Adults with perinatally acquired HIV may be at unique risk for incomplete seroprotection from childhood measles vaccination. We examined measles seroresponse among a retrospective cohort of young adults with both perinatally- and nonperinatally acquired HIV. Among 322 individuals, only 14% had rubeola serology performed. Rubeola seroprotection was low (15.8%) among people with HIV (PWH) adults and was significantly lower than adults with nonperinatally acquired HIV (96%).

BACKGROUND:People on HIV antiretroviral therapy are living longer but face shorter comorbidity-free lives, due to the early onset of non-communicable diseases associated with aging. We examined the association of perinatal HIV infection or exposure and cardiometabolic disorders among young adults. METHODS:This cross-sectional study of cardiometabolic disorders included youths: perinatally acquired HIV (PHIV = 154), non-perinatally acquired HIV (NPHIV = 155), HIV-exposed uninfected (HEU = 154), and HIV-unexposed uninfected (HUU = 197), in two tertiary health centers in Nigeria. Hypertension prevalence and related metabolic disorders were assessed using criteria from the Seventh Joint National Committee and the Joint Interim Statement of the International Diabetes Federation (IDF) Task Force on Epidemiology and Prevention, respectively. Logistic regression models estimated the association between HIV status and these disorders. RESULTS:Of the 660 participants with a median age of 20 years, females comprised 53%. Hypertension prevalence was 16.1% [95% CI: (10.3-21.9)] in PHIV, NPHIV, and HEU, while HUU had the highest rate at 51.6% [95% CI: (49.1-62.9)]. No significant differences in cardiometabolic parameters among the groups were found, but elevated blood glucose [23.5% (95% CI: 20.4-26.9)] ( P < 0.001), low HDL-C [65.0% (95% CI: 61.3-68.5)] ( P = 0.004), and abdominal obesity [15.6% (95% CI: 13.0-18.6)] ( P = 0.024) were more common components of metabolic syndrome (MetS). PHIV showed lower likelihoods of prehypertension [adjusted odds ratio (AOR): 0.55 (95% CI: 0.32-0.93)] and elevated blood glucose [AOR: 0.23 (95% CI: 0.09-0.55)], but higher likelihood of low HDL-C [AOR: 2.08 (95% CI: 1.30-3.34)]. HEU had lower odds of MetS [AOR: 0.39 (95% CI: 0.16-0.93)] and abdominal obesity [AOR: 0.49 (95% CI: 0.24-0.99)] than HUU. CONCLUSION:Integrating NCD screening into HIV management for youth can enhance early detection and prevent complications.

INTRODUCTION:Hepatitis C virus (HCV)/HIV co-infection has been identified as a risk for impaired CD4+ T-cell recovery, possibly mediated by HCV-induced liver fibrosis and/or immune activation. As HCV direct-acting antivirals (DAAs) may partially reverse liver fibrosis and immune activation, sustained HCV virological response (SVR) may lead to improved CD4 recovery. We explored the effect of HCV DAA-induced SVR on CD4 recovery among patients living with both HCV and HIV, including those with poor CD4 recovery on antiretroviral therapy (immunological non-responders [INRs]). METHODS:Subjects aged ≥18 years living with both HIV and HCV who achieved SVR with DAA were included. Pre-DAA CD4 counts were included only after sustained HIV viral suppression and HIV viral suppression was maintained for the duration of the study. Segmented regression of interrupted time series analysis was used to evaluate changes in median CD4 count in the pre-DAA period (-36 months) versus the post-DAA period (+36 months). RESULTS:In total, 156 patients were included. In the full cohort, median CD4 counts increased by 15% (p = 0.002) in the 6-month period following DAA initiation, whereafter CD4 counts decreased by 2.7% per 6-month period (p = 0.004). Among the 13 INRs, there was no immediate effect on median CD4 in the first 6 months after DAA initiation, whereafter there was a sustained CD4 increase (4.1% per 6-month time interval [p = 0.02]). In total, 54% of INRs recorded a post-DAA CD4 count of >350 cells/mm3. CONCLUSIONS:Successful DAA therapy induced a modest immediate CD4 immunological reconstitution among this cohort of patients living with both HIV and HCV, although this effect waned with time. By contrast, among INRs, achieving HCV SVR led to slower but sustained CD4 count recovery.

