AbstractPeople living homeless and people with substance use disorders are at increased risk for HIV but experience multiple intersecting barriers to accessing medical care. Low-barrier care has emerged as a strategy to engage persons with complex needs in care, particularly in the fields of HIV and substance use treatment. We describe our experience implementing low-barrier whole person care for HIV treatment and prevention at 3 community-embedded sites in King County, Washington, and outline key operational and clinic characteristics that helped facilitate success.

AbstractPeople with human immunodeficiency virus (HIV) have an earlier occurrence of aging complications, including cognitive impairment (CI). Chronic immune activation from cytomegalovirus (CMV) may contribute to increased inflammation and CI. We explored this association using several measures of CMV immune response among people with HIV (PWH). In a case-control design, we compared CMV immunoglobulin G (IgG), enzyme-linked immunospot (ELISpot), and flow cytometry between cases (subsequent CI) and controls (no CI). Baseline CMV IgG, CMV ELISpot, or flow measures were not associated with subsequent CI. This exploratory analysis supports larger studies using more nuanced immunophenotyping to clarify relationship between CMV and development of CI in PWH.

AbstractPeople with HIV have higher risk for rejection after kidney transplantation but the mechanism is poorly understood. As HIV latency promotes immune dysregulation and chronic inflammation, we evaluated whether the size of the HIV latent viral reservoir (LVR) at baseline and through 52-weeks is associated with rejection in kidney transplant recipients with HIV from donors with and without HIV. Using the intact proviral DNA assay, we found no differences in the LVR between those who experienced rejection (n=14) versus those who did not (N=55) regardless of donor HIV status. These data support the feasibility of HIV+ to HIV+ organ transplantation.Clinical Trials Registration. NCT03500315.

AbstractPeople with HIV who are re-entering the community after incarceration encounter multiple barriers to engagement in HIV care and treatment. We conducted a narrative review of recent interventions (2020-2023) developed to address barriers and improve HIV-related health outcomes for people with HIV and incarceration experience in the U.S. This review yielded six interventions published in the peer-reviewed literature, and four interventions from the gray literature (i.e., informally published interventions). Eight of the interventions used the strategy of providing re-entry services to support engagement in HIV care and social services after release from incarceration. Of the peer-reviewed studies, only two reported statistically significant improvements in HIV-related outcomes. Gray literature interventions lacked the methodological details necessary to interpret findings. Systems-level and multi-level interventions were promising but need more rigorous study. To end the HIV epidemic, more innovation is needed to address barriers to care for people with HIV and incarceration experience.

AbstractPeople who use drugs (PWUD) are increasingly acquiring and transmitting hepatitis C virus (HCV) and being admitted to the hospital for often costly non-HCV related conditions. Traditionally, treatment of HCV has been deferred to the outpatient setting. However, outpatient HCV follow-up can be an arduous process to navigate with resultant gaps in care, especially for PWUD with numerous complex psychosocial and medical co-morbidities. Hospitalization presents a key opportunity to initiate treatment, and several institutions have piloted inpatient treatment models with intensive outreach. We conducted a narrative review of peer-reviewed literature (2014–2024) evaluating hospital-based HCV treatment models for PWUD; six studies from four countries met inclusion criteria. Evidence suggests that engaging PWUD during hospitalization leads to higher treatment initiation and completion compared to standard of care outpatient referral. Inpatient HCV treatment models should be one part of a comprehensive plan in the US and internationally to eliminate HCV for all.

AbstractPeople who use drugs (PWUD) are increasingly acquiring and transmitting hepatitis C virus (HCV) and being admitted to the hospital for often costly non–HCV-related conditions. Traditionally, treatment of HCV has been deferred to the outpatient setting. However, outpatient HCV follow-up can be an arduous process to navigate with resultant gaps in care, especially for PWUD with numerous complex psychosocial and medical comorbidities. Hospitalization presents a key opportunity to initiate treatment, and several institutions have piloted inpatient treatment models with intensive outreach. We conducted a narrative review of peer-reviewed literature (2014–2024) evaluating hospital-based HCV treatment models for PWUD; 6 studies from 4 countries met inclusion criteria. Evidence suggests that engaging PWUD during hospitalization leads to higher treatment initiation and completion as compared with standard-of-care outpatient referral. Inpatient HCV treatment models should be one part of a comprehensive plan in the United States and internationally to eliminate HCV for all.

AbstractPeople with HIV-1 have higher risk for rejection after kidney transplantation but the mechanism is poorly understood. As HIV latency promotes immune dysregulation and chronic inflammation, we evaluated whether the size of the HIV latent viral reservoir (LVR) at baseline and through 52-weeks is associated with rejection in kidney transplant recipients with HIV from donors with and without HIV. Using the intact proviral DNA assay, we found no differences in the LVR between those who experienced rejection (n = 14) versus those who did not (N = 55) regardless of donor HIV status. These data support the feasibility of HIV+ to HIV+ organ transplantation.Clinical Trials Registration. NCT03500315.

AbstractPeople sometimes experience shame in response to being looked down upon, despite rejecting the negative attitudes taken towards them by others. I aim to explain why—while also holding onto the idea that shame is a response to an apparent flaw in oneself. At the heart of my proposal is...

