data were collected from 400 male HIV/AIDS patients who received medical attention from hospitals in Gombe State, Nigeria, utilizing the convenience sampling method. SmartPLS was used for data analysis. The results show that satisfaction has a positive impact on trust, word-of-mouth and revisit intention. Furthermore, trust and word-of-mouth had a significant impact on revisit intentions. Word-of-mouth played a significant mediating role in the relationship between satisfaction and revisit intention. Trust played an insignificant mediating role between satisfaction and revisit intention. Additionally, word-of-mouth had a significant mediating effect on the relationship between trust and revisit intention. Healthcare organisations should prioritise patient satisfaction because it influences their likelihood of returning. Addressing the needs of male HIV patients can significantly enhance their overall healthcare experience, which would lead them to spread positive word of mouth. Healthcare administrators should make it a top priority to provide superior services that match or exceed patient expectations. The study used quantitative data and focused on the male gender. Also, the empirical research is carried out in public hospitals; however, there are some differences between the types of hospitals in terms of the factors that affect male HIV/AIDS patients' revisits. We employed a cross-sectional study. As a result, we recommend expanding it into a longitudinal study, as it allows the researcher to validate the causal mechanism and obtain results that are more generalizable. Healthcare managers should actively encourage positive patient reviews and recommendations. Setting up systems to record and distribute patient success stories can improve the hospital's reputation and attract new patients. Increased word-of-mouth advertising can naturally result from encouraging positive encounters and outcomes. Healthcare administrators should establish channels for sharing information regarding therapies, procedures and support services that are transparent and easy to obtain. Patients' intentions to return for follow-up appointments can be favourably influenced by education on the value of ongoing care. Male HIV/AIDS patients who are satisfied with their care have a tendency to trust medical professionals more, which promotes enhanced therapeutic outcomes and greater compliance with treatment regimens. Positive comments from those with the condition can also reduce stigma and motivate community members to seek treatment, fostering a supportive environment for those living with HIV/AIDS. The study emphasises how important it is for patients and healthcare providers to have stronger, greater empathy connections, which could contribute to decreasing health disparities. The study investigates the effect of satisfaction on the revisit intention of male HIV/AIDS patients and also highlights how trust and WOM mediate this relationship.

Schizophrenia, Off-Label Antipsychotics, and Dementia Risk in People With HIV.

Comorbidities such as schizophrenia and medication such as antipsychotics may influence the risk of dementia among people living with HIV (PLWH). The objective of this article is to assess the associations among HIV patients with schizophrenia, off-label antipsychotics, and dementia risk. US Department of Veterans Affairs health care facilities from 2000 to September 2023. Retrospective cohort study of PLWH treated by the US Department of Veterans Affairs with history of schizophrenia, off-label antipsychotic use, and neither schizophrenia nor antipsychotic use. Propensity score-matched non-HIV controls were included for the respective HIV groups. The hazard of dementia is estimated using Cox proportional hazards models. PLWH and schizophrenia, were found to have a 2.49 higher hazard of dementia than HIV patients with no history of schizophrenia or antipsychotic medication use (hazard ratio [HR] = 2.49, 95% confidence interval [CI]: 1.85 to 3.35). PLWH and off-label antipsychotic use were found to have a 1.77-fold higher hazard of dementia than HIV patients with no history of schizophrenia or antipsychotic medication use (HR = 1.77, 95% CI: 1.37 to 2.28). Propensity score-matched analysis reveals that, among patients with schizophrenia, those with HIV had a 1.65-fold higher hazard of dementia (HR = 1.65, 95% CI: 1.12 to 2.44). Among patients with no schizophrenia or antipsychotic medication, those with HIV had a 1.47-fold higher hazard of dementia (HR = 1.47, 95% CI: 1.33 to 1.63). This study demonstrates that among PLWH, history of schizophrenia or off-label antipsychotic medication use are associated with substantial increases in dementia incidence. Furthermore, propensity score-matched control analysis reveals that HIV infection itself is independently and significantly associated with elevated dementia risk.

337 Weight loss in an HIV patient with lung cancer: you can‘t judge a book by its cover

337 Weight loss in an HIV patient with lung cancer: you can‘t judge a book by its cover

Ptosis in human immunodeficiency virus-infected patients under long-term antiretroviral treatment.

