Clostridium subterminale is a low virulence species of Clostridium that is an infrequent cause of human infections. We report a case of C. subterminale bacteremia in an immunocompetent patient who developed botulism-like symptoms.

Adrenal insufficiency is a rare manifestation of tissue-invasive cytomegalovirus (CMV) disease. CMV is one of the leading opportunistic pathogens affecting renal transplant recipients. Its prevalence in the adrenal glands of autopsied AIDS cases has been well documented. We report a rare case of CMV-associated adrenal insufficiency in a renal transplant recipient.

Background Early in the COVID-19 pandemic, tenofovir (TAF/TDF) was identified as a potential agent for SARS-CoV-2 due to binding to RNA-dependent RNA polymerase similarly to remdesivir. This led to the hypothesis that TAF/TDF may be lessening the severity and improving outcomes of COVID-19 infection. COVID-19 Severity COVID-19 Infection Outcomes Methods Patients were identified by searching for HIV infection and SARS-CoV2 PCR testing. Type of antiretroviral therapy (ART), CD4+ cell count, HIV viral load (VL), comorbidities, presenting symptoms, severity of COVID infection, and outcomes were analyzed. COVID disease was classified as mild, moderate, severe, or critical based on World Health Organization criteria. We primarily sought to determine the effect of TAF/TDF on the severity of COVID infection. The secondary endpoint was to determine the effect of low CD4 count and HIV VL on the severity of infection. Results 39 HIV+ patients were tested at least once for SARS-CoV2 by PCR at VA NJ Health Care System. 18 of 39 patients were PCR positive. In those, common presenting symptoms included: fever (15/18), cough (7/18), and lethargy/fatigue (6/18). 16 of the 39 HIV+ patients’ ART included TAF/TDF; 8 of 18 COVID+ and 8 of 21 COVID-. In the COVID- group, 2 patients had CD4 count < 200 cells/mm3, 3 patients had HIV VL >200, and 19 of 21 had at least 1 comorbidity. In the COVID+ group, 3 had CD4 count < 200 cells/mm3, none had detectible HIV viremia, and all but one had comorbidities. Of COVID+ infections, 7 were mild, 3 moderate, 8 severe, and 5 patients died. 4 of the 5 patients that did not survive were in non-TAF/TDF group. All 3 patients with CD4 count < 200 cells/mm3 had severe disease. 6 out of 8 patients developed mild disease in TAF/TDF group vs. 1 out of 10 patients in non-TAF/TDF group. 1 out of 8 and 7 out of 10 patients had severe or critical disease in TAF/TDF vs non-TAF/TDF groups respectively. Conclusion In this sample of 18 HIV+ patients with COVID-19 infection, patients receiving TAF/TDF were more likely to develop mild disease and have full recovery than those who were on TAF/TDF-free regimens (75% vs. 10% and 87.5% vs. 50%, respectively). Patients not on TAF/TDF-based regimens had a higher rate of developing severe and critical COVID-19 disease (40% vs. 0% and 30% vs. 12.5%, respectively). Disclosures All Authors: No reported disclosures

Background The data on retreatment of patients with second-generation DAA treatment failure is limited. AASLD retreatment guidelines were established but are classified as class IIb/Level C. We analyzed treatment outcomes in NJ VA patients with prior second-generation DAA failure over a period of 1 year.Methods We performed a retrospective health record review of all HCV patients treated between May 1, 2016 and May 1, 2017. HCV genotypes (GT), the presence of cirrhosis and HIV, DAA type, and RAVs post treatment were evaluated in the treatment failure (TF) group, defined as an inability to achieve the sustained virological response 12 weeks post therapy (SVR12). These patients were retreated with a new DAA regimen selected for their individual characteristics, GT and presence of RAVs and retreatment success rates were recorded.ResultsOf 312 HCV patients, 10 failed second-generation DAA therapy during the outlined period. The TF group had 2 patients with HIV, 5 with cirrhosis, 6 with GT 1a, 2 with GT 1b, and 2 with GT 3a. Patients with GT 1a/b were initially treated with Ledipasvir/Sofosbuvir (LDV/SOF) ± Ribavirin (RBV). One patient with GT 3a was treated with LDV/SOF +RBV, and 1 with SOF+RBV. Three patients stopped treatment early due to side effects or non-compliance. Post-treatment resistance panel was available for 7/10 patients with the following detected mutations: Q30H/K/E/R, L31 L/M, Q20Q, M28V, Q80K, Y93A/H. 2/8 GT1a/b patients were re-treated with SOF/Elbasvir(EBR)/Grazoprevir(GZR)/RBV, 2 with SOF/ Velpatasvir (VEL)/RBV, 2 with EBR/GZR+/-RBV, and 2 with Viekira/SOF/RBV. 1 patient with GT 3a was retreated with SOF/Daclatasvir (DAC), 1 with SOF/VEL/RBV. All 10 patients had an undetectable viral load (VL) at the end of treatment. SVR12 has been achieved for all 5 patients that were tested, with the remaining 5 awaiting week 12.Conclusion The HCV second-generation DAA treatment failure rate in patients at the NJ VAHCS over 1 year was 3.2%. Analysis of available data indicates that the presence of RAVs might be the major cause of treatment failure among HCV patients treated with DAAs in NJ VA. Different retreatment regimens were used for a period of 12–24 weeks with 100% undetectable VL at end of treatment.Disclosures All authors: No reported disclosures.

No abstract