Abstract Background The efficacy and safety of long-acting injectable, cabotegravir/rilpivirine (CAB/RPV), was established in people with HIV (PHIV) on a stable oral antiretroviral (ART) regimen with viral suppression ≥ 6 months prior to CAB/RPV initiation and with no history of treatment failure. Given the design of the CAB/RPV clinical studies, there have been varying recommendations for its initiation in real-world settings due to the lack of data in patients with either incomplete, or shorter duration of pre-treatment viral suppression. The objective of this study was to describe virologic outcomes among patients on CAB/RPV based on duration of pre-treatment viral suppression. Methods This was a single-center, retrospective, observational study of PHIV initiated on CAB/RPV at an HIV clinic in Baltimore, MD, between Jan 2021-Dec 2022. Patients were stratified by duration of viral suppression prior to CAB/RPV initiation. Viral suppression was evaluated at weeks 8-24 post CAB/RPV initiation and stratified by body mass index (BMI), baseline drug resistance, and CAB/RPV dosing frequency. Results A total of 78 patients were included in this study. The mean age was 47 years, 41% were female at birth, and 92% were Black/African American. At weeks 8-24, 62 patients had HIV RNAs available with 87% (54/62) having achieved viral suppression (< 50 copies/ml). Viral suppression was achieved in 94% (n=33/35), 67% (2/3), and 78% (18/23) of patients who had been virologically suppressed for > 12 months, 6-12 months, and 0-6 months, respectively. Of the 8 patients that did not achieve viral suppression, 6 were able to suppress on CAB/RPV between 125-364 days, 1 had no subsequent HIV RNA result available, and 1 discontinued treatment due to increase in HIV RNA but had been durably suppressed for over 12 months prior to CAB/RPV initiation. We found no differences between viral suppression on CAB/RPV and BMI, baseline mutations, and dosing frequency. Conclusion Virologic outcomes did not differ based on duration of viral suppression prior to initiation of CAB/RPV. Though larger studies should be completed, long-acting CAB/RPV has remained effective in patients with variable durations of pre-treatment viral suppression and in patients who did not have viral suppression prior to switch. Disclosures All Authors: No reported disclosures

Shams, Madeeha MBBS; Rose, Gary S. MD; Hachaambwa, Lottie M. MB ChB; Ryscavage, Patrick MD; Singh, Zeba N. MBBS Author Information

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Strategies are needed to optimize HIV health care transition (HCT). We describe HCT outcomes within the University of Maryland STEP Program, which is built upon integration of an adult HIV provider and navigator into the pediatric clinic, and coordinated collaboration between pediatric and adult HIV multi-disciplinary care teams. These outcomes were compared to a historical institutional HCT cohort (N = 50) which attempted transition in an earlier time period (2004-2012). Fifty-eight patients were enrolled during the study period, and 34 attempted HCT. In total, 84 patients underwent attempted HCT. In the STEP cohort, linkage to adult care was 94% and 12 month retention in adult care (95%) was statistically higher compared to the historical cohort. Rates of viral suppression did not differ pre- and post-HCT among STEP Program patients. These results support the concept of an integrated pediatric and adult HIV HCT model though the ability to achieve sustainable HCT success will require further study.

OBJECTIVES:Although the risk of AIDS-associated diseases has declined dramatically with combination antiretroviral therapy (cART), the incidence rates of chronic non-AIDS-associated diseases in perinatally HIV-infected adults have risen and have not been well characterized. Both traditional and HIV-associated risk factors have been found to contribute to hypertension in non-perinatally HIV-infected adults; whether these same factors contribute to hypertension in perinatally infected adults is not known. The purpose of this study was to determine the socio-demographic, clinical, virological and immunological factors associated with systemic hypertension among a cohort of perinatally HIV-infected adolescents and young adults.METHODS:We conducted a case-control study among a population of adults aged 18-35 years with perinatally acquired HIV infection receiving care at the University of Maryland Medical Center. Covariates assessed included traditional risk factors such as age, family history of hypertension, and smoking, as well as numerous HIV- and antiretroviral-associated covariates, including CD4 nadir.RESULTS:Approximately 31% of the cohort met criteria for hypertension. There were no significant differences in the odds of most traditional or HIV-associated risk factors among perinatally HIV-infected adults with hypertension compared with those with no diagnosis of hypertension. Exposure to lopinavir/ritonavir was associated with greater odds of not having hypertension, while a concurrent diagnosis of chronic kidney disease (CKD) was associated with greater odds of having hypertension.CONCLUSIONS:The results of this study suggest that most traditional and HIV-related risk factors do not appear to increase the odds of having hypertension in this cohort of individuals. The aetiology of hypertension in this population remains to be elucidated.