To present cases of ptosis in HIV-1 patients on long-term antiretroviral therapy (ART) and review the existing literature. Five HIV-1-positive patients with slowly progressive bilateral ptosis underwent a comprehensive diagnostic evaluation, including imaging studies, neurophysiological testing, muscle biopsy, and genetic analysis. A literature review was conducted. On clinical examination, all patients presented with bilateral symmetrical non-fatigable ptosis, three exhibited facial lipoatrophy and two also had mild multidirectional ophthalmoparesis and all had ocular abnormalities in Hess screen test. Additionally, one patient displayed proptosis, three had floppy lower eyelids, and four presented with exotropia. Anti-acetylcholine receptor antibodies were negative in all patients. Brain magnetic resonance imaging (MRI), motor unit potential analysis, and single-fiber electromyography were unremarkable. Orbital MRI revealed introrbital fat expansion in one patient, and limb muscle biopsies were inconclusive in two cases. Blood genetic testing for chronic progressive external ophthalmoplegia was negative in all patients. A total of 30 similar cases have been documented in the literature, with some studies reporting key findings such as muscle histology indicative of mitochondrial myopathy, MRI revealing patchy extraocular muscle hyperintensity, and muscle genetic testing identifying mitochondrial deoxyribonucleic acid (DNA) deletions. Ptosis surgical repair appears to be the most effective treatment. HIV patients on long-term ART may develop ocular muscle involvement due to mitochondrial dysfunction, with bilateral ptosis being the primary manifestation. Diagnosis is challenging and requires the exclusion of other conditions. Ptosis surgery can significantly improve quality of life.

Ritonavir enhances the efficacy of amprenavir: A promising combination therapy by targeting Leishmania DNA topoisomerase I for treatment of visceral leishmaniasis.

Visceral leishmaniasis (VL) is an opportunistic infection in HIV patients with higher relapse and mortality rate. The number of HIV-VL patients is comparatively higher in areas where both infections are endemic. However, the conventional chemotherapeutic agents have limited success due to drug toxicity, efficacy variance and overall cost of treatment. Therefore, it is crucial to discover and develop newer potent antileishmanial agents for successful eradication of the disease. Our previous report, for the first time showed the leishminicidal effect of amprenavir (APV) mediated by inhibition of L.donovani Topoisomerase I (LdTopILS). So, we intended to demonstrate the effect of APV in combination with ritonavir (RTV). The present study revealed that the complete catalytic inhibition of LdTopILS by APV (10μM) in combination with RTV (5μM), compare to APV (20μM) as previously reported (Roy et al., 2021). Moreover, APV (5μM) in combination with RTV (4μM) exhibited promastigote inhibition with IC50 values of 2.4±0.6μMat 12h and 1.6±0.7μMat 24h, respectively. The study was extended in animal model where the in vivo antileishmanial efficacy of APV-RTV in BALB/c mice demonstrated that treatment of APV in combination with RTV led to significant splenic and hepatic protection as compared to single dose of APV. Moreover, the antileishmanial activity of APV in combination with RTV was exerted via inhibition of LdTopILS at much lower concentration of APV and this inhibition of the enzyme induced programmed cell death in Leishmania parasites by generating oxidative stress within the cells. From the in vitro, ex vivo and in vivo studies, it was indicated that lower dose of APV in combination with RTV elevated the effective killing of the parasites as compared to the single higher dose of APV. Thus, the current study highlights repurposing of available protease inhibitors in combination, which might be exploited further for the therapeutic development against VL as well as HIV-VL co-infection.

Abstract WP320: Disparities in Stroke-Related Mortality Among HIV Patients based on race and gender in the United States from 1999 to 2020, analysis from Center for Disease Control and Prevention of Wide-Ranging On-Line Data (CDC-WONDER)

Abstract WP320: Disparities in Stroke-Related Mortality Among HIV Patients based on race and gender in the United States from 1999 to 2020, analysis from Center for Disease Control and Prevention of Wide-Ranging On-Line Data (CDC-WONDER)

Effect of antiretroviral treatment in myocardial function of treatment naive patients with HIV

Abstract Background/Aim HIV infection is related with cardiovascular adverse events. We investigated the effects of antiretroviral treatment in myocardial and vascular function of newly diagnosed patients with HIV. Patients and methods: A total of 70 newly diagnosed HIV patients were enrolled. Patients were randomized to 4 different treatments which were descovy plus resolsta (emtricitabine/ tenofovir alafenamide), tivicay plus descovy (tenofovir alafenamide/ emtricitabine), genvoya (elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide) and descovy plus isentress (raltegravir). We measured at baseline and 12 months posttreatment: (a) Left Ventricular (LV) Global Longitudinal Strain (GLS), (b) LV Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), Global Work Efficiency (GWE). At baseline, we compared the HIV patients with 35 healthy matched controls. Results At baseline patients with HIV had devastated myocardial function, endothelial function and endothelial glycocalyx compared with healthy controls. Twelve months after intervention HIV patients improved myocardial function, as assessed by GLS, GWI and GCW as well as endothelial function as evaluated by decrease of PBR5-25. Nevertheless, in HIV patients 12 months post treatment myocardial and endothelial function and endothelial glycocaylyx was impaired in comparison with healthy controls. Conclusions Treatment with antiretroviral therapy partially improves myocardial and arterial function 12 months post treatment.

