Infectious Diseases Outpatient Clinic Research Articles

Pharmacist intervention to improve patients' knowledge and attitude towards hepatitis B infection.

Lack of knowledge/awareness of people living with hepatitis B (PLH) often leads to misinformation and stigmatisation. This study aimed to assess the contribution of the clinical pharmacist (CP)-led education on knowledge of PLH about their disease. This prospective, cross-sectional study was carried out between 1 October 2017 and 1 April 2018, at infectious disease and gastroenterology outpatient clinics in a university hospital. All PLH were interviewed face-to-face by a CP and a questionnaire about hepatitis B virus (HBV) knowledge was applied both at the beginning of the study (first interview) and 3months later (second interview). Correct information was provided verbally to the patients by the CP concerning their incorrect answers during the first interview. A 10% increase in the number of correct answers was targeted for the second interview. A total of 147 PLH with a mean age of 43.05±13.25years were included in the study (55.8% female). In the first interview, the mean (±standard deviation) number of correct answers was 35.53±9.15 out of 51 questions. In the second interview, correct answers were 48.67±2.74 with an increase of 25.8% (P<.001). In the first interview, the number of correct answers was higher for the following groups: 20-39 age group, people with monthly income of>1081 $ and university graduates. The number of correct answers to all questions but one was elevated (P<.001) in the second interview. Answers to the question "there is a carrier state in chronic hepatitis B (CHB)" did not change (P=.125). Significant improvement was observed in the correct answer rate after CP's contribution, therefore as a team member, CP has an important role in improving patients' knowledge and attitude towards HBV infection.

Assessment of Pulmonary Arterial Hemodynamic and Vascular Changes by Pulmonary Pulse Transit Time in Patients with Human Immunodeficiency Virus Infection.

Introduction:Pulmonary arterial hypertension and human immunodeficiency virus (HIV) infection is a well-known association. Pulmonary pulse transit time (pPTT) is a recent echocardiographic marker that might be used for evaluation of pulmonary arterial stiffness (PAS) in patients with HIV infection. We aimed to investigate whether pPTT elevated in patients with HIV infection compared to healthy controls and its association with echocardiographic indices of right ventricular functions.Materials and Methods:Fifty HIV (+) patients from infectious disease outpatient clinics and fifty age- and sex-matched HIV (−) healthy volunteers were enrolled in this study. pPTT was measured from pulmonary vein flow velocity as the time interval between the R-wave in the electrocardiography and corresponding peak late systolic was then calculated as the mean from two separate pw-Doppler measurements.Results:pPTT, tricuspid annular peak systolic excursion (TAPSE) and right ventricle fractional area change (FAC) were significantly lower in patients with HIV than control patients (177.1 ± 34.9 vs. 215.7 ± 35.7 msn, P < 0.001; 2.33 ± 0.28 vs. 2.19 ± 0.22, P = 0.039; 45 [4.25] vs. 41.1 [4.0], P = 0.032, respectively). pPTT was positively correlated with FAC, TAPSE and cluster of differentiation 4 count (r = 0.210; P = 0.036, r = 0.256; P = 0.041, r = 0.304; P = 0.044, respectively).Conclusion:Our study showed that pPTT, TAPSE, and right ventricle FAC levels were lower in patients with HIV infection. pPTT is an important predictor in patients with HIV expected to develop pulmonary vascular pathology.

Telephone consults at the Infectious Disease Outpatient Clinic during the early period of the COVID-19 epidemic.

Once novel coronavirus disease 2019 (COVID-19) emerged in Wuhan, China in December 2019 and the first case in Japan was reported the following month, telephone inquiries to the Infectious Disease Outpatient Clinic increased. During the first wave of the epidemic, before medical measures for this emerging infectious disease were in place, the Outpatient Clinic received a significant amount of inquiries, reflecting the prevailing social turmoil. During the second wave, inquiries did not increase because a proper system of medical care was in place in hospitals and communities. Therefore, in the early stages of an emerging infectious disease, relevant information needs to be quickly consolidated and it needs to be linked to measures that are appropriate to the situation.