Abstract Background The incidence of systemic hypertension (HTN) among perinatally-HIV-infected (PHIV) patients appears to increase as they enter adulthood. Among non-perinatally HIV-infected adults both traditional and HIV-associated risk factors have been found to contribute to HTN. Whether these same factors contribute to HTN in PHIV is unknown. The purpose of this study was to determine the socio-demographic, clinical, virologic, and immunologic factors associated with HTN among a cohort of PHIV adolescents and young adults, aged ≥18 years. Methods We conducted a case–control study among a population of 160 PHIV adults with and without HTN who were receiving care at the University of Maryland and aged 18–35 years as of December 31, 2017. Covariates assessed included traditional risk factors such as age, family history of HTN, and smoking, as well as HIV- and antiretroviral-associated covariates. Results We identified 49 HTN cases (30.6%) and 111 (69.4%) controls. There were no significant differences in the odds of most traditional (age, gender, race, family history of HTN, tobacco, alcohol, and/or other drug use) or HIV-associated (CD4 nadir <100 cells/mm3, individual ART exposure, ART interruption) risk factors among PHIV adults with HTN compared with those with no diagnosis of HTN. Cases had lower odds of a history of treatment with lopinavir/ritonavir (LPV/r). Cases had 3.7 (95% CI 1.11, 12.56) times the odds of a prior diagnosis of chronic kidney disease (CKD) compared with controls after controlling for CD4 nadir and ARV treatment history. Conclusion The results of this study suggest that most traditional and HIV-related risk factors do not appear to increase the odds of having HTN in this PHIV cohort. However, HTN among PHIV may be driven in part by CKD, and a focus on the prevention and early management of CKD in this group may be necessary to prevent the development of HTN. Additionally, there may be as yet unidentified risk factors for HTN among PHIV which require further exploration. Given the large and growing population of PHIV entering adulthood worldwide, it is imperative to explore risk factors for and effects of HTN in large, diverse PHIV populations. Disclosures All authors: No reported disclosures.

Objectives: This study's primary objective was to characterize attitudes to long-acting antiretrovirals (LAARV), among youth aged 13-24 years living with perinatally acquired HIV and nonperinatally acquired HIV. Secondary objectives included: assessing whether those with detectable HIV RNA PCR viral load had higher enthusiasm for LAARV compared to those with suppressed viral load, and examining characteristics associated with LAARV enthusiasm. Methods: A cross-sectional survey of 303 youth living with HIV (YHIV) followed at 4 pediatric/adolescent HIV clinics in the United States was performed to determine interest in LAARV, using a modified survey instrument previously used in adults. Interest in LAARV across groups was compared. Poisson regression with robust variance was used to determine the impact of various characteristics on interest in LAARV. Findings: Overall, 88% of YHIV reported probable or definite willingness to use LAARV. The enthusiasm level was similar between youth with perinatally acquired HIV and nonperinatally acquired HIV (P = 0.93). Youth with HIV viral load >1000 copies per milliliter had significantly higher interest than youth with suppressed viral load [prevalence ratio 1.12 (95% confidence interval: 1.03 to 1.20); P = 0.005]. Female youth participants who had had past experience with implantable contraceptive methods had a significantly higher interest in LAARV (100% vs. 85.5%; P = 0.002). Proportion of respondents endorsing definite willingness to use was significantly higher with decreased injection frequency compared with increased injection frequency. Interpretation: YHIV at 4 urban US pediatric/adolescent HIV clinics had high levels of enthusiasm for LAARV. LAARV should be given high priority as a potentially viable treatment option to improve clinical outcomes in YHIV.

