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Background Ethical patient outreach is critical for engaging patients with HIV in HIV cure–directed research. We sought to examine HIV clinical providers' awareness of current HIV cure–directed research strategies investigated through the Martin Delaney Collaboratories (MDC) and providers' attitudes toward patient outreach for HIV cure–directed research and to identify opportunities for clinical provider education on MDC research strategies. Methods We conducted a 1-time, cross-sectional, web-based survey with 64 HIV clinical providers (physicians, physician assistants, and nurses) in Philadelphia. A descriptive analysis was generated to determine clinical providers' awareness of MDC research strategies and attitudes toward patient outreach. Bivariate analyses were conducted to evaluate differences in awareness and attitudes by provider characteristics. Results Most providers were aware of MDC strategies, and nearly three-fourths of providers reported familiarity with 1 of the 2 Philadelphia MDC research programs. Providers overwhelmingly endorsed the need for clinicians to assist with patient outreach for HIV cure–directed research and were willing to recommend patients to participate. Enthusiasm for patient outreach waned if a study required a patient to undergo analytic treatment interruptions (ATIs). Providers identified preferred resources for receiving HIV cure–directed research updates, including webinars with continuing education credit and conferences. Conclusions Our study's findings advocate for added investment toward developing resources that better engage clinical providers about HIV cure–directed research updates and ongoing studies, including the importance of ATIs. As gatekeepers to patient participation on HIV cure–directed studies, added efforts to increase provider knowledge of specific HIV cure–directed research will advance patient education and ethical outreach. [ABSTRACT FROM AUTHOR]

This study describes the largest cohort to date (n = 147) of pregnant patients with human immunodeficiency virus (HIV) on bictegravir (BIC). BIC in pregnancy was associated with high levels of viral suppression and perinatal outcomes similar to those in the published literature. These findings support consideration for the use of BIC in managing HIV during pregnancy. [ABSTRACT FROM AUTHOR]

Antiretrovirals are often approved by the Food and Drug Administration without sufficient safety data regarding their use in pregnancy. To quantify this delay, we calculated the interval from the approval date to their inclusion in the Antiretroviral Pregnancy Registry prospective analysis (≥200 first-trimester exposures); the median delay was 6 years. [ABSTRACT FROM AUTHOR]

Pregnant persons with chronic health conditions often require pharmacotherapy to remain healthy. The Antiretroviral Pregnancy Registry is a prospective, international, voluntary, and exposure registry that collects information on antiretroviral (ARV) exposure; however, a minority of providers use the registry, leaving critical gaps to guide prescribing in this population. The Task Force for the Elimination of Perinatal HIV Transmission in the United States, funded by the Centers for Disease Control and Prevention, has identified the monitoring of ARV safety as a paramount concern in the ongoing mission to eliminate perinatal human immunodeficiency virus (HIV) transmission. As active members of this task force, we urge all healthcare providers who care for pregnant individuals to prioritize reporting all ARV exposures to the registry. [ABSTRACT FROM AUTHOR]

Background Injectable cabotegravir (CAB)/rilpivirine (RPV) is the only combination long-acting (LA) antiretroviral regimen approved for HIV. RPV may not be effective among individuals with non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance, which has >10% prevalence in many countries. Lenacapavir (LEN) is an LA capsid inhibitor given every 6 months, but has not been studied in combination with other LA agents. Methods We assembled a case series from 4 US academic medical centers where patients with adherence challenges were prescribed LEN subcutaneously every 26 weeks/CAB (+/− RPV) intramuscularly every 4 or 8 weeks. Descriptive statistics, including viral load (VL) outcomes, were summarized. Results All patients (n = 34: 76% male; 24% cis/trans female; 41% Black; 38% Latino/a; median age [range], 47 [28–75] years; 29% and 71% on CAB every 4 or 8 weeks) reported challenges adhering to oral ART. The reasons for using LEN/CAB with or without RPV were documented or suspected NNRTI mutations (n = 21, 59%), integrase mutations (n = 5, 15%), high VL (n = 6, 18%), or continued viremia on CAB/RPV alone (n = 4, 12%). Injection site reactions on LA LEN were reported in 44% (32% grade I, 12% grade 2). All patients but 2 (32/34; 94%) were suppressed (VL <75 copies/mL) after starting LEN at a median (range) of 8 (4–16) weeks, with 16/34 (47%) suppressed at baseline. Conclusions In this case series of 34 patients on LEN/CAB, high rates of virologic suppression (94%) were observed. Reasons for using LEN/CAB included adherence challenges and underlying resistance, mostly to NNRTIs. These data support a clinical trial of LEN/CAB among persons with NNRTI resistance. [ABSTRACT FROM AUTHOR]

