Background Probiotics decrease the risk of necrotizing enterocolits (NEC). We sought to determine the impact of Bifidobacterium longum subsp. infantis (B. infantis) in the established rat model of NEC. Methods Rat pups delivered one day prior to term gestation were assigned to one of three groups: dam-fed (DF), formula-fed (FF), or fed with formula supplemented with 5 × 106 CFU B. infantis per day (FF+Binf). Experimental pups were exposed to hypoxia and cold stress. Ileal tissue was examined for pathology and expression of inflammatory mediators, antimicrobial peptides, and goblet-cell products. Ceca were assessed for bacterial composition by analysis of 16S rRNA sequence. Results Administration of B. infantis significantly reduced the incidence of NEC, decreased expression of Il6, Cxcl1, Tnfa, Il23, and iNOS, and decreased expression of the antimicrobial peptides Reg3b and Reg3g. There was significant microbial heterogeneity both within groups and between experiments. The cecal microbiota was not significantly different between the FF and FF+Binf groups. Bifidobacteria were not detected in the cecum in significant numbers. Conclusions In the rat model, the inflammation associated with NEC was attenuated by administration of probiotic B. infantis. Dysbiosis was highly variable precluding determination of the precise role of the microbiota in experimental NEC.

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Background The risk of coccidioidomycosis (CM) as a life-threatening respiratory illness or disseminated CM (DCM) increases as much as 150-fold in immunosuppressed patients. The safety of biologic response modifiers (BRMs) as treatment for patients with autoimmune disease (AI) in CM-endemic regions is not well defined. We sought to determine that risk in the Tucson and Phoenix areas. Methods We conducted a retrospective study reviewing demographics, Arizona residency length, clinical presentations, specific AI diagnoses, CM test results, and BRM treatments in electronic medical records (EMR) of patients >18 years old with International Classification of Diseases (ICD-10) codes for CM and AI from 10/01/2017 to 12/31/2019. Results We reviewed 944 charts with overlapping ICD-10 codes for CM and AI, of which 138 were confirmed to have both diagnoses. Male gender was associated with more CM (p=0.003), and African ancestry was three times more likely than European to develop DCM (p<0.001). Comparing CM+/AI+ (138) with CM+/AI- (449) patients, there were no significant differences in CM clinical presentations. Patients receiving BRMs had 2.4 times more DCM compared to Pulmonary CM (PCM). Conclusions AI does not increase the risk of any specific CM clinical presentation, and BRM treatment of most AI patients does not lead to severe CM. However, BRMs significantly increase the risk of DCM, and prospective studies are needed to identify the immunogenetic subset that permits BRM-associated DCM.

Conclusion.In the complex environment of a pediatric HIV specialty clinic, most PLWH mounted Ab responses to 4v HPV that were durable. H18 was least immunogenic. Patients with higher HIV VL were less likely to seroconvert for all types and were more likely to sero-revert.Disclosures. All Authors: No reported disclosures Antiretroviral Laboratory Monitoring and Implications for HIV Clinical Care in the Era of COVID-19 and Beyond

Background In the era of COVID-19, providers are delaying laboratory testing in people with HIV (PWH) to avoid unnecessary exposures despite antiretroviral guidelines recommending periodic testing. The purpose of this study was to examine the clinical significance of periodic renal, liver, and lipid testing. Methods We reviewed the charts of 265 people with HIV (PWH) who initiated outpatient care at HIV clinic between 1/1/16 and 12/21/18 and had at least two clinic visits. Analysis included frequency distributions, descriptive statistics, one-sided binomial exact tests, and Poisson models with 95% confidence intervals (CI). Results Eighty-five percent (221) of PWH had no laboratory abnormalities while on antiretroviral therapy (ART). The most common abnormality was a glomerular filtration rate (GFR) < 60 ml/min found in 10% of PWH. Multivariate analysis revealed that diabetes mellitus (DM) was associated with an increased risk of GFR < 60 ml/min (estimated rate ratio 2.68, 95% CI 1.35-5.33) and age < 60 years (estimated rate ratio .122, 95% CI .05-.32) was associated with a decreased risk (estimated rate ratio .24, CI .14 –.43). When a GFR was < 60 ml/min or an AST or ALT was >2X upper limit of normal (ULN), no action was taken in 52% of the cases. When an action was taken, the most common action was to repeat testing (18%). After a lipid panel result, the most common actions were to calculate a 10-year cardiovascular risk score (32%) and add a statin (18%). Taking action after lipid panel results was strongly associated with age ≥ 40 (estimated rate ratio 9.1, 95% CI 3.3-25). ART was changed in seven PWH based on GFR, AST/ALT, or lipid panel results. There were four individuals with poor outcomes including cerebrovascular accident, acute renal failure, end stage renal disease, congestive heart failure, myocardial infarction, and death. Contributing factors were hypertension, DM, and hypercholesterolemia. Conclusion Individuals < 40 years without ithout comorbidities had a low risk of having clinically significant renal and liver function abnormalities and rarely had actions taken after renal, liver, or lipid results. In the era of COVID-19 and beyond, it may be prudent for in certain groups to delay or eliminate liver, renal, and lipid testing to eliminate exposure, reduce cost, and avoid patient anxiety. Disclosures All Authors: No reported disclosures