One of the risk factors for poor outcome with SARS-CoV-2 infection is diabetes mellitus; diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the most serious complications of diabetes mellitus. We aimed to explore the clinical characteristics and outcomes of COVID-19 patients presenting with combined DKA/HHS to our institution. Methods: A retrospective, hospital based observation case series was performed on patients with SARS-CoV-2 admitted to Intensive Care Unit between 3/20/2020 and 4/20/2020. Inclusion criteria were: (1) Blood Glucose >250 mg/dL; (2) Serum bicarbonate <18 mmol/L; (3) Anion Gap >10; (4) serum pH <7.3; (5) ketonemia or ketonuria; (6) effective/calculated plasma osmolality >304 mOsm/kg and (7) positive SARS-CoV-2 RT-PCR. Results: We reported 6 patients who presented during this period with combined DKA/HHS. Their median age was 50 years, all males, three Hispanic, and three African American. Hispanic patients, had more severe acidosis, and multiple comorbidities, with a higher mortality. The striking feature was that combined DKA/HHS was the initial presentation for COVID-19 for most of the cases. Discussion: Our observational retrospective case series shows that diabetic patients are at risk of developing combined DKA/ HHS associated with COVID-19 and a substantial mortality. To our knowledge, we are first to report the clinical characteristics and outcome in this group of patients.

BackgroundCombination drug therapy is the standard of care for HIV treatment. PI monotherapy is considered experimental in the United States. However, some patients end up receiving PI monotherapy secondary to resistance and/or drug intolerance to other antiretroviral (cART) classes. This study will discuss real-life clinical results in patients on PI monotherapy and examine the potential for the development of primary PI mutations.MethodsAn observational retrospective study conducted in an inner-city HIV clinic identified 10 patients on PI monotherapy who each had two GenoSure Archive® (Labcorp) resistance profiles performed. Gender, race, prior cART, and baseline VL and CD4+ count were captured. VL and CD4+ count were trended in the time period between resistance tests. These profiles were then compared checking for the emergence of new primary PI mutations.ResultsSeven out of 10 patients were African American, two were Hispanic, one was Caucasian, and half were male. The mean time interval between archived resistance tests was 6.87 months. During the time between resistance profiles, nine were on darunavir and one switched from lopinavir to darunavir for less pill burden. Eight had an undetectable VL (defined by <50 copies/mL) at the first resistance test, seven had undetectable VL at the second resistance test, and six remained undetectable over the entire period between profiles. There were three that demonstrated blips in VL and one that experienced virological failure between the two sets of resistance tests. One patient had an initial resistance profile showing primary resistance to lopinavir. No patients gained any primary PI mutations to darunavir.ConclusionThe results of this study suggest that mainly darunavir-based PI monotherapy has good genetic barrier, even in the setting of virological failure. Larger studies examining similar data over longer durations are needed to confirm this finding.Disclosures All authors: No reported disclosures.

Background Data on risk of thromboembolism in PLWH is limited. HIV is often recognized as a chronic inflammatory disease and has been recognized as a prothrombotic condition. We aimed to analyze the incidence and demographic of venous thromboembolism such as pulmonary embolism and deep vein thrombosis in PLWH admitted to our hospital. Methods We conducted a retrospective hospital cohort study on PLWH ≥ 18 years old who were admitted to our hospital between 09/01/2018 and 09/01/2019. Study individuals were recruited if they had complete laboratory profile and well-defined clinical outcomes. Demographic, clinical and laboratory data were reviewed and retrieved. Descriptive analysis was employed to describe the demographic profile of PLWH with venous thromboembolism. Results Out of the 192 hospitalized PLWH during the study period, 15 (8%) patients had documented deep vein thrombosis (DVT) and/or pulmonary embolism (PE). History of DVT/PE was present in 5 (33%) patients while the rest had new onset of DVT/PE. Out of the 15 patients, 4 (27%) had DVT and PE, 4 (27%) had only DVT and 7 (46%) had only PE. The median age was 57 years, ranged from 40 to 74 years; 4 males and 11 females. As for ethnicities, 2 Caucasian, 12 were African American and 1 Hispanic. The average D-dimer was 4491. The median CD4 count for PLWH with venous thromboembolism was 487 and a median viral load of 900. In contrary, the median CD4 count of PLWH without venous thromboembolism was 420 and median viral load of 140. Though not statistically significance, higher viral load seems to associate with risk of venous thromboembolism. Surprisingly, female gender is an independent risk factor for venous thromboembolism in PLWH (z-score 2.75, p=0.0059; odds ratio [OR], 4.67; 95% confidence interval [CI], 1.56-13.69). Conclusion Our observation of PLWH with venous thromboembolism suggest that this population has an increased risk of venous thromboembolism as compared to general population. Female gender is an independent risk factor for venous thromboembolism in PLWH and higher HIV viral load seems to associate with higher risk. Larger prospective studies in this population are needed to dissect the interplay between HIV and venous thromboembolism. Disclosures All Authors: No reported disclosures

Background One of the risk factors for poor outcome with SARS-CoV-2 infection is diabetes mellitus; diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the most serious complications of diabetes mellitus. We aimed to explore the clinical characteristics and outcomes of COVID-19 patients presenting with isolated DKA or combined DKA/HHS to our institution. Methods A retrospective, hospital based observation case series was performed on patients with SARS-CoV-2 admitted to Intensive Care Unit between 03/20/20 and 04/20/20. Inclusion criteria were: 1) Blood Glucose &gt;250mg/dL; 2) Serum bicarbonate &lt; 18 mmol/L; 3) Anion Gap &gt;10; 4) serum pH &lt; 7.3; 4) ketonemia or ketonuria; and 5) positive SARS-CoV-2 RT-PCR. Hyperosmolality, on the other hand, was defined as an effective/calculated plasma osmolality &gt;304 mOsm/kg. Results A total of 87 patients with COVID-19 were admitted to the ICU during the study period, 12 of them had either isolated DKA or DKA/HHS. Baseline demographics, lab values and outcome are summarized in Table 1. Six of the patients had isolated DKA and six had combined DKA and HHS. The median age for the patient was 49.5 years old (range from 19 to 62 years old). The male to female ratio was 5:1. Of the 12 patients, 10 patients (83%) had a history of DM, nine were type 2 and only one type 1; two patients were newly diagnosed DM, presenting as DKA, presumptively precipitated by COVID-19. Five patients (42%) had a BMI &gt;30 kg/m2. As for ethnicity; seven were Hispanic (59%), four African American (33%), and one Caucasian (8%). Patients with combined DKA/HHS, higher BMI, higher HbA1c, severe acidosis tended to have higher mortality. The striking feature was that isolated DKA or combined DKA/HHS was the initial presentation for COVID-19 for most of the cases. Table 1: Demographic characteristic, inflammatory markers and outcome. Conclusion Our observational retrospective case series reinforces the need to watch for new onset DM and monitor blood sugar closely in those with known diabetes mellitus during SARS-CoV-2 infection, in order to avoid such serious complications as DKA and HHS. Disclosures Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)