614. Long-Acting Lipoglycopeptides for the Treatment of Bone and Joint Infections and Bacteremia in Infectious Disease Outpatient Infusion Clinics

BackgroundLong-acting lipoglycopeptides (LGPs) are approved for the treatment of acute bacterial skin and skin-structure infections. Broad Gram-positive coverage and weekly dosing regimens are useful for other diagnoses, but real-world data supporting such use are sparse. We review our experience of dalbavancin and oritavancin for the treatment of bone and joint infection (BJI) and bacteremia (BAC) in outpatient infusion clinics (OICs).MethodsWe conducted a multicenter, retrospective, observational cohort study of patients (pts) receiving long-acting LGPs in OICs over 2 yrs from 2018-2019 for BJI and BAC. Data collected included demographics, diagnosis, dosing regimen, microbiology, clinical outcomes, and adverse events (AEs). Clinical success, defined as resolution of infection with continued oral antibiotics allowed, was assessed at the next follow-up visit. Worsening infection, the need for additional intravenous therapy, and discontinuations during therapy were deemed non-successful.ResultsWe identified 70 pts (mean age: 64±16 years, 53% male) from 25 OICs, who received dalbavancin (n=50), oritavancin (n=19) and both (n=1). BJI accounted for 55 (79%) with 31 osteomyelitis, 9 bursitis, 7 prosthetic joint, 7 septic arthritis and 1 tenosynovitis. BAC was the primary diagnosis in 15 (21%) and sources were 6 device, 2 lower respiratory tract, 2 urinary tract and 5 unknown. 46% of pts were treated in the OIC without prior hospitalization. 72 Gram-positive isolates were obtained from 67 pts, with Staphylococcus aureus predominant (42/72, 58%), including methicillin-resistant (26/72, 36%) and methicillin-susceptible isolates (16/72, 22%). Median number of doses administered were 2 [IQR 1-2] in BJI and 1 in BAC [IQR 1-2]. Overall clinical success was 86% (57/66), with 4 non-evaluable. BJI had 85% success (44/52), with 90% in osteomyelitis (28/31), 50% in prosthetic joint (3/6) and 87% (13/15) in the others. Clinical success was 93% (13/14) in BAC. Three pts (4%) on dalbavancin experienced mild AEs, none resulting in discontinuation of therapy.ConclusionThis multicenter real-world study of long-acting LGPs demonstrates safety and high clinical success rates in BJI and BAC. Our experience suggests a role for use of these agents in treatment of BJI and BAC in the outpatient setting.Disclosures Brian S. Metzger, MD, MPH, Allergan (Speaker’s Bureau)Cumberland (Speaker’s Bureau)Melinta (Speaker’s Bureau) Ramesh V. Nathan, MD, FIDSA, Merck & Co. (Other Financial or Material Support, Grant Steering Committee Member) Lucinda J. Van Anglen, PharmD, Merck & Co. (Grant/Research Support)

601. Disparities in Diabetes Care: Smoking Cessation among Women and Minorities Living with HIV at an Urban Academic Medical Center

BackgroundPeople living with HIV (PLWH) and diabetes mellitus are at increased risk of developing significant medical complications such as atherosclerotic cardiovascular disease. Disproportionate rates of diabetes and HIV among minority groups raise the issue of how demographic disparities may impact care. The American Diabetes Association (ADA) 2020 guidelines for diabetes care recommend optimal glycemic levels (A), blood pressure control (B), lipid reduction (C), and smoking cessation (N), commonly referred to as ABC or ABCN criteria. This quality assessment project examines diabetes management in PLWH by gender, race/ethnicity, and BMI, in a predominantly minority-serving clinic, as assessed by rates of guideline adherence to the above metrics.MethodsThis project was reviewed and approved by the Rutgers IRB. Patients from an HIV registry of University Hospital Infectious Disease Outpatient clinic in Newark, NJ were reviewed for a diagnosis of diabetes and both a clinic visit and an A1c score recorded between 2/1/2019 and 1/31/2020. Achieving glycemic target was defined as HbA1c < 7.5 for patients < 65 and HbA1c < 8 for patients > 65. Target adherence criteria also included a blood pressure average of < 140/90 over this period and an LDL-c of < 100 mg/dL. Non-smoking status includes both former and never smokers.ResultsOf 1035 patients reviewed, a total of 172 met criteria. Adherence rate for achieving goal HbA1c was 61.6% (95% CI 54.2-68.6, n=172). Blood pressure and LDL-c adherence rates were 65.1% (95% CI 57.7-71.8, n=172) and 67.4% (95% CI 60.1-74.0, n=172), respectively. ABC and ABCN rates were 24.4% (95% CI 18.6-31.4, n=172) and 18.6% (95% CI 13.5-25.1, n=172). The overall smoking rate, as well as the rates in the female subgroup, those with BMI 18.5-24.9, and the non-Hispanic black subgroup were significantly higher than the national average (P< 0.05).Table 1: Demographic Data of PLWH and Diabetes Table 2: Adherence to ABCN Criteria in Diabetes Care by Demographics for PLWH from 2/1/2019 – 1/31/2020 ConclusionFor diabetic PLWH, smoking cessation requires improvement, particularly in female, normal BMI, and non-Hispanic black subgroups. These findings, in addition to a majority overweight patient population, highlight the need for increased education and interventions aimed at nutritional counseling and risk factor mitigation among all patient subgroups.Disclosures All Authors: No reported disclosures