P-482. Evaluating Vitamin B12 Deficiency in People Living with HIV Compared to Metformin Users

Abstract Background Vitamin B12 is a water-soluble vitamin critical for the development and function of the central nervous system, as well as the formation of red blood cells and DNA synthesis. Both HIV and metformin use have been associated with vitamin B12 deficiency. The degree of vitamin B12 deficiency in HV has not been quantified compared to other known causative conditions. Our study aims to describe the incidence of vitamin B12 deficiency in HIV-infected individuals compared to metformin-induced vitamin B12 deficiency. Our secondary goal is to describe the demographics of HIV patients requiring B12 replacement therapy. Methods This database study evaluated de-identified medical records from 01/01/2015 to 07/01/2023 at a single large academic institution. We evaluated two study populations: HIV patients and metformin users. For inclusion, both populations required a lab test for vitamin B12 level after starting metformin or the diagnosis of HIV. We defined vitamin B12 deficiency as starting B12 replacement therapy within 4 months of the lab test. Results We identified 3,253 HIV and 50,751 metformin-use patients for our study. Among all HIV patients, 717 received a B12 lab test, and 144 (20%, 95% CI 0.173 to 0.232) required replacement therapy. Metformin users had 7773 individuals that received a B12 lab test, and 1187 (15%, 95% CI 0.145 to 0.161) required replacement therapy. The rate of B12 deficiencies was higher among the HIV population (20%) than the metformin (15%), p=0.0007. The relative risk for vitamin B12 deficiency among the HIV population is 1.315 (95% CI 1.126 to 1.536). The number of HIV patients not on metformin with a B12 lab test was 631, and 124 required replacement therapy (19.7%). The HIV population was primarily men (84%), with 50% in the age range of 40-60 years and 63% identified as white. Conclusion Vitamin B12 deficiency is a known problem associated with metformin administration and HIV infection. This study identified that our HIV population has higher rates of vitamin B12 deficiency than the metformin group. The cause of this deficiency is unknown. Improved awareness of vitamin B12 deficiency in HIV patients may facilitate improved monitoring and supplementation, which in turn may decrease HIV-associated comorbidities such as dementia and neuropathy. Disclosures Lee Nguyen, PharmD, APh, BCPS-AQ ID, BCIDP, Merck & Co: Grant/Research Support

P-468. Prevalence and Associated Factors of Patients Presenting with Advanced HIV Disease in Tertiary Hospital in Bangkok

Abstract Background Late entry to healthcare services for HIV patients leads to adverse outcomes and increased mortality particularly advanced HIV disease (AHD) who first presented with opportunistic infection (OI). However, epidemiological data on AHD among Thai patients in suburban government hospital during the Treat-All era was lacking and required to guide the healthcare strategies. This study aims to assess the prevalence, clinical characteristics and risk factors of patients presenting with AHD at Bhumibol Adulyadej Hospital, a tertiary hospital in Bangkok. Methods A retrospective cross-sectional study was conducted among newly diagnosed adult HIV patients from 1 October 2019 to 30 September 2023, through electronic chart review. The WHO clinical staging 3-4 was used to define AHD. Logistic regression was used to identify factors associated with AHD. Results Among 372 patients, 40.32% presented with AHD, with a median CD4 cell count of 36 (IQR 13-137) cells/mm3. Most of the newly diagnosed HIV patients were single males residing in the hospital’s service area. AHD patients were predominantly aged 30-59 years (62.00%) and identified through clinical suspicious testing (88.67%) rather than voluntary counseling testing (VCT). Risk factors of AHD included ages 30-59 years (adjusted OR (aOR) 1.94 [95%CI 1.13-3.34]) and > 59 years (aOR 4.58 [95%CI 1.49-14.06]), clinical suspicious testing (aOR 11.98 [95%CI 6.61-21.71]), unprotected sex (aOR 1.74 [95%CI 1.01-2.98]), and partner seropositive (aOR 0.18 [95%CI 0.05-0.62]). One-year mortality was significantly higher in AHD who were diagnosed from 2019-2022 (20.31% V.S. 9.88%, p=0.011). The most common OIs among AHD were tuberculosis (54.00%), pneumocystis pneumonia (40.67%) and cryptococcosis (17.33%) consecutively. Conclusion Presenting with AHD was common and associated with high mortality. VCT plays a minor role in the study population. The early HIV infection detection program remains needed in all risk groups but should target heterosexual males aged > 30. Disclosures All Authors: No reported disclosures

