Abstract Background There is a paucity of outcome studies on HIV-associated lymphoma treated with chemotherapy with or without autologous hematopoietic stem cell transplantation (autoHSCT) in comparison to HIV-uninfected individuals with similar histology. Methods In our retrospective matched cohort study, we enrolled adult HIV-positive patients with lymphoma treated with chemotherapy with (group 2) or without autoHSCT (group 1) between January 1, 2007 to December 31, 2018 at the University of Kansas Medical Center and followed until May 1, 2020. Group 1 were matched 1:1 to HIV-negative patients based on age, gender, lymphoma histology, stage at diagnosis, year of lymphoma diagnosis, and Group 2 were matched 1:2 to HIV-negative patients based on age at autoHSCT, gender, lymphoma histology, stage at diagnosis and year of transplantation. Overall survival (OS) and progression-free survival (PFS) at 2 years were calculated using Kaplan-Meier (KM) analysis, and adjustment for ECOG and IPI/IPS scores was done using multivariate Cox model. Results We had 37 HIV+ patients with lymphoma in our cohort: 9 Hodgkin’s disease (HD), 28 Non Hodgkin’s Lymphoma (NHL). Eleven underwent autoHSCT (3 HD, 8 NHL). The majority were white (76.2%), non-hispanic (92.9%), males (90.5%) and mean age was 46 years. Median CD4 was 172.5, HIV viral load was < 50 copies/mL in 43..2%, and 76.2% were on antiretroviral therapy (ART) at diagnosis. ART was interrupted in 14.6% and adjusted in 40.5% of patients. After excluding rare histological types, 22 in group 1 and 9 in group 2 were included in the matched analysis. On KM survival at 2-years, group 1 had worse OS (75% vs 95%, p=0.02), and a trend for worse PFS (75% vs 90%, p=0.07) than the matched referent group, while group 2 had similar OS (100% vs 94%, p= 0.47) and better PFS (100% vs 70%, p=0.02) than the matched referent group. On Cox models adjusting for ECOG and IPI/IPS, HIV status was no longer independently associated with OS in group 1 or PFS in group 2. Group 1 HIV lymphoma cases and controls characteristics Group 2 HIV lymphoma with HSCT cases and controls characteristics Conclusion In patients with HIV and lymphoma treated with chemotherapy with or without autoHSCT, the outcomes are comparable to those without HIV in our single center contempory cohort. Disclosures Wissam El Atrouni, MD, ViiV (Advisor or Review Panel member)
Abstract Background Norovirus (NoV) results in relapsing, remitting diarrhea in immunocompromised hosts (ICH). No prospective studies of existing therapies including nitazoxanide (NTZ) have included evaluation of patient reported outcomes (PRO) or reported impact on patient quality of life (QOL). Methods We conducted a NIH-sponsored multi-center, prospective, randomized, double-blind study of NTZ for the treatment of NoV in adult HSCT and SOT recipients. Subjects with a positive NoV testing and active GI symptoms were randomly assigned (1:1) to NTZ 500 mg twice daily or placebo (P) for 56 consecutives doses and followed for 6 months. PRO diary assessments based on recognized questionnaires were collected: IBSQOL, EuroQOL, PROMIS Emotional, PROMIS GI, PANAS and PROMIS Physical Function Questionnaires.Figure 1.Patient-Reported Quality of Life by EuroQOL-5 Dimension and Study Day – Nitazoxanide vs Placebo, mITT Population Results 31 subjects (16 NTZ, 15 P) were enrolled (Table 1). Early withdrawal was documented in 5 subjects from each group. Thirty (30) had received solid organ transplants. Most had chronic (> = 14d) symptoms (77%). Based on data collected from PRO diaries, there were no significant between-treatment differences for change in diarrhea or nausea from baseline to day 180 (p=0.590 and 0.271). There was no significant difference in median time to 50% reduction in antimotility agents (NTZ 7d vs placebo 5d, p=0.830). However, the EuroQOL-5 questionnaire responses showed that patients seem to report less problems with anxiety/depression (NTZ 29% vs placebo 38%), mobility (21% vs 50%) and usual activities (29 vs 64%) at the end of study drug with NTZ (Fig. 1). There were significant difference in improvement of reported incontinence events between groups over time, which likely impact perceived QOL and activity level. Importantly, analysis of PROs demonstrates the significant and longstanding impact of NoV on ICH with high rates of anxiety/depression and reduced mobility at 180 days. Conclusion PROs from this study provided significant insight into