This post hoc analysis of the randomized, double-blind, placebo-controlled trial ACTT-2 (Adaptive COVID-19 Treatment Trial-2) sought to determine whether any patient characteristics are associated with treatment benefit from the immunomodulator baricitinib among hospitalized patients with COVID-19 who fall into the "high-risk" quartile. Visual Abstract. A Risk Profile Using Simple Hematologic Parameters to Assess Benefits From Baricitinib in Patients Hospitalized With COVID-19: A Post Hoc Analysis of the Adaptive COVID-19 Treatment Trial-2 This post hoc analysis of the randomized, double-blind, placebo-controlled trial ACTT-2 (Adaptive COVID-19 Treatment Trial-2) sought to determine whether any patient characteristics are associated with treatment benefit from the immunomodulator baricitinib among hospitalized patients with COVID-19 who fall into the "high-risk" quartile. Background: The ACTT risk profile, which was developed from ACTT-1 (Adaptive COVID-19 Treatment Trial-1), demonstrated that hospitalized patients with COVID-19 in the high-risk quartile (characterized by low absolute lymphocyte count [ALC], high absolute neutrophil count [ANC], and low platelet count at baseline) benefited most from treatment with the antiviral remdesivir. It is unknown which patient characteristics are associated with benefit from treatment with the immunomodulator baricitinib. Objective: To apply the ACTT risk profile to the ACTT-2 cohort to investigate potential baricitinib-related treatment effects by risk quartile. Design: Post hoc analysis of ACTT-2, a randomized, double-blind, placebo-controlled trial. (ClinicalTrials.gov: NCT04401579) Setting: Sixty-seven trial sites in 8 countries. Participants: Adults hospitalized with COVID-19 (n = 999; 85% U.S. participants). Intervention: Baricitinib+remdesivir versus placebo+remdesivir. Measurements: Mortality, progression to invasive mechanical ventilation (IMV) or death, and recovery, all within 28 days; ALC, ANC, and platelet count trajectories. Results: In the high-risk quartile, baricitinib+remdesivir was associated with reduced risk for death (hazard ratio [HR], 0.38 [95% CI, 0.16 to 0.86]; P = 0.020), decreased progression to IMV or death (HR, 0.57 [CI, 0.35 to 0.93]; P = 0.024), and improved recovery rate (HR, 1.53 [CI, 1.16 to 2.02]; P = 0.002) compared with placebo+remdesivir. After 5 days, participants receiving baricitinib+remdesivir had significantly larger increases in ALC and significantly larger decreases in ANC compared with control participants, with the largest effects observed in the high-risk quartile. Limitation: Secondary analysis of data collected before circulation of current SARS-CoV-2 variants. Conclusion: The ACTT risk profile identifies a subgroup of hospitalized patients who benefit most from baricitinib treatment and captures a patient phenotype of treatment response to an immunomodulator and an antiviral. Changes in ALC and ANC trajectory suggest a mechanism whereby an immunomodulator limits severe COVID-19. Primary Funding Source: National Institute of Allergy and Infectious Diseases. [ABSTRACT FROM AUTHOR]

Osegueda and colleagues evaluated the HIV reservoir within breast milk cells in the context of long-term sustained viral suppression, and they provide reassuring new data. The editorialists discuss the findings and the implications for counseling regarding breastfeeding in the setting of maternal HIV infection. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are associated with negative health outcomes; however, screening for ACEs is not routinely performed among people living with HIV (PLWH). We conducted a single-center, cross-sectional pilot study to define the (1) prevalence of ACEs in PLWH and (2) acceptability of ACEs screening in routine out-patient clinical care. One hundred participants completed screening: median age of participants was 49 years (interquartile range: 38.5-59.5), 73% male, 66% Non-Hispanic Black/African American, and 47% gay/lesbian. Clinically significant ACEs score, defined as ≥4, was reported in 51%. High ACEs score was more common among participants <50 years old (64.7% vs. 36.7%; p < 0.01), but the prevalence of ACEs ≥4 did not differ by gender, race, ethnicity, or sexual orientation. Among participants with ≥4 ACEs, 44.4% screened negative on both PHQ-9 and PC-PTSD screens. The majority of participants (89%) reported a positive experience with ACEs screening. The prevalence of clinically significant ACEs in this clinic population of PLWH was more than twice that reported in the general population. Routine ACEs screening can improve delivery of trauma-informed care in the HIV primary care setting. [ABSTRACT FROM AUTHOR]