Background Bacterial STIs such as syphilis, rectal gonorrhea (GC) and chlamydia (CT) are strongly associated with increased risk of HIV acquisition, and are a marker of ongoing sexual risk behavior among HIV pre-exposure prophylaxis (PrEP) users. STI positivity among men who have sex with men (MSM) PrEP-users in settings where PrEP has been implemented is understudied. Our objective was to determine syphilis and rectal GC/CT positivity among MSM PrEP-users enrolled in a large PrEP demonstration project in Baltimore City, Maryland. Methods The demonstration project was a collaboration between a city health department, an academic evaluation partner, six clinical sites and one CBO. STI results at PrEP initiation and routine 6- and 12-month PrEP-care visits were collected among MSM receiving PrEP at participating clinical sites between September 30, 2015-March 31, 2018. Syphilis and rectal GC/CT positivity was calculated among those screened at each visit. Results During the study period, 290 MSM initiated PrEP, of whom 46.9%(136) were Black/African-American, and 51.4%(149) aged 25–34 years. At PrEP initiation, 79.2%(230) and 56.1%(165) were screened for syphilis and rectal GC/CT, respectively; the proportion screened at 6- and 12-month PrEP-care visits was slightly lower. Overall, including PrEP initiation and care visits, 11.6%(30/258) were ever syphilis positive, 17.9%(35/196) ever rectal GC positive, and 22.5%(44/196) ever rectal CT positive. Specifically, at PrEP initiation, 7.8%(18/230) were syphilis positive; 11.1%(18/162) rectal GC positive, and 11.7% (19/162) rectal CT positive. Positivity at 6- and 12-month PrEP-care visits was similar to positivity at PrEP initiation. Conclusion Despite CDC recommendations for biannual STI screening among PrEP-users, the proportion of MSM PrEP-users screened was suboptimal. The overall and ongoing positivity of syphilis and rectal GC/CT suggest that a substantial proportion of MSM PrEP-users may be engaging in ongoing sexual risk behaviors. Strategies are needed to encourage providers to screen PrEP-users more frequently for STIs and promote safer sexual practices. Disclosure No significant relationships.

Background Persistent HIV pre-exposure prophylaxis (PrEP) use is critical to preventing HIV acquisition. U.S. Centers for Disease Control and Prevention (CDC) recommends quarterly clinical evaluation for individuals using PrEP. Individual-level adherence to quarterly PrEP-care visits is largely unknown. Our objective was to describe patterns of quarterly PrEP-care visit attendance among individuals enrolled in a large demonstration project to increase PrEP delivery in Baltimore City, Maryland. Methods The project was a collaboration between a city health department, an academic evaluation partner, 6 clinical sites and one community based organization (CBO). Demographic and quarterly PrEP-care visit information from individuals initiating PrEP between October 1, 2015 and August 31, 2017 was abstracted from medical records using standardized forms. Participants were followed for one year. PrEP-care was categorized as ‘Persistent’ (attending all quarterly PrEP-care visits), ‘Episodic’ (missing > 1 PrEP-care visit and re-engaging PrEP-care visit), or ‘Discontinued’ (lost to follow-up after missing > 1 PrEP-care visit). Results During the study period, 333 individuals initiated PrEP, among whom 52.9% (176) were Black/African-American, 82.3% (274) cisgender male, 73.6% (245) men who have sex with men (MSM), and 47.7% (159) aged 25–24 years. 9.0% (30), 40.5% (135), and 50.5% (168) were persistent, episodic and discontinued PrEP-care users, respectively. Over half (51.1%, 69/135) of episodic users missed the first quarterly visit; mean time to PrEP re-engaging was 6.3 months (SD: 2.18). About half (45.2%, 76/168) of those discontinuing PrEP-care did so within 3-months. Conclusion Over one year, < 10% of individuals initiating PrEP were persistently in PrEP-care, and half discontinued PrEP-care completely. This suggests PrEP’s effectiveness in reducing HIV transmission in Baltimore City may be limited. Future work should focus on identifying individual and structural barriers and facilitators to discontinuing PrEP-care and factors associated with re-engaging PrEP-care to inform interventions to improve persistent PrEP-care, and decrease ongoing HIV transmission. Disclosure No significant relationships.