the expected course of NoV infection in ICH, including persistent but intermittent diarrhea, prolonged anxiety and depression, reduced mobility and reduced usual activity even out to 180 days post monitoring. This study provides data to support the use of PROs as primary endpoints in these studies. Disclosures Ajit Limaye, Professor/MD, Memo: Advisor/Consultant|merck: Advisor/Consultant|merck: Grant/Research Support|moderna: Advisor/Consultant|moderna: site investigator|NobelPharma: DSMB member Steven A. Pergam, MD, MPH, Cidara: Advisor/Consultant|F2G: Advisor/Consultant|Global Life Technologies: Grant/Research Support|Symbio: Advisor/Consultant Michael D. Green, MD, MPH, ADMA: Advisor/Consultant|Bristol Myers Squibb: Advisor/Consultant|ITB-MED: Advisor/Consultant|kamada: Honoraria Lara A. Danziger-Isakov, MD, MPH, Aicuris: clinical research contract, paid to institutio|Ansun BioPharma: clinical research contract, paid to institution|Astellas: Advisor/Consultant|Astellas: clinical research contract, paid to institutio|Merck: clinical research contract, paid to institutio|Pfizer: Grant/Research Support|Takeda: clinical research contract, paid to institutio Michael Ison, MD MS, GlaxoSmithKline: Grant/Research Support|UpToDate: Royalties
Abstract Background Extracorporeal photopheresis (ECP), is a cell-based immune-modulatory therapy used in the treatment of steroid refractory chronic graft versus host disease (cGHVD). It is unclear whether ECP is associated with an increased risk of infections compared to alternative treatment. We aimed to study the infectious complications in patients who are on ECP post allogeneic hematopoietic stem cell transplant (alloHSCT). Methods We conducted a retrospective cohort study of adult patients with cGVHD post alloHSCT who were initiated on ECP or second line immunosuppressive agents (SLIS). The study period was from March 1, 2014 to October 1, 2018. Each subject in the ECP arm was matched to the SLIS arm according to gender, age, underlying disease, and date of diagnosis of cGVHD. All subjects were followed for one-year post treatment. The main outcome was incidence of each type of infection (event rate/ person-years). Kaplan Meier analysis was used, evaluating time to infection with log rank test. The spectrum of infectious complications was described. Results Seventy-seven patients were included (36 in ECP and 41 in SLIS arm). Median age was 57.4 years (18.1 -73.4), and 59.7% of patients were male. The most common underlying diseases were acute myeloid leukemia (45.4%), myelodysplastic syndrome (20.8%) and non-Hodgkin’s lymphoma (15.6%). A total occurrence of 94 infections was observed in the ECP arm, compared to 118 in SLIS arm. Bacterial infections accounted for majority of the infections in ECP arm (50%) compared to SLIS arm in which viruses were most common (49.2%). Bacterial pneumonia was the most common clinical syndrome (34% and 27.3%, in the ECP and SLIS arms, respectively). Bacteremia accounted for 12.8% of infections in the ECP arm compared to 16.4% in the SLIS arm. There was no difference in the event rates of infections among the two groups [2.58/ person-years in ECP group vs 3.60/person-years, p = 0.3766], or the probability of infection at any time between the ECP and SLIS group on Kaplan Meier (log rank test, p-value=0.36)(Figure 1). Kaplan-Meier plot of time to the earliest infection diagnosis between ECP and control group Conclusion Bacterial and viral pneumonia were the most common infections in patients undergoing ECP. Overall, ECP does not confer an increased risk of infectious complications compared to second line IS agents. Disclosures Wissam El Atrouni, MD, ViiV (Advisor or Review Panel member)
Background.The aim of this study was to identify overall sexually transmitted diseases (STD) burden in HIV infected patients and determine compliance with sexual health screening and treatment based on CDC 2010 Guideline in our HIV clinic.Methods.This is a retrospective cohort study of all adult patients attending at least 2 visits at the University of Kansas Medical Center outpatient infectious diseases clinic between October 1, 2010 and August 15, 2013.Syphilis, gonorrhea, chlamydia, genital warts, genital herpes, hepatitis A, B, C testing frequency, diagnoses and treatments were abstracted from the charts.Period prevalence, compliance with screening methods, frequency, and treatment were measured.Percentages below are calculated out of the total cohort.