615. Overlooking those at Intermediate Risk? ASCVD Prevention Measures among People Living with HIV at an Urban Academic Medical Center

BackgroundThe American College of Cardiology (ACC) recognizes HIV as a risk factor for atherosclerotic cardiovascular disease (ASCVD). However, 2019 guidelines do not address people living with HIV (PLWH), aside from stating that their Risk Estimator Plus tool, which is used to calculate a 10-year risk for ASCVD and advise management, likely underestimates CVD risk in PLWH. This quality assessment project examines rates of ACC guideline adherence for ASCVD prevention for PLWH who have calculated risk scores in the low (< 7.5%), intermediate (> 7.5% & < 20%), and high-risk (> 20%) ranges. Patients analyzed are from an HIV registry of University Hospital Infectious Disease Outpatient clinic in Newark, NJ. The clinic’s 2451 total patients are 40% female, 63% non-Hispanic black, 23% Hispanic, and 64% > 45 years old.MethodsThis project was approved by the Rutgers IRB. Patients (40-79 years) with a clinic visit from 2/1/2019 to 1/31/2020 were reviewed. ASCVD risk scores were calculated using the Risk Estimator Plus for all patients when data was available. Guideline adherence rate was defined as following 2019 ACC guidelines for appropriate statin therapy, while considering medication interactions.ResultsOf the 1127 patients who met criteria, 744 ASCVD risk scores were calculated. Lipid values outside the calculator range (229) or no documented lipids (154) resulted in non-calculatable scores. Guideline adherence rate for the intermediate-risk group was significantly less than the high-risk and low-risk groups (P< 0.05): low-risk 92.8% (95% CI 90.0-95.1, n=346), intermediate-risk 35.2% (95% CI 29.7-41.1, n=270), and high-risk 52.3% (95% CI 43.8-60.8, n=128). Adherence rates within the intermediate-risk group for patients with hypertension (HTN) and smokers were significantly less than those with CVD (P< 0.05).Table 1: Patients with Calculated ASCVD Risk Score > 20 for PLWH from 2/1/2019 – 1/31/2020 Table 2: Patients with Calculated ASCVD Risk Score > 7.5 & < 20 for PLWH from 2/1/2019 – 1/31/2020 Table 3: Patients with Calculated ASCVD Risk Score < 7.5 for PLWH from 2/1/2019 – 1/31/2020 ConclusionLower overall guideline adherence rates within the intermediate risk group, and particularly among those with a history of HTN and smoking, highlights the need for targeted care. Provider education on the calculation and application of ASCVD risk scores, as well as increased awareness of the risk-enhancing nature of HIV infection in coexistence with the traditional risk factors of CVD history, diabetes, HTN, and smoking are important steps to increase adherence rates.Disclosures All Authors: No reported disclosures

Bir Eğitim Araştırma Hastanesinde İnfeksiyon Hastalıkları Polikliniğine Başvuran Hastalarda Grip Aşısı ile İlgili Bilgi Düzeyi, Tutum ve Farkındalığın Değerlendirilmesi

Bir Eğitim Araştırma Hastanesinde İnfeksiyon Hastalıkları Polikliniğine Başvuran Hastalarda Grip Aşısı ile İlgili Bilgi Düzeyi, Tutum ve Farkındalığın Değerlendirilmesi

Turkish validity and reliability of the InternalizedAIDS-Related Stigma Scale.

This study was conducted methodologically to adapt the Internalized AIDS-Related Stigma Scale (IA-RSS) to Turkish society. DESIGNANDMETHODS: The universe of the study consisted of 250 people who were treated in the infectious diseases outpatient clinic. A total of 60 individuals living with human immunodeficiency virus (HIV) composed the sample. The Individual Information Form and IA-RSS were used for data collection. All the statistical procedures performed in the validity and reliability stages of the study show that the scale is a valid, reliable measurement tool for the Turkish culture. PRACTICEIMPLICATIONS: The Turkish version of the IA-RSS was determined as a valid and reliable screening tool that measures internal stigmatization in living with HIV.

Non-COVID-19 Patients with Life-threatening Diseases Who Visited a Fever Clinic: A Single-center, Observational Study in Tokyo, Japan.