Abstract Background Advances in HIV care and treatment have resulted in perinatally infected children aging into adulthood. These patients may be at higher risk of HIV-associated non-AIDS conditions, including systemic hypertension (HTN). This study examined the association between HIV infection and the prevalence of HTN among young adults receiving care in West Baltimore. Methods We conducted a cross-sectional study of young adults with perinatally-acquired (PA) HIV frequency matched on race and sex to a stratified random sample of young adults with non perinatally-acquired (NPA) HIV and HIV-uninfected young adults (UI). All subjects were aged 18–29 years of age as of September 1, 2014. The outcome of HTN was ascertained through chart review (two systolic blood pressure measurements > = 140 mmHg or diastolic > = 90 mmHg at least three months apart; and/or physician prescription for an antihypertensive mediation). Logistic regression was used to estimate adjusted prevalence odds ratios (aPOR) and 95% confidence intervals (CI) for the association between HIV infection and HTN. All data were collected from clinics within the University of Maryland Medical System. Results Three hundred and twenty-four patients were included in the study, 108 per exposure group. The prevalence of HTN was 23% among PA patients, 10% among NPA patients, and 9% among UI patients. The median age was 24 (IQR 22 - 26), 95% were African American, and 42% were male. PA patients had the highest prevalence of chronic kidney disease (CKD) and dyslipidemia (19% and 13% respectively) compared with NPA (1% and 3%) and UI (0% and 5%). PA patients had 3 (95% CI 1.4 - 6.6) times the base odds (controlling for matching variables) of prevalent HTN compared with UI patients and NPA had 1.1 times the base odds (95% CI 0.5 - 2.7) compared with UI patients. After controlling for race, gender, family history of HTN, and CKD, the prevalence odds ratio for HTN was 2.7 (95% CI 1.06 - 7.0) times higher for PA compared with UI, and 1.3 (95% CI 0.5 - 3.4) times higher for NPA compared with UI. Conclusion Our findings suggest that the prevalence of HTN among young adults with PA HIV is significantly higher than sex and race matched UI patients of similar age. HIV providers should carefully monitor these patients for the development of HTN, particularly as they enter adulthood. Disclosures All authors: No reported disclosures.

Introduction: The transition from paediatric to adult care poses risks to the health of young adults living with HIV if unsuccessful, including interruptions in care and poor health outcomes. Evolving best practices in HIV healthcare transition should ideally be informed by real-world qualitative and quantitative clinical healthcare transition outcomes. There has been a recent proliferation of HIV healthcare transition outcome research, largely from Europe and North America.Methods: A literature search was undertaken using the online databases PubMed, Web of Science, and Google Scholar. Medical subject and text word searches were combined for terms relating to HIV, paediatric transition outcomes, and internal and external factors were used to identify peer-reviewed articles.Results: In this paper, we review data on HIV healthcare transition outcomes in North America and Europe. Internal and external factors which may impact the success of HIV healthcare transition are examined. We describe ongoing research efforts to capture transition outcomes in the North America and Europe. Clinical, operational, and implementation science research gaps that exist to date are highlighted. Efforts to improve HIV healthcare transition research through country-level surveillance networks and large multicentre cohorts, including data integration and linkage between paediatric and adult cohorts are discussed.Conclusions: We identified the need for a comprehensive approach to implementing empirically supported protocols to support healthcare transition for ALHIV. While there is limited prospective longitudinal cohort data available at this time, cohorts linking the paediatric and adolescent with ongoing surveillance into adulthood are being developed. Through a review of existing qualitative and quantitative healthcare transition outcomes studies, we identify emerging areas of consensus surrounding healthcare transition research implementation. Successful healthcare transition programmes in Europe and North America often share several characteristics, including implementation of a youth friendly multidisciplinary approach, consistent communication and integration between paediatric and adult care teams, and an individualized approach which is attuned the adolescent's transition readiness. Moving forward, the voices of youth and young adults living with HIV should be included in the development and evaluation of healthcare transition protocols to ensure that the definition of successful transition reflects all of the stakeholders in the transition process.

