LB-6. Increased Diagnoses of Acute HIV Infection through Routine ED Screening and Rapid Linkage to Care and initiation of HAART During the COVID-19 Pandemic

Abstract Background The COVID-19 pandemic has negatively impacted routine HIV screening in healthcare settings. This has serious implications, especially for patients with acute HIV infection (AHI) presenting with symptoms suggesting COVID-19 infection. This is a high priority population for rapid linkage to care (LTC) and initiation of HAART. Methods We reviewed data from our eXpanded HIV Testing and LTC (X-TLC) Program, a collaboration effort between 13 healthcare centers on the South and West Sides of Chicago. Since 2016, most sites had 4th or 5th generation HIV Ag/Ab testing available. Results Most sites experienced reductions in HIV screens during the COVID-19 pandemic. Advanced planning by our ED incorporated blood draws for HIV screens as part of COVID-19 evaluations. UCM performed 19,111 HIV screens (11,133 in the ED) between 1/1/20 and 8/17/20, along with 100,635 COVID PCRs (14,754 in ED) between 3/17/20 and 8/17/20. Nine patients were diagnosed with AHI after the first case of COVID-19 in Chicago (1/24/20), and 7 were diagnosed after the first case of community transmission in Cook County (3/8/20). All cases of AHI were diagnosed in the ED. The rate of AHI was significantly higher in 2020 versus the prior 4 years (14.4 vs 6.8 per year, p < 0.05). AHI patients comprised 25.7 % (9/35) of all new diagnoses, the highest percent ever. There were 7 men (6 identified as MSM) and 2 cis-gender women, median age of 25 years (21 to 28 years). The median viral load was 6 million (115,000 to > 6 million) copies/mL. Eight of 9 patients presented with an illness indistinguishable from COVID-19, including 1co-infected patient. All were LTC and started on HAART from time of PCR result within a median of 1 day (0–38), but 3 days (range 1–41) from sample collection as a result of delayed reflex PCR confirmatory testing due to high demands on lab personnel and scarcity of reagents due to COVID-19 PCR volumes (since resolved). HIV Screening and COVID-19 Testing in the ED During COVID-19 Conclusion Continued HIV screening in our ED during the COVID-19 pandemic identified an increased number of patients with AHI. These individuals may be more likely to present for care due to fear of COVID-19 infection. We achieved rapid LTC and initiation of HAART without any incremental increases in resources. All HIV screening programs should incorporate blood-based HIV screening into their COVID-19 testing programs. Disclosures Moira McNulty, MD, MS, Gilead Sciences (Grant/Research Support)

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Implementing Rapid Initiation of Antiretroviral Therapy for Acute HIV Infection Within a Routine Testing and Linkage to Care Program in Chicago

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958220939754 ◽

2020 ◽

Vol 19 ◽

pp. 232595822093975

Author(s):

Moira McNulty ◽

Jessica Schmitt ◽

Eleanor Friedman ◽

Bijou Hunt ◽

Audra Tobin ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Hiv Infection ◽

Hiv Testing ◽

Viral Suppression ◽

Linkage To Care ◽

Care Program ◽

Acute Hiv Infection ◽

Screening Programs ◽

Acute Hiv ◽

Therapy Clients

Growing evidence suggests that rapid initiation of antiretroviral therapy for HIV improves care continuum outcomes. We evaluated process and clinical outcomes for rapid initiation in acute HIV infection within a multisite health care–based HIV testing and linkage to care program in Chicago. Through retrospective analysis of HIV testing data (2016-2017), we assessed linkage to care, initiation of antiretroviral therapy, and viral suppression. Of 334 new HIV diagnoses, 33 (9.9%) individuals had acute HIV infection. Median time to linkage was 11 (interquartile range [IQR]: 5-19.5) days, with 15 days (IQR 5-27) to initiation of antiretroviral therapy. Clients achieved viral suppression at a median of 131 (IQR: 54-188) days. Of all, 69.7% were retained in care, all of whom were virally suppressed. Sites required few additional resources to incorporate rapid initiation into existing processes. Integration of rapid initiation of antiretroviral therapy into existing HIV screening programs is a promising strategy for scaling up this important intervention.

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562. Management and Outcomes of Patients With Acute HIV Infection in an Expanded Testing and Linkage to Care Program

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.570 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S208-S209

Author(s):

Moira C McNulty ◽

Jessica Schmitt ◽

Eleanor Friedman ◽

Bijou Hunt ◽

Audra Tobin ◽

...

Keyword(s):

Hiv Infection ◽

Linkage To Care ◽

Care Program ◽

Acute Hiv Infection ◽

Acute Hiv

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Acute HIV Infection and Implications of Fourth-Generation HIV Screening in Emergency Departments

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2014.07.004 ◽

2014 ◽

Vol 64 (5) ◽

pp. 547-551 ◽

Cited By ~ 9

Author(s):

Jason S. Haukoos ◽

Michael S. Lyons ◽

Douglas A.E. White ◽

Yu-Hsiang Hsieh ◽

Richard E. Rothman

Keyword(s):

Hiv Infection ◽

Emergency Departments ◽

Fourth Generation ◽

Hiv Screening ◽

Acute Hiv Infection ◽

Acute Hiv

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Colorectal Disorders in Acute Human Immunodeficiency Virus Infection: A Case Series

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw014 ◽

2016 ◽

Vol 3 (1) ◽

Cited By ~ 1

Author(s):

Theppharit Panichsillapakit ◽

Derek Patel ◽

Joanne Santangelo ◽

Douglas D. Richman ◽

Susan J. Little ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Hiv Infection ◽

Acute Infection ◽

Case Series ◽

Low Grade ◽

Gi Tract ◽

Acute Hiv Infection ◽

First Case ◽

Immunodeficiency Virus ◽

Acute Hiv

Abstract Background. The gastrointestinal (GI) tract is important in the pathogenesis of human immunodeficiency virus (HIV) infection. We report a case series of lower GI endoscopic and histopathologic findings of HIV-infected individuals after presentation with acute infection. Methods. We performed a retrospective case review of individuals infected with HIV who enrolled between August 2010 and April 2013 in a primary infection treatment trial. All participants started the trial during acute infection and underwent colonoscopy with biopsies at baseline and after the start of antiretroviral treatment. Results. Twenty acutely infected individuals were included in the study (mean age, 33 years; range, 20–54 years). All participants were male who reported having receptive anal sex as an HIV risk factor. Nine individuals (45%) had at least 1 finding by colorectal pathology; 1 person had 2 diagnoses (diverticulosis and focal active proctitis). The histopathological findings revealed anal dysplasia in 3 cases: 2 had high-grade anal intraepithelial neoplasia (AIN) and 1 had low-grade AIN. Two persons had a colorectal polyp, 1 hyperplastic and 1 adenomatous. Three persons were diagnosed with diverticulosis, and 2 persons were diagnosed with proctitis, including 1 with focal active proctitis and 1 with cytomegalovirus proctitis. Conclusions. To our knowledge, this is the first case series report of lower GI disorders in acute HIV-infected individuals. Although the causal relationship remains uncertain, we describe the endoscopic findings that were observed during acute HIV infection among men who have sex with men. Understanding the prevalence of these pathologies may likely shed light on how acute HIV infection damages the lower GI tract.

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