Objective In fever clinics screening coronavirus disease (COVID-19), there could be patients with life-threatening diseases that physicians should not overlook. We exploratorily investigated the final diagnosis among non-COVID-19 hospitalized patients who visited the fever clinic. Methods This was a retrospective, observational, and single-centered study conducted in the National Center for Global Health and Medicine (NCGM), Tokyo, Japan. We conducted a retrospective chart review of patients who visited the fever clinic in the NCGM from 11 March 2020 to 24 April 2020. Patients Patients who met the following clinical criteria visited the fever clinic in the NCGM: (1) body temperature >37.5℃, (2) any symptoms consistent with COVID-19 or (3) referral from local healthcare facilities. In the fever clinic, all patients who met the above criteria had severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test with nasopharyngeal swab specimens. Patients with severe symptoms or an unstable condition were sent to an outpatient clinic for infectious diseases for further evaluation and treatment. Results Among 1,470 patients who visited the fever clinic, 84 patients were hospitalized, and 45 of them were diagnosed as having COVID-19. Among the remaining 39 non-COVID-19 patients, there were nine patients with life-threatening diseases. The life-threatening diseases included acute heart failure, septic shock, pneumocystis pneumonia, peritonsillar abscess, and necrotizing fasciitis. Conclusion Physicians should evaluate each patient carefully while considering other life-threatening conditions even in such a COVID-19 pandemic era.

Çocuklarda Periyodik Ateş, Aftöz Stomatit, Farenjit ve Adenit (PFAPA) Sendromu: 82 Hastanın Retrospektif Olarak Değerlendirilmesi

Amaç: Periyodik ateş, aftöz stomatit, farenjit ve adenit (PFAPA) sendromu ani yükselen ateş, stomatit, farenjit ve adenit ile karakterize olup çocukluk çağında en yaygın görülen tekrarlayan ateş sendromudur. Bu çalışmada, bu hastalığa dair farkındalığı artırmak amacıyla PFAPA sendromu tanısı almış olan çocuklara dair klinik veriler değerlendirilmiştir. Gereç ve Yöntemler: Bu retrospektif çalışma 1 Ekim 2017—30 Haziran 2019 döneminde Diyarbakır Çocuk Hastalıkları Hastanesi Çocuk Enfeksiyon Polikliniği’nde PFAPA tanısıyla izlenmiş olan 82 hastayı kapsamıştır. Hastaların demografik özellikleri, klinik ve laboratuvar bulguları, gördüğü tedaviler ve tedaviye yanıtları ile ilgili veriler tıbbi kayıtlardan elde edilmiştir. Bulgular: Hastaların 52’si erkek, 30’u kızdı. Medyan şikayet başlangıç yaşı 18 (1–120) ay, medyan tanı yaşı 53 (12–172) aydı. Seksen iki hastanın hepsinde ateş ve farenjit, 56’sında lenfadenit, 48’inde kriptik tonsilit, 28’inde stomatit mevcuttu. Laboratuvar tetkiklerinde lökositoz (%46,38), nötrofili (%59,7) ve lenfopeni (%4,47) tespit edildi. C-reaktif protein hastaların %86,56’sında pozitif olup medyan değer 69,9 (6,19–279) mg/dl idi. Eritrosit sedimantasyon hızı medyan değeri 36 (7–101) ml/saat idi. Otuz dört (%41,46) hastada ateş nedeniyle en az bir kez hastaneye yatırılma hikayesi vardı. Elli sekiz (%71) hastanın birinci derece akrabalarında sık tonsilit atakları mevcuttu ve bunlardan 21’i (%25,6) tonsilektomi geçirmişti. Tüm hastalarda metilprednisolon tedavisine dramatik yanıt alınmıştı. Tartışma ve Sonuç: PFAPA sendromunda erken tanı gereksiz tetkik, tedavi ve hastaneye yatışları önlemek için önemlidir. Beş yaşından küçük olan ve yineleyen ateş ve tonsilit atakları ile getirilen, özellikle de ailesinde sık tonsilit geçirme veya tonsilektomi hikayesi olan çocuklarda ayırıcı tanıda PFAPA sendromu göz önünde bulundurulmalıdır.

Cognitive changes in patient living with HIV-AIDS and apolipoprotein-E polymorphism: is there an association?

