831. Hepatitis C Virus Micro-elimination Within a Human Immunodeficiency Virus Clinic: Challenges in the Home Stretch

Abstract Background Hepatitis c virus (HCV) eradication among persons with HIV (PWH) is alluring since DAAs efficacy is high regardless of HIV status and PWH in care are usually screened for HCV. Despite the potential, barriers to care have prevented many from achieving sustained virologic response (SVR). We performed a pharmacist-led campaign to reduce the proportion of PWH with active HCV and describe the barriers to care. Methods This retrospective review evaluated patients receiving care at a Ryan White-funded clinic from 07/2018 to 12/2020. Patients were eligible if HCV diagnosed ≥1 year and receiving HIV care. The primary endpoint was to compare the prevalence HCV before and after a pharmacy initiative to target the remaining patients at the clinic not treated during first 3 ½ year period of oral DAA therapy availability. Secondary analysis was to identify barriers to care, measure the proportion of patients in each step of the HCV care cascade, and determine predictors of SVR. Among barriers to care, inconsistent engagement was defined as patients with habitual missed appointments. Logistic regression and Chi-square tests were performed. Results 46 of 1,100 PWH had active HCV for ≥1 year. Median age, years since HIV and HCV diagnoses were 58.5 years of age, 17 years, and 11.5 years, respectively. Most patients were male (70%), Black (61%), Latinx (28%), HCV genotype 1 (90%), had an HIV RNA < 200 copies/mL (72%), & had Medicaid (87%). 32/46 patients agreed to therapy, with all getting insurance approval and DAAs delivered. Glecaprevir/pibrentasvir (73%) was the preferred by payors, followed by sofosbuvir/velpatasvir (15%). Eight remained with active HCV and 19 achieved SVR. The prevalence rate dropped from 4.2% to 0.7% (P < 0.0001). Active drug use, inconsistent engagement, mental health disorder and nonadherence were initial barriers to care. After multivariate analysis, patients with inconsistent engagement continued to be less likely achieve SVR compared to those we remained consistently in care (aOR: 0.062, 95 CI: 0.009-0.421). HCV care cascade in PWH within a Ryan White-funded clinic Active HCV includes 46 patients with chronic HCV infection receiving HIV in care at clinic, DAA approval process describes patients agreeing to HCV treatment along a continuum of pending laboratory results or pending prior authorization requests, DAA procurement depicts patients that have received approval and delivery of medications, DAA initiation describes patients who started treatment (27 patients), and SVR documented defines patients with an undetectable HCV RNA 12 weeks after therapy (19 patients). Conclusion Pharmacists can impact the burden of HCV among PWH receiving care. The HCV care cascade remains tied to the HIV continuum of care, with disengagement from care remaining an important rate-limiting step impeding micro-elimination. Disclosures All Authors: No reported disclosures


