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Background The kidney is a common target for human immunodeficiency virus (HIV), making renal disease a common noninfectious complication of HIV. Microalbuminuria is an important marker that can detect early renal damage. Timely detection of microalbuminuria is important to initiate renal management and stop the progression of renal dysfunction in people with HIV. Limited data are available about renal abnormalities in people with perinatal HIV infection. The objective of this study was to determine the prevalence of microalbuminuria in a cohort of perinatally HIV-infected children and young adults receiving combination antiretroviral therapy and investigate correlations between microalbuminuria and clinical and laboratory findings. Methods This was a retrospective study of 71 patients with HIV followed in an urban pediatric HIV clinic in Houston, Texas, between October 2007 and August 2016. Demographic, clinical, and laboratory data were compared between subjects with persistent microalbuminuria (PM) and those without. PM is defined as a microalbumin-to-creatinine ratio ≥30 mg/g on at least 2 occasions separated by at least 1 month. Results Sixteen of 71 patients (23%) met the definition of PM. In univariate analysis, patients with PM had significantly higher CD8+ T-cell activation and lower CD4+ T-cell nadir. Multivariate analysis demonstrated increased microalbuminuria to be independently associated with older age and CD8+ T-cell activation measured as CD8+HLA-DR+ T-cell percentage. Conclusions Older age and increased activation of CD8+HLA-DR+ on T cells correlate with presence of microalbuminuria in this cohort of HIV-infected patients. [ABSTRACT FROM AUTHOR]

Background. Robust immune restoration in human immunodeficiency virus (HIV)-positive patients is dependent on thymic function. However, few studies have investigated thymic function and its correlation with disease progression over time in HIVpositive patients. Methods. In this longitudinal prospective study, we followed 69 HIV-positive patients who were perinatally infected. Peripheral blood mononuclear cells were stained with monoclonal anti-CD4 and anti-CD31 and recent thymic emigrants (CD4+recently emigrated from the thymus (RTE), CD4+CD31+) quantified by flow cytometry. Statistical analysis used Wilcoxon rank sum test, Kruskal-Wallis, Spearman correlation, and Kaplan-Meier estimates; Cox regression models were performed for the longitudinal analysis. Results. Median age of HIV positive patients enrolled was 13 years (interquartile range [IQR], 8.6). CD4+RTE% decreased with age and was higher in females. Median CD4+RTE% was 53.5%, IQR, 22.9. CD4+RTE% was closely related to CD4+% and absolute counts but independent of viral load and CD8+CD38+%. Antiretroviral compliance as well as higher nadir CD4+% were associated with higher CD4+RTE%. Low CD4+RTE% predicted poor progression of VL and CD4+% over time. Conclusions. CD4+RTE% predicts disease progression and may reflect history of disease in HIV-positive patients and adolescents. They are easy to measure in the clinical setting and may be helpful markers in guiding treatment decisions. [ABSTRACT FROM AUTHOR]

Background It is recommended that all adults presenting to Emergency Departments (ED) be offered opt out testing for HIV. There is evidence that detection of HIV infection, disclosure of infected status to the patient, and enrollment into HIV care are best accomplished during the ED visit. Any delay results in loss of patients. Among critical variables are capacities to conduct screening and confirmatory testing during the time the patient is a resident in the ED. We report on a facility where HIV screening is performed during ED patient dwell times but confirmatory results follow in ≥24h. The conundrum is whether patients found HIV positive by a screening test should be informed of the positive screening finding before confirmatory results are in hand. Methods Data obtained from a routine opt-out HIV screening program for the interval June 2017 to March 2019 conducted at the ED in Houston, Texas were evaluated. Patients between 18–65 years with Glasgow Score >9 were eligible for testing. HIV fourth-generation ADVIA Centaur™ Ag/Ab COMBO (Siemens) was used for screening. Positives screening tests were followed by Gennius™ HIV1/HIV2 confirmatory test. Results 12,040 HIV fourth-generation tests were performed; 232 (1.9%) were positive; the specificity of the screening testing was 98.2%. Twenty-two (9.5%) of screening test positive individuals were found HIV false positive (Ag/Ab positive and Gennius negative). The population had a mean age of 43.8 years (21–64), was predominately female (63.6%) and white (40.9%). Further testing was completed for 14 of the 22 patients with false-positive screening tests. 13 had negative tests for HIV RNA and 1 had a second HIV Ag/Ab test with negative findings. 8 (36.3%) screening test false-positive patients could not be located after their departure from the ED. Conclusion If patients were disclosed of their HIV-positive status because of the screening test result, approximately 10% of these individuals would have been incorrectly categorized generating significant personal and social disruption while waiting for the confirmatory result. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Individuals living with HIV infection and/or Hep C infection and unaware of their infected status are at risk of significant morbidity and a risk to public health. It has been recommended that all conscious adults presenting to Emergency Departments (EDs) be tested for HIV and increasingly testing for Hep C. Testing of all arrivals is important because a majority of both infections may not present signature signs or symptoms associated with the reason for the ED visit. For these reasons, the implementation of a bundled HIV/HepC testing protocol is reported here. Methods Data from 4 years of HIV/Hep C screening of patients 18 to 64 years old made in 9 EDs in the Houston Metropolitan Area are reviewed. Screening for HIV was using HIV fourth-generation ADVIA Centaur™ Ag/Ab COMBO (Siemens) and Hep C was tested for using Gilead Hep C Ab testing. Results During January 2013 until October 2016, 3,976 HIV/Hep C test bundles were performed. There were 40 (1.0%) HIV+ and 407 (10.2%) Hep C positive detected. Nine (0.2%) of these individuals were positive for both HIV and Hep C. A 22.5% of HIV-positive patients were co-infected with Hep C. The population had a median age of 53 years, comprising an equal number of males and females. Conclusion A significant prevalence of Hep C (10%) and HIV (1%) was found in patients presenting for any cause of major EDs in the Houston region. Bundled HIV/Hep C testing of all arrivals to EDs is an effective way to identify individuals that need to be directed to antiviral and linkage to care. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Measurements of CD4 + CD31 + cells gave results consistent with those expected for recent thymus emigrant (RTE) CD4 + cells. The method was markedly simpler than established procedures for measurement of CD4 + RTE cells and is usable in locations with limited facilities and budgets., (© The American Society of Tropical Medicine and Hygiene.)