Patients with HIV-AIDS treated with antiretroviral drugs still have high prevalence of cognitive disorders and many factors are likely to contribute for ongoing neurologic decline such as chronic low-level infection, coinfections with hepatitis B and C and genetic influences, both the virus and the host. Some evidences suggest that the genetic APOE polymorphism may be an associated risk factor. This study aimed to evaluate the association between APOE polymorphisms and cognitive disorders in patients with HIV-AIDS.This was a cross-sectional study comprising 133 patients aged 19-59years old, with HIV-AIDS and were assisted at the infectious disease outpatient clinics at Hospital Universitário Oswaldo Cruz, in Recife, Brazil. For cognitive evaluation, Mini-Mental State Examination test (MMSE) and Montreal Cognitive Assessment test (MoCA) were used. The determination of APOE gene polymorphism was performed by using the PCR-RFLP technique.Sociodemographic and clinical characteristics were not significantly associated to APOE ε4 polymorphism, except for the high results of CD4 rate (p < 0.015). There was an absence associated between APOE ε4 polymorphism and neurocognitive tests.This study found no association between cognitive alterations and APOE polymorphism in patients with HIV-AIDS in the Northeast of Brazil. The imbalance of APOE allelic frequency distribution, according to Hardy-Weinberg law, there could be an adjustment phase of its equilibrium suffered by the HIV virus, however, the mechanism is still unknown.

Kronik Hepatit B Virüs enfeksiyonu olan hastalarda Hepatit A Virüs seroprevalansı

Amaç: Bu çalışmada, Kronik Hepatit B tanısı ile takipli hastaların Hepatit A seroprevalansının retrospektif olarak araştırılması ve duyarlı kişilerin aşılanması amaçlanmıştır.&#x0D; Gereç ve Yöntemler: Kasım 2018–Kasım 2019 tarihleri arasında hastanemiz enfeksiyon hastalıkları polikliniğine başvuran kronik hepatit B tanılı hastaların HAV Ab-IgG sonuçları değerlendirildi. HAVAb-IgG tetkiki, ARCHITECT i2000SR analizatöründe ARCHITECT® HAVAb-IgG test kiti ile Kemilüminesan Mikropartikül İmmünoassay (CMIA) yöntemi kullanılarak araştırılmıştır. Verilerin istatistiksel analiz Statistical Package for Social Scienses (SPSS) 21 (Inc. Chicago, Illinois, ABD) istatistik paket programıyla analiz edilmiştir. &#x0D; Bulgular: Kronik hepatit B tanısıyla izlenen 138 hasta değerlendirildi. Hastaların 27’sinde HAV Ab-IgG tetkiki yapılmamıştı. Çalışmaya 111 hasta dahil edildi. Hastaların 64’ü (%57,7) kadın, 47’si (%42,3) erkekti. Hastalar 15-84 yaş aralığına sahipti. Yaş ortalaması 48,01±11,86 yıl olarak tespit edildi. Anti-HAV IgG 105 (%94,6) hastada pozitif, 6 (%5,4) hastada negatifti. Anti-HAV IgG pozitif hastaların yaş ortalaması 49,25±11,31 tespit edildi. Anti-HAV IgG negatif olan hastaların 2’si (%33,3) kadın, 4’ü (%66,7) erkekti. Hastalar 15-36 yaş aralığına sahipti. Yaş ortalaması 26,16±5,16 yıl olarak tespit edildi. &#x0D; Sonuç: Kronik hepatit B virüs enfeksiyonu olan hastalarda hepatit A virüs seroprevalansı %94,6 olarak bulundu. HBV enfeksiyonu olan hastalarda HAV Ab-IgG tetkiki yapılmalı ve Anti-HAV IgG negatif olan hastalar aşılama programına alınmalıdır.

137EMF Effectiveness of Emergency Department Screening on Hepatitis C Treatment and Cure