Background The Adaptive COVID Treatment Trial-2 (ACTT-2) found that baricitinib in combination with remdesivir therapy (BCT) sped recovery in hospitalized coronavirus disease 2019 (COVID-19) patients vs remdesivir monotherapy (RMT). We examined how BCT affected progression throughout hospitalization and utilization of intensive respiratory therapies. Methods We characterized the clinical trajectories of 891 ACTT-2 participants requiring supplemental oxygen or higher levels of respiratory support at enrollment. We estimated the effect of BCT on cumulative incidence of clinical improvement and deterioration using competing risks models. We developed multistate models to estimate the effect of BCT on clinical improvement and deterioration and on utilization of respiratory therapies. Results BCT resulted in more linear improvement and lower incidence of clinical deterioration compared with RMT (hazard ratio [HR], 0.74; 95% CI, 0.58 to 0.95). The benefit was pronounced among participants enrolled on high-flow oxygen or noninvasive positive-pressure ventilation. In this group, BCT sped clinical improvement (HR, 1.21; 95% CI, 0.99 to 1.51) while slowing clinical deterioration (HR, 0.71; 95% CI, 0.48 to 1.02), which reduced the expected days in ordinal score (OS) 6 per 100 patients by 74 days (95% CI, −8 to 154 days) and the expected days in OS 7 per 100 patients by 161 days (95% CI, 46 to 291 days) compared with RMT. BCT did not benefit participants who were mechanically ventilated at enrollment. Conclusions Compared with RMT, BCT reduces the clinical burden and utilization of intensive respiratory therapies for patients requiring low-flow oxygen or noninvasive positive-pressure ventilation compared with RMT and may thereby improve care for this patient population. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America."

This post hoc analysis of the Adaptive Coronavirus Disease 2019 (COVID-19) Treatment Trial-1 (ACTT-1) shows a treatment effect of remdesivir (RDV) on progression to invasive mechanical ventilation (IMV) or death. Additionally, we create a risk profile that better predicts progression than baseline oxygen requirement alone. The highest risk group derives the greatest treatment effect from RDV. [ABSTRACT FROM AUTHOR]

Advances in antiretroviral therapy (ART) have made it possible for persons with human immunodeficiency virus (HIV) to live a near expected life span, without progressing to AIDS or transmitting HIV to sexual partners or infants. There is, therefore, increasing emphasis on maintaining health throughout the life span. To receive optimal medical care and achieve desired outcomes, persons with HIV must be consistently engaged in care and able to access uninterrupted treatment, including ART. Comprehensive evidence-based HIV primary care guidance is, therefore, more important than ever. Creating a patient-centered, stigma-free care environment is essential for care engagement. Barriers to care must be decreased at the societal, health system, clinic, and individual levels. As the population ages and noncommunicable diseases arise, providing comprehensive healthcare for persons with HIV becomes increasingly complex, including management of multiple comorbidities and the associated challenges of polypharmacy, while not neglecting HIV-related health concerns. Clinicians must address issues specific to persons of childbearing potential, including care during preconception and pregnancy, and to children, adolescents, and transgender and gender-diverse individuals. This guidance from an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America updates previous 2013 primary care guidelines. [ABSTRACT FROM AUTHOR]