P-33. Vaccine Hesitancy in HIV Patients Following the COVID19 Pandemic

Abstract Background The prevalence of vaccine hesitancy has been rising over the last several years and was exacerbated by the Covid19 epidemic with the introduction of the novel Covid19 vaccines. There are concerns that immunosuppressed individuals such as HIV patients may also demonstrate vaccine hesitancy to recommended non-Covid19 vaccines. In this study, we evaluated the rate of refusal of non-Covid19 vaccines in the pre- and post-period after release of the Covid19 vaccine. Table 1 Summary of Vaccination Results. The distribution of the Pre-Covid and Post-Covid Group for each tested vaccine were compared. The direction of the distribution trend is listed and whether or not it was statistically significant (p<0.05) Methods We measured and compared the number of vaccines offered and refused at each visit over the total number of visits for 195 outpatients with HIV for 18 months and pre- and post-release of the Covid19 vaccines to the general public. The vaccines studied included the following: tetanus, pneumococcal, shingles, hepatitis A and B, and influenza. The data was collected using hospital records from the electronic medical record as well as Michigan Care Improvement Registry (MICR). Data was analyzed using descriptive statistics and the Wilcoxon signed ranks test. The Mann-Whitney U test, Kruskal-Wallis test and Pearson’s correlation were performed for this vaccine. In all statistical tests, a p-value less than 0.05 was taken to indicate statistical significance. Results Collectively, there were more refusals in the period after release of the Covid19 vaccine for non-Covid19 vaccines. This was also the case for all individual vaccines, except hepatitis A. There was an overall statistically significant difference (p < 0.001) in the distribution of vaccine refusals between the pre-Covid19 and post-Covid19 period. This was observed for the pneumococcal (p=0.026), hepatitis B (p=0.035), and shingles vaccine (p < 0.001) respectively. Conclusion This study provides evidence that there is an increase in non-Covid19 vaccine hesitancy following the release of the Covid19 vaccine among HIV outpatients. Larger studies should be performed to confirm this observation. Disclosures All Authors: No reported disclosures

Low levels of Plasmodium falciparum parasitaemia among patients receiving antiretroviral therapy at the treatment centre of the Regional Hospital Bamenda, Northwest Cameroon.

Malaria and HIV are leading causes of death in Africa, including Cameroon. Antiretroviral therapy (ART) is expected to boost immunity and reduce vulnerability to opportunistic infections. Reports on comorbidities including malaria are common in Cameroon. To determine the prevalence of malaria parasitaemia, clinical manifestations, treatment related factors and prevention methods associated with malaria parasitaemia as well as parasite density among HIV patients on ART. It was a cross-sectional study among HIV patients on ART at the Regional Hospital Bamenda. A pre-tested questionnaire was used to collect data on participants' socio-demographic characteristics, clinical manifestations, history of HIV treatment and malaria prevention methods. Microscopy was used for malaria parasite diagnosis and to determine white blood cell (WBC) count. Data was analysed using SPSS version 20. The study included 181 participants. The overall prevalence of malaria parasitaemia was 9.4%. Although there were no significant statistical differences, the following trends were observed in the results: 55-71 year old age group (14%) was most infected with malaria parasite with the highest prevalence among those on the 8A first-line ART (10.3%, 14/122); (χ2=1.03, p=0.96), only participants in the 8A and 12A ART protocols were infected; parasite prevalence was higher in patients with detectable viral load (14.3%, 3/21), (OR=.0.57 (CI: 0.15-2.2), p=0.41), while GMPD varied from 45.7-53.3-±23.1/μl of blood. Low malaria parasite prevalence and density were detected amongst HIV patients receiving ART. A systematic malaria test could be helpful to avert morbidity and improve the general health of patients on ART.

P-462. Disparities in HPV Vaccination among HIV Patients at a Rural Federally Funded HIV Clinic- A Retrospective Study

Abstract Background Our study aimed to evaluate the demographic factors of HPV vaccination among racial minorities of HIV patients at a non-academic Ryan White clinic in rural Pennsylvania. Methods A retrospective cross sectional study (n=143) was conducted on a population composed of White (51.05%), White Hispanics WH (11.19%), Black (27.97%), Black Hispanics BH (1.4%), and Unknown (8.39%). Proportions and chi-square tests were used and multivariate regression analysis was done with p≤0.05 as significant. Results Our study found that 35% of the population was vaccinated, with 60.7% receiving three doses and 23.2% receiving two doses. Age was a key factor (p=0.000) for vaccination acceptance (VA), with those aged 25-45 years having a higher VA than the nonvaccinated (NonVA) (62% vs. 24.7%). VA was lower among those aged 46-65 years (30% vs. 61.3%) and those over 65 years (8% vs. 14%). Lack of awareness of the benefits and misconceptions about the side effects of vaccination are common among different age groups. Males were predominant in our study, with VA higher than NonVA (86% vs. 81.7%, p=0.5), though the difference was not significant. VA by race showed marginal significance (p=0.1), with Whites having the highest VA (40%), followed by Blacks (32%) and Hispanics (20%). Multivariate regression revealed that the 46-65 age group had 80% lower odds of VA compared to the 25-45 group (aOR 0.2, p=0.000), while >65 years had 78% lower odds (aOR 0.22, p=0.021). This regression analysis was adjusted for race (White=Ref, Black p=0.7, Hispanic p=0.1). Upon further stratification of the Hispanic population, VA in the 25-45 years was 6.4% for Black Hispanics and 22.6% for White Hispanics (p=0.000). Conclusion Our study highlights that age and ethnicity are significant predictors of vaccination acceptance, with younger individuals and Whites demonstrating a higher likelihood of vaccination acceptance. Among the racial minorities, vaccination acceptance was lowest in Hispanics. These findings underscore the importance of demographic and cultural factors affecting vaccination rates. Targeted interventions to increase awareness and future studies are needed to determine the factors associated with vaccine hesitancy and work toward implementing new strategies to improve it. Disclosures All Authors: No reported disclosures