ABSTRACT Outcomes following healthcare transition (HCT) from pediatric to adult HIV care are not well described. We sought to describe clinical outcomes following HCT within our institution among young adults with behavioral-acquired (N = 31) and perinatally-acquired (N = 19) HIV. We conducted a retrospective cohort study among HIV-infected adults who attempted transition from pediatric to adult HIV care within our institution. The primary end point was retention in care, defined as the completion of at least two visits over 12 months following linkage to adult care. Additional end points include time to linkage to adult care, and changes in CD4 + T cell count and HIV RNA across time. Outcomes were compared between perinatal and behavioral HIV cohorts. Binary data were analyzed using the Fisher exact test and continuous data were analyzed using the Mann–Whitney test. Forty-three (86%) of 50 patients were successfully linked to adult care. The median time to linkage was 98 days. Fifty percent of patients achieved full retention in care at 12 months post-linkage. Though those with behavioral-acquired HIV attempted transfer at an older age, the groups did not differ in rates of linkage and retention in adult care. CD4 + T cell counts and rates of viral suppression did not differ between pre- and post-HCT periods. Despite high rates of successful linkage to adult care in our study population, rates of retention in adult HIV care following HCT were low. These results imply that challenges remain in the adult HIV care setting toward improving the HCT process.

Patients with perinatally acquired HIV may be at risk for the development of age-related non-AIDS diseases. The primary aim of this study was to describe patterns of systemic hypertension among a cohort of adults (≥18 years) with perinatally acquired HIV. A retrospective cohort study was conducted among adults (≥18 years) with perinatally acquired HIV infection. Primary outcomes included documentation of systemic hypertension as well as several additional non-AIDS-associated illnesses. Systemic hypertension incidence rates and rate ratios (RRs) were calculated among groups aged ≥18 and <18 years at the time of hypertension diagnosis. The overall prevalence of hypertension in the cohort (N = 109) was 26.6%, and the incidence rate of hypertension was significantly higher among those aged ≥18 years compared to those who are aged <18 years at the time of diagnosis (RR: 10.0, CI: 7.29-13.71). By multivariable analysis, only coexisting renal disease was associated with an increased risk of hypertension diagnosis.

Introduction: Adolescents are a unique and sometimes neglected group in the planning of healthcare services. This is the case in many parts of sub-Saharan Africa, where more than eight out of ten of the world's HIV-infected adolescents live. Although the last decade has seen a reduction in AIDS-related mortality worldwide, largely due to improved access to effective antiretroviral therapy (ART), AIDS remains a significant contributor to adolescent mortality in sub-Saharan Africa. Although inadequate access to ART in parts of the subcontinent may be implicated, research among youth with HIV elsewhere in the world suggests that suboptimal adherence to ART may play a significant role. In this article, we summarize the epidemiology of HIV among sub-Saharan African adolescents and review their adherence to ART, emphasizing the unique challenges and factors associated with adherence behaviour.Methods: We conducted a comprehensive search of online databases for articles, relevant abstracts, and conference reports from meetings held between 2010 and 2014. Our search terms included "adherence,'' "compliance,'' "antiretroviral use'' and "antiretroviral adherence,'' in combination with "adolescents,'' "youth,'' "HIV,'' "Africa,'' "interventions'' and the MeSH term "Africa South of the Sahara.'' Of 19,537 articles and abstracts identified, 215 met inclusion criteria, and 148 were reviewed.Discussion: Adolescents comprise a substantial portion of the population in many sub-Saharan African countries. They are at particular risk of HIV and may experience worse outcomes. Although demonstrated to have unique challenges, there is a dearth of comprehensive health services for adolescents, especially for those with HIV in sub-Saharan Africa. ART adherence is poorer among older adolescents than other age groups, and psychosocial, socio-economic, individual, and treatment-related factors influence adherence behaviour among adolescents in this region. With the exception of a few examples based on affective, cognitive, and behavioural strategies, most adherence interventions have been targeted at adults with HIV.Conclusions: Although higher levels of ART adherence have been reported in sub-Saharan Africa than in other well-resourced settings, adolescents in the region may have poorer adherence patterns. There is substantial need for interventions to improve adherence in this unique population.

The diagnosis of invasive pulmonary aspergillosis is challenging. It is unclear whether galactomannan (GM) results from bronchial wash (BW) and bronchoalveolar lavage (BAL) samples differ in a clinically meaningful way.