California has a long history of damage from postfire flooding and debris flows, often described as the fire-flood sequence. Post-wildfire assessment has been conducted on California's non-federal lands for more than 60 years. From 1956 to 1999, the focus was on aerial grass seeding for emergency revegetation. Later, hillslope treatments including straw mulch and hydromulch were shown to be more effective in reducing erosion, but their high cost make them generally infeasible. In the 1990s the state moved away from aerial grass seeding and embraced a dual strategy for minimizing post-fire impacts. First, fire suppression repair work became consistently applied to all fires. Typical repairs include installing waterbreaks on firelines, grading roads, removing soil from crossings, and mulching mechanically disturbed areas near streams. Second, there was greater use of interdisciplinary teams to evaluate lifesafety and property threats from debris flows, flooding, and rockfall on non-federal lands. The state process was pioneered by the California Geological Survey (CGS) in 1993 and has benefited from advances in spatially explicit modeling since 2000. Currently, state teams are co-led by the California Department of Forestry and Fire Protection and CGS, with evaluations only conducted on fires with significant threats. This approach is effective for rapidly notifying emergency management agencies of hazards, helping to protect lives and property. This process will benefit from further technological advances, monitoring, and improved modeling. Strategies for improving post-fire hazard evaluation and better emergency preparedness through pre-fire hazard mitigation planning are provided. [ABSTRACT FROM AUTHOR]

Purpose Identifying hospitalizations for serious infections among patients dispensed biologic therapies within healthcare databases is important for post‐marketing surveillance of these drugs. We determined the positive predictive value (PPV) of an ICD‐10‐CM‐based diagnostic coding algorithm to identify hospitalization for serious infection among patients dispensed biologic therapy within the FDA's Sentinel Distributed Database. Methods: We identified health plan members who met the following algorithm criteria: (1) hospital ICD‐10‐CM discharge diagnosis of serious infection between July 1, 2016 and August 31, 2018; (2) either outpatient/emergency department infection diagnosis or outpatient antimicrobial treatment within 7 days prior to hospitalization; (3) inflammatory bowel disease, psoriasis, or rheumatological diagnosis within 1 year prior to hospitalization, and (4) were dispensed outpatient biologic therapy within 90 days prior to admission. Medical records were reviewed by infectious disease clinicians to adjudicate hospitalizations for serious infection. The PPV (95% confidence interval [CI]) for confirmed events was determined after further weighting by the prevalence of the type of serious infection in the database. Results: Among 223 selected health plan members who met the algorithm, 209 (93.7% [95% CI, 90.1%–96.9%]) were confirmed to have a hospitalization for serious infection. After weighting by the prevalence of the type of serious infection, the PPV of the ICD‐10‐CM algorithm identifying a hospitalization for serious infection was 80.2% (95% CI, 75.3%–84.7%). Conclusions: The ICD‐10‐CM‐based algorithm for hospitalization for serious infection among patients dispensed biologic therapies within the Sentinel Distributed Database had 80% PPV for confirmed events and could be considered for use within pharmacoepidemiologic studies. [ABSTRACT FROM AUTHOR]

Following wildfires, the probability of flooding and debris flows increase, posing risks to human lives, downstream communities, infrastructure, and ecosystems. In southern California (USA), the Rowe, Countryman, and Storey (RCS) 1949 methodology is an empirical method that is used to rapidly estimate post‐fire peak streamflow. We re‐evaluated the accuracy of RCS for 33 watersheds under current conditions. Pre‐fire peak streamflow prediction performance was low, where the average R2 was 0.29 and average RMSE was 1.10 cms/km2 for the 2‐ and 10‐year recurrence interval events, respectively. Post‐fire, RCS performance was also low, with an average R2 of 0.26 and RMSE of 15.77 cms/km2 for the 2‐ and 10‐year events. We demonstrated that RCS overgeneralizes watershed processes and does not adequately represent the spatial and temporal variability in systems affected by wildfire and extreme weather events and often underpredicted peak streamflow without sediment bulking factors. A novel application of machine learning was used to identify critical watershed characteristics including local physiography, land cover, geology, slope, aspect, rainfall intensity, and soil burn severity, resulting in two random forest models with 45 and five parameters (RF‐45 and RF‐5, respectively) to predict post‐fire peak streamflow. RF‐45 and RF‐5 performed better than the RCS method; however, they demonstrated the importance and reliance on data availability. The important parameters identified by the machine learning techniques were used to create a three‐dimensional polynomial function to calculate post‐fire peak streamflow in small catchments in southern California during the first year after fire (R2 = 0.82; RMSE = 6.59 cms/km2) which can be used as an interim tool by post‐fire risk assessment teams. We conclude that a significant increase in data collection of high temporal and spatial resolution rainfall intensity, streamflow, and sediment loading in channels will help to guide future model development to quantify post‐fire flood risk. [ABSTRACT FROM AUTHOR]