P-449. Healthcare Burden of Venous Thromboembolism (VTE) among People Living with Human Immunodeficiency Virus (PLHIV): A Nationwide Inpatient Data Analysis (2019-2021)

Abstract Background Venous Thromboembolism (VTE) imposes a substantial economic burden, estimated to incur almost $10 billion each year. People Living with Human Immunodeficiency Virus (PLHIV) face an almost two- to tenfold higher risk of developing VTE compared to the general population. However, limited data exists on the healthcare burden of VTE among PLHIV. The study investigated the healthcare burden of VTE among PLHIV compared to non-HIV patients. Additionally, the study examined the difference in sociodemographic factors between the two groups. Methods We analyzed data from the National Inpatient Sample database from 2019 to 2021 to identify all hospitalizations with a primary diagnosis of Acute Venous Thromboembolism. Subsequently, we categorized patients into HIV and non-HIV groups. Stata 18.0 was utilized for analysis, with a p-value < 0.05 indicating statistical significance. Hospital costs were adjusted for inflation using the US Consumer Price Index. Results Among the 821,494 hospitalizations for VTE, 2230 patients had HIV infection. HIV patients were significantly younger (52.5 vs. 63.4 years) and predominantly male, Black (56.3% vs. 20.0%), and Hispanic (11.3% vs. 7.2%) individuals. The HIV group exhibited longer hospital stays (6.23 vs. 4.37 days) and incurred higher total hospital costs ($19,117 vs. $14,115) after adjusting for age and sex. Notably, there was a positive correlation between length of stay and hospital costs (r=0.68, p< 0.001). The incidence of AKI and pneumonia significantly prolonged hospital stays in the HIV subgroup (aOR: 2.96, 95% CI: 1.21-4.70; aOR: 2.92, 95% CI: 0.42-5.42). From 2019 to 2021, hospital costs showed a significant increase ($18338, $20330, $24507, p=0.034), while the hospital length of stay displayed an increasing trend but was not statistically significant (mean in days: 5.9, 6.4, 7.0, p=0.147). There was no specific trend observed in the VTE rate each year (0.28%, 0.26%, 0.28%, p=0.7875) among the HIV subgroup. Conclusion The healthcare burden of VTE hospitalization is higher among PLHIV. There has been a concerning increasing trend in hospital costs among PLHIV from 2019 to 2021. Future studies should investigate additional factors contributing to this healthcare burden to enhance the cost-effectiveness of care. Disclosures All Authors: No reported disclosures

P-431. Epidemiologic profile of patients with HIV/AIDS in critical care, a Colombian cohort study

Abstract Background The underlying cause of mortality in patients with HIV/AIDS admitted to critical care units has been changing since the advent of highly active antiretroviral therapy (HAART). This study was done to describe the clinical and epidemiologic profile of patients with HIV in a low-middle income country in the HAART era Baseline characteristics of 806 HIV admissions to ICU *Only patients with CD4 count ≤200 cel/ µL. Missing data in 21 of 743 patients with CD4 count data available and ≤200 cells/µL ART: antiretroviral therapy. CKD: chronic kidney disease. COPD: chronic obstructive pulmonary disease. Methods This was a retrospective cohort study which included adult patients with a diagnosis of HIV, admitted for at least 24 hours to the intensive care unit (ICU) in either of 5 hospitals in Medellín, Colombia, between January 2009 and December 2020. Demographic, clinical and laboratory data were collected. A descriptive analysis and an univariable analysis were done and missing data were imputed. A binomial logistic regression was performed with age and sex considered a priori as confounders; other variables were included in the multivariable analysis if p< 0.05. Causes for ICU admission in HIV-positive patients *Patients could have more than 1 cause of admission to ICU **Patients could have more than 1 opportunistic infection at ICU admission CMV: cytomegalovirus. CNS: central nervous system. HSV: herpes simplex virus. MAC: Mycobacterium avium complex. OI: opportunistic infection. PCP: Pneumocystis jiroveci. TB: tuberculosis. Results During the study period, 806 admissions of HIV patients to the ICU were recorded. More than 80% of patients had a CD4 count of < 200 cells/µL. ICU admission for an opportunistic infection (OI) was more frequent in patients who died, compared to patients without an OI. OIs explained 76% of admissions (Table 1). The main cause for ICU admission was respiratory failure followed by sepsis and central nervous system (CNS) compromise (Table 2). A recent diagnosis of HIV (< 1 year), history of a hematologic malignancy, an APACHE II score ≥20, acute respiratory failure, CNS compromise as the cause of ICU admission and empiric use of amphotericin B were all associated to higher mortality among HIV patients admitted to the ICU (Table 3). A trend to a lower proportion of OIs as the cause for admission, correlated with a lower mortality trend throughout the years (close to 50% mortality in 2009 and to 15% in 2020 (Graph 1). Variables associated with mortality in HIV infected patients admitted to the ICU AKI: acute kidney injury. ART: antiretroviral therapy. CNS: central nervous system. OI: opportunistic infection. ORa: adjusted Odds ratio Conclusion The main cause of mortality in VIH patients admitted to the ICU continues to be respiratory failure and sepsis secondary to OIs in low-middle income countries like Colombia. Mortality was associated to overall disease severity (respiratory failure, APACHE II score ≥20) and certain host conditions (hematologic malignancies and CNS compromise). Despite an epidemiologic profile typical for a low-middle income country, mortality has been decreasing consistently throughout the years. Trends in mortality and type of admission diagnosis in HIV infected patients admitted to the ICU Disclosures All Authors: No reported disclosures