Emergency Department (ED) hepatitis C virus (HCV) screening programs are proliferating. The effectiveness of ED screening, compared to traditional clinic-based screening, at treating and curing HCV is unknown. The objective of this study is to evaluate treatment outcomes for patients identified HCV+ in the ED compared to those screened HCV+ in community clinics. A retrospective cohort study was performed including all patients found HCV seropositive (HCV+) at two urban medical centers in New Orleans, LA from March 2015 to August 2017. Those screened HCV+ in the ED were compared to patients screened HCV+ at one of seven neighboring community clinics. In both screening settings, all chronically infected patients were referred to the same infectious disease outpatient clinic for management of HCV infection. Study outcomes were: starting HCV therapy, completing HCV therapy, and achieving functional HCV cure (sustained virologic response at 12 weeks). Time from HCV antibody screening to each treatment outcome was measured. Analysis was performed using multivariable log-binomial regression, adjusting for insurance and history of intravenous drug use. A total of 3,929 patients (3,556 ED and 373 clinic) were screened HCV+, while 2,720 patients (2,562 ED and 158 clinic) were found chronically infected by persistent HCV RNA. HCV therapy was started in 9.8% of ED patients (median time=13.4 months) and 3.8% of clinic patients (median time=15.8 months). Compared to those screened in a clinic, patients testing HCV+ in the ED had significantly higher likelihood of starting therapy (adjusted relative risk [aRR]=2.82; 95% confidence interval [CI]=1.28-6.23; p=0.01). HCV therapy was completed in 7.8% of ED patients (median time=16.4 months) and 3.8% of clinic patients (median time=18.1 months). Compared to those screened in a clinic, patients testing HCV+ in the ED had significantly higher likelihood of completing therapy (aRR=2.28; 95% CI=1.03-5.05; p=0.04). Functional cure was achieved in 5.6% of ED patients (median time=19.0 months) and 1.9% of clinic patients (median time=23.7 months). Compared to those screened in a clinic, patients testing HCV+ in the ED had significantly higher likelihood of achieving cure (aRR=3.29, 95% CI=1.06-10.19; p=0.04). Patients diagnosed HCV+ in the emergency department were significantly more likely to initiate HCV therapy, complete HCV therapy, and achieve HCV cure, compared to patients screened in a community clinic. We believe the success of ED screening can be attributed to co-localization of follow-up HCV staging and treatment services in proximity to the ED. Furthermore, reflex ordering of viral RNA in the ED improved timeliness and confirmation of HCV chronic infection, likely increasing the momentum of ED patients to start treatment and achieve cure. Expanding ED-based HCV screening may serve as the most effective strategy to deliver HCV treatment and improve patient outcomes.

Siirt İlinde Yüksek Hepatit Delta Antikoru Sıklığı

Amaç: Eş zamanlı hepatit delta virüs (HDV) enfeksiyonu varlığı kronik hepatit B (KHB) ilişkili karaciğer hastalığının seyrini olumsuz yönde etkilemektedir. Bu çalışmada Siirt ilinde hepatit B virusu (HBV) ile kronik olarak enfekte olan hepatit gelişmiş ve gelişmemiş olgularda delta antikoru (anti-HDV) sıklığının belirlenmesi ve HDV koenfeksiyonu varlığının klinik etkilerinin irdelenmesi amaçlanmıştır. Gereç ve Yöntemler: Bu retrospektif kesitsel çalışmaya Şubat 2017-Şubat 2018 tarihleri arasında Siirt Devlet Hastanesi Enfeksiyon Hastalıkları polikliniğine başvuran Anti-HDV testi bakılmış 288’i HBV ile kronik olarak enfekte, 174’ü KHB gelişmiş toplam 462 olgu dahil edildi. HBV deoksiribonükleik asit (DNA), hepatit B “e” antijeni (HBeAg), alanin aminotransferaz (ALT), HDV ribonükleik asit (RNA) sonuçları ile siroz ve hepatosellüler karsinom (HCC) durumu ile ilgili verilere retrospektif olarak ulaşılmıştır. Çalışmaya alınan hastalar Anti-HDV pozitif (n=128) ve negatif (n=334) olmak üzere iki gruba ayrıldı. KHB, siroz ve HCC sıklığı gruplar arasında karşılaştırılmıştır. Bulgular: Toplam 462 olgunun 205’i (%44,4) kadın, 257’si erkek (%55,6) olup, medyan yaşı 37 (çeyrekler arası aralık (IQR) 26 ila 49) idi. Anti-HDV pozitifliği saptanan toplam 128 (%27,8) olgunun 32’sinde HDV RNA çalışılabilmiş ve 9’unda pozitif olarak saptanmıştır. Çalışmamızda nonsirotik ve sirotik olgulardaki anti-HDV sıklığının sırasıyla %26,2 ve %68,8 olduğu görülmüştür. Anti-HDV pozitif olgularda KHB, siroz ve HCC sıklığının Anti-HDV negatif olgulara göre anlamlı oranda yüksek olduğu görülmüştür (p=0,003, p=0,001, p=0,021). Sonuç: Bu çalışmada elde edilen verilere dayanarak, Siirt ilinde HBV ile enfekte olgularda Anti-HDV sıklığının Türkiye ortalamasının (%5,2) çok üzerinde olduğu ve Anti-HDV pozitif olguların KHB, siroz ve HCC gelişimi açısından Anti-HDV negatif olgulara oranla daha yakın izlem gerektirdiği söylenebilir.

Typical Evolution of a Cutaneous Anthrax Lesion

An illustrated case of cutaneous anthrax acquired in eastern Turkey was described in this report. A 56-year-old female patient applied to the infectious diseases outpatient clinic with a painless, dark-colored swelling over her right middle finger accompanied by edema extending to the right hand. Typical disease course of a cutaneous anthrax lesion evolved in a few days. This case report was presented in order to help clinicians to recognize the different stages of the disease in clinical practice. Keywords: anthrax , cutaneous anthrax , eschar , edema

The balancing perspective of hard-to-reach hepatitis C patients who were lost to follow-up: A qualitative study.