Summary: What is known and objective: With the advent of antiretroviral therapy and the resultant decrease in mortality among adults living with human immunodeficiency virus (HIV), there is now an increased incidence of obesity and obesity‐related comorbidities in these patients. Bariatric surgery is becoming an increasingly common treatment option for patients who are classified as clinically obese. There are limited data regarding the use of antiretroviral therapy in patients who have undergone bariatric surgery. The purpose of this review was to evaluate the available literature regarding antiretroviral therapy and pharmaceutical properties in this special population. Methods: Literature review was performed through PubMed, utilizing search terms of bariatric surgery, sleeve gastrectomy, Roux‐en‐Y, HIV infection, obesity and antiretroviral. Direct medical information requests to antiretroviral pharmaceutical manufacturers were also completed. Results: Several case series and case reports have been published which demonstrate minimal risk of complications and maintenance of virologic suppression in the vast majority of patients. Bariatric surgery appears to be an effective mechanism for assistance in controlling obesity in patients infected with HIV; however, numerous factors may impact the safe and effective use of antiretroviral therapy. What is new and conclusion: Due to the physiologic changes and postoperative management following bariatric surgery, evaluation of the patients' medication regimens must be considered and several factors should be taken into account when choosing the appropriate antiretroviral regimen for these patients. Furthermore, communication between the patients' surgeon, HIV provider and a clinical pharmacist should occur prior to surgery to ensure the patient is optimized to achieve the best outcome including maintaining virologic suppression. [ABSTRACT FROM AUTHOR]

Eye disease is a well-documented complication of HIV infection. Opportunistic infections generally comprised the majority of pre-antiretroviral therapy (ART) eye complications. With the introduction of ART, opportunistic infections diminished. However, early ART regimens were cumbersome regarding side effects and pill burden, making patient compliance difficult. Newer ART regimens are better tolerated and consist of fewer pills, theoretically making compliance easier and therapy more effective. The aim of this chart review study is to examine eye disease epidemiology in HIV patients as ART has evolved. We reviewed 222 admissions at Thomas Jefferson University Hospitals for 188 patients. These cases were divided into two groups. The first group was comprised of patients admitted from 1995 through 2003, while the second group consisted of patients admitted from 2003 to 2010. Eye disease epidemiology was compared between the two groups. Our study did note a significant decrease in eye diseases caused by opportunistic infections in the 2003-2010 patient group. Noninfectious eye disease is a significant complication in this group. [ABSTRACT FROM AUTHOR]

Human immunodeficiency virus (HIV) infection and the receipt of antiretroviral therapy have been associated with the development of cardiovascular disease. The occurrence of cardiovascular events in HIV-infected patients has often been associated with treatment-induced dyslipidemia, insulin resistance, and body composition changes. These treatment-related complications are often the result of exposures to protease inhibitors or thymidine analogs such as stavudine or zidovudine. Recent investigations, however, have suggested an association between exposure to the nucleoside reverse transcriptase inhibitor, abacavir, and the occurrence of cardiovascular disease events. Based on these findings, current guidelines recommend using caution in patients receiving abacavir who are at a high risk for cardiovascular disease. Decisions to replace abacavir in a patient's regimen should be considered on an individual basis and with complete evaluation of the associated benefits and risks. Furthermore, additional studies are necessary to definitively determine the association between abacavir exposure and the occurrence of cardiovascular disease events. Studies are also necessary to definitively identify the contributions of both HIV infection and individual antiretroviral agents on the development of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as the most common cause of skin and soft tissue infections (SSTIs). Methods. Retrospective chart review of 43 adult HIV-infected patients with CAMRSA SSTI was conducted. Results. Antibiotic susceptibility was as follows: vancomycin (100%), rifampin (100%), gentamicin (97.7%), tetracycline (96.5%), trimethoprim-sulfamethoxazole (95.2%), clindamycin (89.5%), levofloxacin (66.7%), and erythromycin (6.9%). At SSTI presentation, 58.5% of patients had CD4 counts greater than 200 cells/uL, 82.9% had a viral load (VL) below 100 000 log copies/mL, 6 of whom had undetectable VL. All 43 patients received empiric antibiotic therapy. Additionally, 34 patients underwent incision and drainage (I&D). For the 37 patients with follow-up data available at 4 weeks, 30 of the infections were resolved/resolving and 7 had no improvement or worsened. Conclusion. A majority of our patients with CA-MRSA SSTI did not have immunological/ virological markers consistent with severe HIV/AIDS disease at time of presentation. [ABSTRACT FROM AUTHOR]

Develops a mathematical model to analyze the effects of multipath on any modulation of an FM carrier. Assessment of the existing FM stereo system and the proposed FMX system; Impact of FMX system in the degradation of broadcast station coverage; Verification of the model by simulation and actual field testing.