P-450. Burden of Fungal Infection among People Living with HIV (PLHIV): A Nationwide Inpatient Data Analysis (2019-2021)

Abstract Background Fungal diseases represent a significant healthcare concern in the general population. Their prevalence and impact are even more pronounced among PLHIV, yet data within this population remains limited. The study aims to investigate the most prevalent fungal infection among PLHIV and its corresponding healthcare burden. Additionally, it explores the sociodemographic of fungal infection among PLHIV. Methods The National Inpatient Sample database from 2019 to 2021 was utilized to identify all patients with a primary diagnosis of fungal infection. Patients were categorized into HIV and non-HIV. We used Stata 18.0, with a p-value < 0.05 indicating statistical significance. Results Among the 66, 225 hospitalized patients with fungal infection, there were 3543 weighted HIV patients (4.9%). HIV patients were significantly younger (43.8 vs. 62.9), Black (52.7%), with Medicaid (51.2%), and with a low median income of ≤ $49,000 (50.2%). No specific trend was observed from 2019 to 2021 in the prevalence of fungal infections among PLHIV (4.9%, 5.1%, 4.7%) and total hospital costs ($25600, $26913, $25869) There remains an increased likelihood of cryptococcus (OR: 5.69, 95% CI: 4.6-7.0) and pneumocystis (OR: 10.71, 95% CI: 8.7-13.2) among PLHIV compared to the general population after adjusting for age and sex. Cryptococcus infection has a longer length of stay (LOS) compared to other fungal infections among PLHIV (13.5 vs. 7.6, p< 0.05) and higher total hospital costs ($52470 vs. $20153, p< 0.05). The result was consistent with multivariate analysis after adjusting for age, sex, and Charlson comorbidity index (CCI). In contrast, pneumocystis infection among PLHIV had shorter LOS compared to other fungal infections (8.3 vs. 9.8, p< 0.05), and the total hospital costs were significantly lower ($21331 vs. $33542, p< 0.05). However, in a multivariate analysis after adjusting for age, sex, and CCI, only the difference in total hospital costs remained significant. Conclusion Fungal diseases remain a serious concern among PLHIV, presenting with unique sociodemographic characteristics and significant healthcare costs, particularly with cryptococcus infection. Future strategies should be directed at ways to reduce this significant healthcare burden. Disclosures All Authors: No reported disclosures

P-432. Understanding Weight Changes in HIV Patients on Integrase Strand Transfer Inhibitor-based Antiretroviral Therapy: Insights from Southern India

Abstract Background As HIV infection continues to pose a significant public health challenge, especially in regions like Southern India, effective antiretroviral therapy (ART) remains pivotal for improving patient outcomes. Integrase Strand Transfer Inhibitors (INSTIs) have emerged as cornerstone agents in ART regimens, yet their specific impact on weight changes in HIV-infected individuals, particularly in Southern India, warrants comprehensive investigation due to limited existing data. Methods This retrospective study analyzed medical records of HIV-infected patients receiving care at healthcare facilities in Southern India. Patients who initiated INSTI-based antiretroviral therapy between April1, 2022, and December 31, 2023, were included in the analysis. Data on demographic characteristics, baseline weight, and weight measurements at follow-up visits were collected from electronic medical records. Statistical analysis, including descriptive statistics and paired t-tests, was conducted to assess changes in weight over time following initiation of INSTI-based therapy. Results The study included 84 patients diagnosed with HIV, predominantly HIV-1, with a male representation of 61% (n=51) and a median age of 36.3 years (range: 20–65 years). Common opportunistic infections observed were pulmonary tuberculosis, oral candidiasis, and herpes zoster. The primary antiretroviral therapy regimens were TDF+3TC+DTG or TDF+FTC+DTG. Following initiation of INSTI-based therapy, 69% of patients experienced weight gain, averaging 3.81 kg at 3 months, with 18.1% gaining over 4 kg. Median BMI increased from 23.82 kg/m² to 25.9 kg/m² at 8.5 months post-ART initiation. Among ART-naïve patients, 76% experienced weight gain, with 18.1% gaining 8.36 kg at 9 months. Gender and age did not show significant associations with weight gain. However, weight gain exhibited a positive correlation with time after INSTI initiation (r = +1), indicating an expected increase in weight per 0.1 months (F = 4.62, p = 0.032). Conclusion In conclusion, our findings underscore the significant weight gain associated with INSTI-based antiretroviral therapy among HIV-infected patients in Southern India, emphasizing the importance of monitoring and managing metabolic changes in clinical practice. Disclosures All Authors: No reported disclosures