BackgroundIn the foreseeable future, patients with hepatitis C virus (HCV) with good healthcare access will all have been cured and the lost to follow-up (LFU) HCV-population will increasingly exist of hard-to-reach patients. Efforts to retrieve these individuals with HCV have been moderately successful so far. A deeper understanding of the reasons for loss to follow-up and the underlying processes is lacking.AimsTo explore reasons for previous loss to follow-up in patients with HCV who have been brought back into care.MethodsIn 2017, fifteen patients with HCV who were evaluated at the University Medical Center Utrecht (UMCU) Infectious diseases outpatient clinic as part of the “REtrieval And cure of Chronic Hepatitis C” (REACH)-project were included in this study through convenience sampling. Face-to-face semi-structured in-depth interviews were conducted and a qualitative analysis based on the grounded theory was applied.ResultsA basic socio- psychological process named “maintaining the achieved balance” was uncovered in patients with HCV who were LFU. This “achieved balance” is the result of a transformative process following the initial HCV diagnosis. It is a steadfast stance in which participants keep HCV out of sight and in the margin of their lives in order to reestablish an optimal state of well-being. The balancing perspective is subsequently defended by repeated evasive behavioral patterns to avoid confrontation with the disease.ConclusionThe balancing perspective gives insight into why individuals with HCV were not retained in care but also why they remained LFU thereafter. Physicians should realize that this mindset can be persistent and repeated efforts may be needed to finally trace and retrieve these patients.

The Effect of an Integrated Health System Specialty Pharmacy on HIV Antiretroviral Therapy Adherence, Viral Suppression, and CD4 Count in an Outpatient Infectious Disease Clinic.

Adherence to antiretroviral (ARV) therapy is critical in order to achieve and maintain viral suppression and improve immune function. Clinical pharmacists and pharmacies focused on human immunodeficiency virus (HIV) have demonstrated the ability to increase ARV medication adherence and subsequently have a positive effect on these lab markers. To evaluate the effect of an integrated health system specialty pharmacy service with a clinic-embedded, HIV-trained pharmacist and pharmacy technician on ARV medication adherence rate, viral load, and CD4 count. This was a single-center, retrospective cohort study conducted from August 7, 2017, to June 30, 2018, at an indigent outpatient infectious disease clinic within Atrium Health (AH), a not-for-profit health system based in Charlotte, NC. The intervention group (opt-in group) received HIV patient care that involved the health system specialty pharmacy service. Once a patient was enrolled in the specialty pharmacy service, medication reconciliation was completed by the pharmacist, financial assistance and prior authorizations were completed if needed; prescriptions were delivered to the patient; and monthly refills calls were conducted to assess adherence, tolerability, and medication changes. The control group (opt-out group) received HIV patient care that did not incorporate the health system specialty pharmacy. The primary endpoints were medication adherence, viral suppression, and CD4 counts. Within-group comparisons from baseline to follow-up were made along with group-to-group comparisons. Adherence was calculated using medication possession ratio. For those patients using Atrium Health Specialty Pharmacy Service (AH SPS; n = 46), the overall median adherence rate was higher at 100% versus only 94% for those patients (n = 50) that opted out of the service (P < 0.01). All but 3 patients (21.7% at baseline vs. 6.5% at follow-up, P = 0.03) using AH SPS reached viral suppression, and all but 1 had improved immune function with a CD4 count of 200 or greater by the end of the observation period (P = 0.03). The change in viral suppression and CD4 count of 200 or greater was not statistically improved between baseline and follow-up in those opting out of using AH SPS. When comparing the 2 groups at reaching these endpoints, there was no statistically significant difference in viral suppression and CD4 count. AH SPS was able to demonstrate improved ARV adherence in those patients using an integrated specialty pharmacy with an embedded pharmacy team, coordinated monthly medication delivery, and refill reminder and adherence calls. This in turn led to improved viral suppression and immune markers by the end of the observation window for patients using AH SPS. No outside funding supported this study. The authors have nothing to disclose.

Pain self-efficacy, race, and motivation to quit smoking among persons living with HIV (PLWH).