Background. Disseminated Mycobacterium avium complex (MAC) infection occurs in 20-40% of patients with < 50 CD4/mm 3 . Data describing central nervous MAC involvement (CNS-MAC) in disseminated infection is scarce.
Methods. We conducted a retrospective case series in the outpatient infectious diseases clinic in the hospital "Dr. Manuel Gea Gonzales" in Mexico City. We reviewed all records from October 2020 to May 2021 and identified all culture proven MAC infections.
Results. We found 7 cases of MAC, with disseminated infection (positive bone marrow cultures) with 3 out of those 7 meeting our definition for CNS-MAC (positive cerebrospinal fluid culture). All cases of CNS-MAC infection occurred in patients with < 50 CD4/mm 3 and recent HIV diagnosis (1-4 months) that were referred to our institution with consumptive syndrome and fevers. All patients were receiving antiretroviral treatment (ART) with BIC/FTC/TAF and initiated ART in less than 1 month since HIV diagnosis. Opportunistic infections were ruled-out at the moment of CNS-MAC diagnosis (criptococcal meningitis, cytomegalovirus retinitis, tuberculosis and histoplasmosis). All patients exhibited non-specific neurologic symptoms at arrival (headache and bradipsiquia) mixed with more severe symptoms (one case of ataxia, one case of vertigo, one case of III nerve palsy). All patients were treated with Clarithromycin/ Levofloxacin/Ethambutol. Two patients achieved symptom remission and 1 patient was lost to follow-up. Of important note, all CSF analysis and CNS imaging studies carried-out were normal. No MAC bacilli were identified with direct Ziel-Neelsen staining of CSF.
Conclusion. We found a high proportion of CNS-MAC in patients with disseminated MAC infection (42.8%) during the study period. All patients presented CNS symptoms and normal CSF characteristics. In our setting, patients with suspected disseminated MAC infection CD4 counts < 50 cells/mm 3 might represent a specific population that could benefit from routine targeted diagnostic test at presentation in order to establish CNS involvement.
Disclosures. Background. Hepatitis c virus (HCV) eradication among persons with HIV (PWH) is alluring since DAAs efficacy is high regardless of HIV status and PWH in care are usually screened for HCV. Despite the potential, barriers to care have prevented many from achieving sustained virologic response (SVR). We performed a pharmacist-led campaign to reduce the proportion of PWH with active HCV and describe the barriers to care.
Methods. This retrospective review evaluated patients receiving care at a Ryan White-funded clinic from 07/2018 to 12/2020. Patients were eligible if HCV diagnosed ≥1 year and receiving HIV care. The primary endpoint was to compare the prevalence HCV before and after a pharmacy initiative to target the remaining patients at the clinic not treated during first 3 ½ year period of oral DAA therapy availability. Secondary analysis was to identify barriers to care, measure the proportion of patients in each step of the HCV care cascade, and determine predictors of SVR. Among barriers to care, inconsistent engagement was defined as patients with habitual missed appointments. Logistic regression and Chi-square tests were performed.
HCV care cascade in PWH within a Ryan White-funded clinic Active HCV includes 46 patients with chronic HCV infection receiving HIV in care at clinic, DAA approval process describes patients agreeing to HCV treatment along a continuum of pending laboratory results or pending prior authorization requests, DAA procurement depicts patients that have received approval and delivery of medications, DAA initiation describes patients who started treatment (27 patients), and SVR documented defines patients with an undetectable HCV RNA 12 weeks after therapy (19 patients).
Conclusion. Pharmacists can impact the burden of HCV among PWH receiving care. The HCV care cascade remains tied to the HIV continuum of care, with disengagement from care remaining an important rate-limiting step impeding micro-elimination. Background. Weight gain among people living with HIV (PLWH) on antiretroviral therapy (ART) may lead to obesity. This study evaluated association between body mass index (BMI) and health-related quality of life (HRQoL) from the patient's perspective.

Methods.
A cross-sectional study using self-reported data from the 2018 and 2019 US National Health and Wellness Survey (NHWS), a nationally representative online survey of ~75,000 adults was conducted. Respondents self-reporting a physician diagnosis of and prescription use for treatment of HIV were included. HRQoL was assessed using Short-Form 36-Item Health Survey Version 2 [Mental and Physical Component Summary scores (MCS and PCS)] and EQ-5D-5L [dimension responses: "no" vs "any problems"/"yes"); EQ-Visual Analogue Scale (VAS) score]. Bivariate analyses (chi-square tests for categorical and ANOVA for continuous variables) compared patient characteristics and HRQoL outcomes across BMI (kg/m 2 ) categories: normal weight (NW; 18.5-< 25), overweight (OW; 25-< 30) and obese (OB; ≥30). Multivariable models analyzed each outcome as a function of BMI, controlling for age, sex, race, and Charlson Comorbidity Index (CCI; excluding HIV/AIDS).
Results. A total of 566 respondents were analyzed. Majority were aged ≥50 years (58%) and male (87%). The OB (vs NW) group had higher proportion of respondents who were female (22% vs 10%), Black (37% vs 24%), residing in the South (46% vs 33%), and higher mean CCI score (1.28 vs. 0.97) ( Table 1). A higher proportion of OB (vs NW) respondents reported having pain/discomfort and problems with mobility and usual activities but not self-care. Anxiety/depression was reported less in OB vs NW groups (Table 1) However, self-reported use of prescription medications for anxiety (19% vs 20%) and depression (34% vs 25%) was similar in OB and NW groups. PCS and EQ-VAS scores were lower in OB vs OW and NW, but no difference in MCS score was observed (Table 1). Lower PCS and EQ-VAS scores were associated with higher BMI (both p=0.01) but not MCS (p=0.68) in multivariate models.
Conclusion. PLWH with higher BMI have poorer physical and general HRQoL. Impact of potential adverse weight gain and transition to higher BMI on humanistic and clinical outcomes should be considered when selecting ART regimens.