P-795. Unravelling the Enigma: Evaluating False Positive and Invalid Results in Urinary TB LAM Test among HIV Patients with Opportunistic Infections

Abstract Background Various studies suggested that successful implementation of urine Lateral Flow –Lipoarabinomannan (LF LAM) testing could greatly improve TB diagnosis and treatment in HIV patients.Studies from India are scarce regarding urine LF-LAM testing. One should be careful while interpreting the positive test as this test can be positive in NTM, or nocardiasis. This case study highlights the false positive test result of LF-LAM testing and its impact on clinical decision-making in HIV TB co-infection. Methods In,this prospective observational hospital based study total 95 adult patients had been included consecutively regardless of their presenting symptoms or CD4 count.During this study, all recruited patients were underwent for relevant investigation for diagnosing opportunistic infections including TB and simultaneously urine LF-LAM assay tests were performed during hospitalisation.Urine LF- LAM testing had been conducted using the Determine Ag assay and interpreted using the 4-grade scale provided by the manufacturer. Results Out of total 95 patients, 31 were diagnosed with TB, and 25 tested positive for LAM. However, among the 25 LAM-positive patients, five were found to have false-positive results, while two patients received invalid results. Among the six cases of false-positive TB LAM results, three patients had confirmed NTM (Non-tuberculous mycobacterial) infections, one case was culture-positive for nocardiosis, and another had Cryptococcal infection. One case involved urosepsis with Diabetic Ketoacidosis. All five cases were negative for ZN stain, GeneXpert, and TB culture, and no ATT was administered. Tragically, two patients among these five expired. Additionally, both patients with invalid results had chronic kidney disease. Conclusion There can be false-positive TB LAM results with several clinical conditions like NTM infections,Nocardiosis,cryptococosis.These clinical conditions are close differential diagnosis of TB and requires invasive or advance testing methods. While urinary TB LAM testing demonstrates promising sensitivity in diagnosing tuberculosis among hospitalized HIV patients, the occurrence of false-positive results and invalid result outcomes alert clinicians and one should exercise caution in interpreting TB LAM results. Disclosures All Authors: No reported disclosures

631. Cost-effective diagnostic algorithms for Ugandan patients with solid tumors who develop chemotherapy-associated febrile illness

Abstract Background Microbiology diagnostic tests are often prohibitively expensive in resource-limited settings. Cost-effective diagnostic algorithms could potentially guide diagnostic evaluation for chemotherapy-associated febrile illness in resource-limited settings where comprehensive testing is not possible. This is particularly true in sub-Saharan Africa, where the high prevalence of HIV and tuberculosis (TB) place patients at increased risk of developing opportunistic infections that do not frequently occur among patients receiving chemotherapy in the United States or Europe. Methods We created a decision analytic model to evaluate the costs, diagnostic yield, and cost-effectiveness of diagnostic algorithms for adult inpatients with solid tumors who developed fever within 30 days of receiving chemotherapy in Uganda. Since Uganda has a high prevalence of HIV and TB, diagnostics included serum cryptococcal antigen (CrAg) lateral flow assay, Alere TB urinary lipoarabinomannan (LAM), malaria rapid testing, and aerobic blood cultures. We considered the following testing algorithms: 1) a comprehensive approach where all tests were performed, and 2) various stepwise algorithms where tests were performed in series and stopped testing with the first positive result. We obtained prevalence data from a cohort of 100 patients with solid tumors who were admitted to the Uganda Cancer Institute (Kampala, Uganda) with fever. Test performance was taken from the published literature. Results A comprehensive diagnostic testing strategy yielded 64% of correct diagnoses at a cost of $97.85 per correct diagnosis. Of the stepwise strategies, testing CrAg first yielded the cheapest strategy, at a cost of $85.49 per correct diagnosis, and the highest number of appropriate diagnoses (59%). The incremental cost-effectiveness ratio was $234 per additional correct diagnosis for the comprehensive over this sequential strategy. Conclusion Comprehensive diagnostic testing is optimal for patients who experience post-chemotherapy febrile illness in resource-limited settings. If this strategy is not available, stepwise testing with CrAg then TB LAM is the optimal strategy to maximize correct diagnosis and minimize costs. Disclosures All Authors: No reported disclosures

