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Background People living with HIV (PLHIV) suffer from adverse outcomes of metabolic syndrome. We hypothesized the COVID-19 pandemic, particularly with the stay-at-home status in 2020, resulted in physical inactivity and dietary changes leading to increases in weight and body mass index (BMI). Methods This retrospective observational chart review evaluated PLHIV at an infectious diseases clinic with a documented BMI from 2017 to 2020. Data on patients’ demographics, comorbidities, and antiretroviral therapy (ART) as of 2020 and the yearly values of BMI, A1c, and LDL from 2017 to 2020 were collected. Results Among 256 HIV-infected persons, mean age±SD was 48.5±13.1 (median=51; Q1-Q3: 39.5-57.5; range: 20-78) and 95 (37%) were female. Mean BMI were 28.19±6.32, 28.44±5.95, 28.57±5.91, and 29.00±6.09 for 2017, 2018, 2019, and 2020 respectively. Unadjusted and adjusted analysis showed a significant difference in BMI across time, where the mean BMI in 2020 was significantly higher than in 2017 (p< 0.0001), 2018 (p< 0.0001), and 2019 (p< 0.0001). Furthermore, for each consecutive year prior to 2019, there was no significant difference in mean BMI (2017 vs. 2018, p< 0.3464; 2018 vs. 2019, p< 0.4671; 2017 vs. 2019, p< 0.0861). There was a significant difference in A1c when adjusting for age, sex, race, and ART (Geometric Mean: 5.64, 5.68, 5.68, 5.78 for 2017 through 2020), with the visit year 2020 being significantly higher than 2017 (p< 0.003) and 2019 (p< 0.023) but not 2018 (p< 0.092). There were no significant differences in annual LDL using the same variables for adjustment. Body mass index (BMI) increased over time from 2017 to 2020 Mean BMI were 28.2±6.3, 28.4±5.9, 28.6±5.9, and 29.0±6.1 for 2017, 2018, 2019, and 2020 respectively. Pairwise comparison of BMI from 2017 to 2020 Unadjusted and adjusted analysis showed a significant difference in BMI across time, where the mean BMI in 2020 was significantly higher than in 2017 (p<0.0001), 2018 (p<0.0001), and 2019 (p<0.0001). Furthermore, for each consecutive year prior to 2019, there was no significant difference in mean BMI (2017 vs. 2018, p<0.3464; 2018 vs. 2019, p<0.4671; 2017 vs. 2019, p<0.0861). Conclusion Among PLHIV at our clinic, there was a substantial BMI increase in 2020, possibly due to the stay-at-home status in early 2020. A previous study utilized questionnaires to estimate the weight change in this patient population but this is the first report of documented BMI in the clinic setting. It is important to note that the magnitude of these differences was small and should be interpreted with caution. On the other hand, depending on a person’s initial height and weight, a one-unit change in BMI may translate to a substantial weight gain, which can be meaningful. Disclosures All Authors: No reported disclosures.

Background The transition to oral antibiotics in gram-negative bloodstream infections (BSI) can decrease length of stay, avoid central line access, and improve patient convenience. Some studies suggest that the bioavailability of the oral agent selected can impact outcomes. The purpose of this study was to determine when the most appropriate time to oral step-down is, and assess if the bioavailability of the agent selected impacts outcomes. Methods This retrospective observational chart review evaluated adult patients admitted to Long Island Jewish Medical Center during the study period of January 2019 – December 2019 with a gram-negative BSI from a genitourinary source. The primary objective was to assess if the time to oral step-down therapy impacts clinical success. Secondary objectives included assessment of if continued IV therapy or oral step-down impacts outcome measures including clinical failure, length of stay, and duration of therapy, and to compare high versus low bioavailability agents on treatment outcomes. Results A total of 130 patients were included, with 88 patients in the oral step-down group and 42 patients in the IV therapy only group. Clinical failure occurred in 10 patients in the oral step-down group, with 2 de-escalated in the 1-3 day range and 8 de-escalated in the 4-6 day range (p=0.29). There was no difference in clinical failure when the oral step-down group was compared to the IV therapy group (11 vs. 17%; p=0.41). The length of stay was significantly shorter in the oral step-down group (p< 0.0001), while the duration of therapy was shorter in the IV therapy group (p=0.0015). When comparing high and low bioavailability agents, there was no difference in the rate of treatment failure (p=0.74), length of stay (p=0.08), or duration of therapy (p=0.02). Conclusion There was no significant difference in outcomes if patients were de-escalated to oral therapy early versus late in their treatment course. Step-down to oral antibiotics led to decreased length of stay, and the bioavailability of the oral agent selected did not impact outcomes. This study demonstrates the safety and efficacy of prompt oral step-down for gram-negative bacteremia secondary to a genitourinary source which can have positive impacts on patient care. Disclosures All Authors: No reported disclosures