Background In the context of medication safety, women with HIV who are of childbearing potential represent a particular challenge given the prevalence of unplanned pregnancies. Despite this, significant gaps in the literature exist characterizing prescription drug use in this cohort. Our study describes medication use and identifies medications that are contraindicated during pregnancy in a cohort of women with HIV who are of childbearing age. Methods Women with HIV aged 18–45 years who presented to an academic medical center between January 2016 and December 2017 were included for analysis. Patients were excluded if they were prescribed any form of contraception, received permanent sterilization, or were post-menopausal. The number of individual medications prescribed in the electronic medical record during the study period were documented. Chronic medications, defined as those prescribed for longer than 3 months, were analyzed. Patients were identified as experiencing polypharmacy if prescribed 5 or more medications at one time. In addition, contraindicated medications were reviewed and documented. Results A total of 213 patients met inclusion criteria for review. Of these, 169 (79%) and 66 (31%) patients experienced polypharmacy when including and excluding antiretrovirals, respectively. When antiretrovirals were included the mean number of medications prescribed was 7.48 (SD = 3.87) and 3.92 (SD = 3.75) when excluded. Of the 213 patients included, 64 (30%) were prescribed medications contraindicated during pregnancy. The majority of contraindicated medications were angiotensin converting enzyme inhibitors, angiotensin receptor blockers, statins, and hydroxyzine. In this cohort of women of child bearing potential (WOCBP) only 60 patients (28%) had been prescribed prenatal vitamins. Conclusion In this cohort of WOCBP with HIV, polypharmacy was observed in the majority of women. In addition, a third of these women were prescribed medications that are contraindicated during pregnancy. Given the potential impact of contraindicated medications on the developing fetus, our data supports the importance of preconception counseling on this issue as well as understanding the potential safety implications for mother and the fetus. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Childhood trauma has long-lasting implications for adult health as prior work in the general population linked ≥4 adverse childhood experiences (ACEs) to multiple negative health outcomes in adulthood. History of childhood trauma is prevalent in people living with HIV (PLWH); however, screening for history of childhood trauma is not routinely performed in HIV clinical care. Methods We conducted a single-center, cross-sectional quality improvement pilot project to (1) define the prevalence of ACEs in PLWH engaged in care and (2) improve linkage with mental health resources. We hypothesized the prevalence of ≥4 ACEs in PLWH would be >21%, the prevalence previously reported in the local, general population. Patients were approached in the course of routine clinical care at an urban, academic HIV outpatient clinic between October 2018 and April 2019 and offered screening for ACEs, depression, and post-traumatic stress disorder (PTSD) using previously validated tools. Results Forty-nine patients completed the screening. Median age was 48 years [IQR: 37–55]; 69% were male and 53% were gay or bisexual. Most patients identified as black/African American (75%) and white (12%). Median ACEs score was 4 [IQR 1–6], with 51% (95% CI: 36–66%) reporting ≥4 ACEs (Figure 1), and most common ACE being guardian substance abuse (57%) (Figure 2). When compared with men, women had a higher median ACEs score (5 vs. 3, P = 0.04), history of childhood sexual abuse (67% vs. 26%, P < 0.001), parent incarceration (53% vs. 24%, P = 0.04), and parental divorce or separation (73% vs. 41%, P = 0.04). Patients with ≥4 ACEs were more likely to have positive PTSD screens (56% vs. 21%, P = 0.02), moderate depression or greater (37% vs. 11%, P = 0.002), and were more likely to accept on-site mental health referral after screening (36% vs. 8%, P = 0.04). Acceptability of screening was deemed "very good" by patients, with median acceptability score 5 [IQR: 4–5] on a 5-point scale. Conclusion Over half of HIV+ patients screened in our clinic reported ≥4 ACEs, more than twice the prevalence of the general population. ACEs screening facilitated linkage of patients with high ACEs scores to mental healthcare. These results highlight the potential value of routine ACEs screening to enhance delivery of trauma-informed HIV primary care. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]