P-530. Clinician Utilization of CDC-aligned HIV PrEP Panels

Abstract Background In Dec 2021, the CDC issued updated guidelines for HIV PrEP. Diagnostic panels were developed to facilitate the baseline evaluation and monitoring of patients for HIV, STIs, HBV, and HCV among PrEP users. Methods Retrospective analysis of results reported for HIV PrEP panels ordered between Feb 2023 and Mar 2024. The panels were developed to capture HIV PrEP testing for baseline (BL) evaluation and for monitoring of oral and injectable agents in males and females. Tests were aligned with those recommended by the 2021 updated guidelines and included panels with and without HIV-1 RNA PCR. Standalone testing was also available. Testing intervals were assessed. Results 31,347 unique patients had PrEP-related testing. Of those, 25,373 had one or more tests with 146 (0.6%) testing positive for HIV at baseline. 14,480 unique patients had two or more HIV PrEP tests on different dates. 98% were male with a median age of 36 years. 20 of those patients tested positive for HIV (0.14%). Of those, 15 tested positive for HIV Ag/Ab, but 14 were negative for HIV RNA. 5 patients were positive for HIV-1 RNA, but tested negative for HIV Ag/Ab. The HIV false positive rate was 0.25%. There were 5 HIV RNA positive tests out of 52,050 negative HIV Ag/Ab tests (0.001%). Testing closely adhered to recommended intervals for both oral and injectable agents. 15,041 out of 25,227 patients (59.6%) had an STI test during the analysis. 2,876 out of 15,041 patients had at least one STI during PrEP treatment (19.1%). Chlamydia was diagnosed in 5.8% and gonorrhea in 9.2%. 6.7% of patients were positive for treponemal antibodies with 5.1% RPR reactive. STI co-infections were also seen. Those with active HBV and HCV infections while on PrEP were each 0.3%. Conclusion In this large laboratory cohort of patients utilizing HIV PrEP testing, HIV infections were rare, supporting the low rates seen in HIV PrEP trials. Infections were mainly found at BL screening. False positive HIV Ag/Ab results were consistent with published reports. STI rates are significant with approximately 1/5 of patients testing positive, although active HBV and HCV infections were very low for those utilizing PrEP. Disclosures Charles M. Walworth, MD, Labcorp: Employee|Labcorp: Employee|Labcorp: Stocks/Bonds (Public Company) Laura Gillim, PhD, Labcorp: Employee|Labcorp: Stocks/Bonds (Public Company) David Alfego, PhD, Labcorp: Employee|Labcorp: Stocks/Bonds (Public Company) Ato Aikins, PhD, Labcorp: Employee

P-1406. Racial Disparities in HIV Prevalence and Complications in Hospitalized Patients

Abstract Background Racial and ethnic disparities in HIV care and outcomes are well known. Multiple causes have been reported including inequalities in access to care and pre-exposure prophylaxis (PrEP), housing instability, lack of antiretroviral insurance coverage, and economic disadvantages. We aim to evaluate the disparities in HIV prevalence and outcomes in hospitalized patients. Methods We analyzed the 2020 United States National Inpatient Sample (NIS) data of all patients with a diagnosis of HIV admitted inpatient. The NIS database is the largest publicly available database of patients hospitalized in the United States and contains approximately 20% stratified samples of all hospital discharges in the United States. Results There were 38,666 admissions with a diagnosis of HIV in 2020, of which 30.3% were females. 51.6% of the HIV patients were Blacks, 30% Whites, 13.7% Hispanics, 0.7% Asians, 0.6% Native Americans, and 3.4% others. The mean age was 50.8 years, and the mean length of stay was 6.4 days. In the bivariate analysis, the Hispanics were more likely compared to others to have Kaposi Sarcoma (1.8% vs. 1.1%, p< 0.001), cryptococcal meningitis (1.5% vs. 0.6%, p< 0.001), disseminated coccidioidomycosis (0.2% vs 0.0%, p< 0.001), hepatitis C (6.7% vs. 5.3%, p< 0.001), Covid-19 infection (7.9% vs. 4.9%, p< 0.001) and pneumocystis jiroveci pneumonia (3.2% vs. 2.3%, p< 0.001). The multivariate analysis showed no statistically significant racial or ethnic difference in all-cause mortality (p=0.17). However, patients in the highest income quartile had significantly lower all-cause mortality compared to those in the lowest quartile after adjusting for variables including race, ethnicity, and HIV complications (OR 0.69, 95% CI 0.54-0.89, p=0.004). Conclusion Our study showed that the prevalence of HIV is still disproportionally high in Blacks. While about 16% of all patients in our dataset are Black, about 52% of the HIV patients are Black. However, Hispanic patients appear to have more HIV complications. Cultural appropriate interventions to prevent HIV acquisition, increase HIV screening, and early initiation of treatment in racial and ethnic minorities are warranted. Mining a national database can provide insights into morbidity and mortality trends in patients living with HIV. Disclosures All Authors: No reported disclosures