Abstract The field of infectious diseases (ID) offers a rewarding career path and is widely viewed as an essential subspecialty in medicine. However, in recent years, these positive aspects have been overshadowed by concerns surrounding low fellowship match rates, undercompensation, and burnout. The Infectious Diseases Society of America Fellowship Training Program Directors Committee met in 2023, discussed the future of ID as a specialty, and sought to develop strategies to highlight the value and opportunities of ID for future generations, as well as underscore the importance of and provide tools for positive messaging to trainees about the subspecialty. This paper presents ideas generated at this meeting and is meant to serve as a reference for ID training program directors, as well as the wider ID community, in uplifting and shaping the future of the field.
Abstract Background Medical errors contribute to 44,000 – 98,000 deaths annually, which can result in total national costs upwards of 17-29 billion dollars. The Institute of Medicine suggests the application of QI as on of its five core competencies for all health care providers. ACGME has recognized the importance of QI curriculum in the training of both residents and fellows. To date, most QI curriculums focus on participation rather than application proficiency. A review performed by ACGME found that participants appeared to have a limited understanding of QI even after partaking in QI curricula. An activity that emphasizes practical application and meets the time constraints of residents and fellows would prove more beneficial than standard approaches. Methods This study included 13 ID, Allergy and Immunology, and Endocrine fellows from the University of Kansas Medical Center. Utilizing a QIKAT-R assessment tool, fellows were given 3 cases for which they had to develop a QI project. The assessment was made based on the ability to make an aim, find a measurable outcome or process that could easily be tabulated, and propose a change that could be tested. Following this, a 1-hour power point presentation which included active learning prompts in developing a QI project was given to the fellows. At the conclusion of the presentation, 3 additional cases were given to the fellows. Their ability to develop a QI project was again evaluated using the QIKAT-R assessment tool. At the end of the session a 5-question satisfaction survey was completed. As a group mean, scores prior to the 1-hour presentation were compared to those afterwards. A paired, single-tail, t-test was utilized to obtain a p-value in order to determine significance of change. Results In total, there was a 42.2% (p=0.00001) increase in total QIKAT-R score after “QI Power Hour.” 92.3% of participants had a positive perception (Agree/Strongly Agree) of the 1-hour session. Conclusion The findings suggest that fellows are able to show a higher proficiency in QI understanding as well as development of future QI projects. Fellows satisfaction of “QI Power Hour” was overall favorable. This study shows that it is possible to easily integrate QI understanding for practical application into the time constraints of a fellowship or residency curriculum. Disclosures All Authors: No reported disclosures
One goal of ecosystem-based management is studying an ecosystem and its people, the socio-ecological system, in a qualitative and quantitative modeling approach that can provide management agencies with possible outcomes of their actions using scenario forecasting. Ecosystem-based fisheries management strives to use the socio-ecological system approach, including direct and indirect impacts on multiple species including the behavioral responses of fishers after a regulatory change (a gillnet ban). Here, we link fisher behavioral networks with a mass-balanced food-web ECOPATH network model of an estuarine ecosystem and its commercial fisheries for an analysis of fishing impacts after a gillnet ban on multiple species using ECOSIM. We modeled fisher behavioral networks using reported catches of species from individual fishers along with the gear fished to create nodes in a gear/species affiliation network. Individual fishers with common gear/species use are indicative of common fishing behavior. When such fishers have high network centrality and are engaged in multiple gear/species fisheries, they can transition to other gear/species fisheries along “switching pathways” when facing a regulatory change. We used an index of joint gear participation to identify likely gear switching pathways, and we predicted changes in fishing effort after a gill net ban. We simulated the gill net ban in ECOSIM under two scenarios of fishing effort: Scenario 1, gill net fishing effort of 0%; Scenario 2, gill net fishing effort of 0% with increased effort in the alternative gear fisheries using the predicted switching pathways for the affiliation network. Scenario 1 predicted an increase in flounder ( Paralichthys spp.) biomass over a decade. Under Scenario 2, fishers targeting flounders were predicted to switch from gill nets to pound nets. Scenario 2 predicted a 7% decline in flounder biomass over ten years, rather than an increase in flounders. The gillnet ban with increased effort due to switching is predicted to have the opposite effect on the conservation goal, which was to increase flounder stocks. Fishery management that incorporates a socio-ecological approach modeling both fisher behaviors and multi-species ecosystem responses can reveal single-species responses that are in the opposite direction of the anticipated management goals.
ABSTRACT We compared Roche MONITOR and Organon Teknika NucliSens assays for human immunodeficiency virus type 1 (HIV-1) RNA in cerebrospinal fluid (CSF). Results of 282 assays were highly correlated ( r = 0.826), with MONITOR values being 0.29 ± 0.4 log 10 copies/ml (mean ± standard deviation) values. Both assays can reliably quantify HIV-1 RNA in CSF.