Pain and cigarette smoking are commonly co-occurring and costly public health issues, and rates of both conditions are elevated among persons living with HIV (PLWH). Recent work has focused on elucidating the role of cognitive factors in pain-smoking interrelations, and PLWH have endorsed various beliefs regarding pain and smoking. There is reason to suspect that pain self-efficacy (i.e., belief in one's ability to cope with pain) may be associated with the maintenance of smoking. However, no previous research has examined relations between pain self-efficacy and motivation to quit. The goal of this study was to conduct the first test of cross-sectional associations between pain self-efficacy and motivation to quit smoking among PLWH. Race was tested as a moderator of the hypothesized associations. Participants (N=76 daily smokers; 37% female; Mage=50.6; MCPD=13.7) were recruited from an outpatient infectious disease clinic for a primary study examining the effects of a personalized feedback intervention for PLWH. Results indicated that pain self-efficacy was positively associated with perceived importance of quitting and intention to quit within the next six months across the entire sample (ps<0.05), and positively associated with readiness to consider smoking cessation and confidence in quitting among Black/African American participants (but not among other participants; ps<0.05). These data provide initial evidence that pain self-efficacy may be related to motivation and intention to quit smoking, particularly among Black/African American PLWH. Future research should test prospective associations between pain self-efficacy and the initiation/maintenance of smoking cessation.

The prevalence of HBsAg / HCV in Aksaray province, demographic data of patients with HCV and the rates of access to new treatments

Aim: Approximately 210 million peoples worldwide are estimated to be infected with chronic HCV. Nowadays, with the use of direct-acting antiviral agents, sustained viral response rates of more than 95% have been achieved in HCV. In our country, these drugs have been used for the last two years. The desired results could not be reached in the number of patients reaching treatment. In this study, we investigated the prevalence of HBsAg and HCV in Aksaray. In addition, we aimed to reveal the demographic characteristics of patients infected with HCV, their awareness about the disease and the rates of access to treatment. Material and methods: In this study, 11716 patients admitted to Aksaray Training and Research Hospital Gastroenterology, Infectious Diseases Outpatient Clinic and Endoscopy Unit between January 2016 and October 2018 were retrospectively screened. HCV positive patients were called from their contact numbers. Results: HBsAg was detected in 244 (2.08%) and anti-HCV positivity in 71 (0.6%) of 11716 patients. Fifty-three patients with HCV were included in the study. 16 patients could not be reached. Nine of these patients were treated with new treatment regimens at the external center. Nine patients were reached during this study and were provided access to treatment. All of these patients were able to tolerate treatment and a permanent viral response was found. Conclusion: Direct effective antiviral agents are effective and safe drugs in patients with HCV. Additional efforts and means of communication are needed to enable patients to access drugs.

760. Assessment of DEXA Scan Ordering Among Infectious Disease Providers at a Large Tertiary-Care Urban Academic Center in the Midwest

BackgroundOsteoporosis is compromised bone strength that predisposes to fracture. It can be diagnosed by Dual-energy x-ray absorptiometry (DEXA) measurement of bone mineral density (BMD). Persons with HIV (PWH) are at higher risk for the development of osteoporosis. As such, the HIV Medicine Association’s (HIVMA) primary care guidelines recommend DEXA screening for all HIV-infected postmenopausal women and men aged ≥50 years. The purpose of this study was to asses the frequency of DEXA utilization within a tertiary-care urban academic center in the Midwest and to identify prevalence of osteoporosis.MethodsA representative sample PWH age ≥50 from our institution’s outpatient infectious disease (ID) clinic were included. All subjects had at least one clinic visit in the last year, were on antiretroviral therapy (ART), and virally suppressed. Unblinded chart review was performed to assess if DEXA was ordered, was DEXA ordered by an ID physician, was DEXA completed, results of DEXA, and whether patients were on a tenofovir disoproxil fumarate (TDF)-containing regimen.Results225 charts were reviewed. 186 (83%) patients were men, with a median age of 58 (range of 50–85). DEXA scans were ordered on 39 (17%) patients, 9 (23%) of which were ordered by their ID provider. Twenty-eight (72%) DEXA scans were performed. Of scans completed, 11 (39%) diagnosed osteoporosis, 15 (54%) osteopenia, and 2 (7%) showed normal BMD. Of all charts reviewed, 29 (13%) were on TDF-containing regimens. Of those individuals with diagnosed abnormal BMD (26), only 1 (4%) was on a TDF-containing regimen.ConclusionDespite HIVMA’s recommendation for osteoporosis screening in PWH, only 17% of eligible patients with well-controlled HIV in our clinic had been referred for DEXA. Of those who had undergone DEXA screening, nearly all (93%) had abnormal BMD. Further investigation is necessary to explore provider and patient barriers for osteoporosis screening in PWH.Disclosures All authors: No reported disclosures.