AbstractPeople with HIV experience geriatric syndromes commonly found in much older populations and may benefit from geriatrician consultation. Multiple clinical models have emerged to address this need. We describe a model at the University of Colorado and the barriers to its robust implementation. The UCHealth Infectious Disease clinic implemented a referral-based model to connect high-risk people with HIV ≥50 years old with the UCHealth Seniors clinic. During geriatric consultation, patients were screened for functional status, preventative care, socioenvironmental factors, and cognitive/mental health concerns. Geriatricians communicated recommendations to the primary HIV provider. HIV providers completed a survey about the program. From January 2018 to July 2019, 11 patients underwent geriatric consultation. The average age was 69 years old (SD = 7.4; range 59–80). Geriatricians made recommendations regarding referral to other health or community-based services (n = 9), medication changes (n = 8), osteoporosis screening (n = 6), and management of memory problems (n = 5). Advanced directives were discussed in all visits. Almost all primary HIV providers said they would refer future patients to the program. The geriatric consultation program improved access to geriatric care but with limited uptake. We posit that lack of provider and patient consensus on the utility of geriatric care, the lack of a co-located clinical model, challenges in addressing polypharmacy, geriatrician shortages, and financial constraints all act as barriers to implementation of models of HIV geriatric care.

AbstractPeople with HIV experience geriatric syndromes commonly found in much older populations and may benefit from geriatrician consultation. Multiple clinical models have emerged to address this need. We describe a model at the University of Colorado and the barriers to its robust implementation. The UCHealth Infectious Disease clinic implemented a referral-based model to connect high-risk people with HIV ≥ 50 years old with the UCHealth Seniors clinic. During geriatric consultation, patients were screened for functional status, preventative care, socioenvironmental factors, and cognitive/mental health concerns. Geriatricians communicated recommendations to the primary HIV provider. HIV providers completed a survey about the program. From January 2018 to July 2019, 11 patients underwent geriatric consultation. The average age was 69 years old (SD=7.4; range 59-80). Geriatricians made recommendations regarding referral to other health or community-based services (n=9), medication changes (n=8), osteoporosis screening (n=6), and management of memory problems (n=5). Advanced directives were discussed in all visits. Almost all primary HIV providers said they would refer future patients to the program. The geriatric consultation program improved access to geriatric care but with limited uptake. We posit that lack of provider and patient consensus on the utility of geriatric care, the lack of a co-located clinical model, challenges in addressing polypharmacy, geriatrician shortages, and financial constraints all act as barriers to implementation of models of HIV geriatric care.

AbstractPeople with HIV who are reentering the community after incarceration encounter multiple barriers to engagement in HIV care and treatment. We conducted a narrative review of recent interventions (2020–2023) developed to address barriers and improve HIV-related health outcomes for people with HIV and incarceration experience in the United States. This review yielded 6 interventions published in the peer-reviewed literature and 4 interventions from the gray literature (ie, informally published interventions). Eight interventions used the strategy of providing reentry services to support engagement in HIV care and social services after release from incarceration. Of the peer-reviewed studies, only 2 reported statistically significant improvements in HIV-related outcomes. Gray literature interventions lacked the methodological details necessary to interpret findings. Systems-level and multilevel interventions were promising but need more rigorous study. To end the HIV epidemic, more innovation is needed to address barriers to care for people with HIV and incarceration experience.

AbstractPeople with HIV may be at increased risk for long COVID after acute SARS-CoV-2 infection. We investigated the association between HIV and long COVID in two large electronic health record databases.Using data from the Patient-Centered Clinical Research Network (PCORnet) and the National Clinical Cohort Collaborative (N3C) from 1/1/2018 to 4/30/2024, our analytic sample included individuals aged ≥21 years with SARS-CoV-2. All individuals were classified as having HIV or not. We estimated the adjusted odds ratio (aOR) of long COVID by HIV status using logistic regression. Multivariable models controlled for potential associated factors and used 2 cohort definitions: a computed phenotype definition or ICD-10 code-based definition.We included 1,369,896 patients from PCORnet (11,964 with and 1,357,932 without HIV) and 3,312,355 patients from N3C (23,931 with and 3,288,424 without HIV). Using the computed phenotype definition of long COVID, we noted a small, but significant, increase in odds of developing long COVID among people with compared to those without HIV (PCORnet aOR 1.09 [CI 1.04-1.14] and N3C aOR 1.18 [CI 1.13-1.23]). Using the ICD-10 definition of long COVID, there was no association between HIV and long-COVID (PCORnet aOR 1.01 [CI 0.88-1.16] and N3C aOR 1.07 [CI 0.97-1.18], respectively).In this large multicenter study, people with HIV had a modestly increased risk of long COVID when defined by a computed phenotype, but not when using ICD-10 codes. These findings suggest that long COVID may be under-recognized in people with HIV and underscore challenges in diagnosing long COVID in populations with baseline chronic conditions.

AbstractPeople living homeless and people with substance use disorders are at increased risk for HIV but experience multiple intersecting barriers to accessing medical care. Low-barrier care has emerged as a strategy to engage persons with complex needs in care, particularly in the fields of HIV and substance use treatment. We describe our experience implementing low-barrier, whole-person care for HIV treatment and prevention at three community-embedded sites in King County, Washington and outline key operational and clinic characteristics that helped facilitate success.

AbstractPeople do much of their thinking in a social context by drawing on information provided by others and sharing their own judgments with others. This