CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

breakthrough infections. The extended Cox proportional hazards models was used to investigate the association between the risk of breakthrough infection and predictor variables. RBD antibody levels were treated as a time-dependent covariate. Results: 983/1286 participants submitted at least one DBS after the primary two dose vaccine series (Spring 2021). 538 participants submitted a DBS following the availability of bivalent BA.4/BA.5 vaccines (September 2022). Of this 175 (32%) developed their first breakthrough infection. In multivariable analysis of these 538 participants, breakthrough infection was not associated with the brand of the primary vaccine series (two mRNA1273- Moderna vs other brands or combinations) nor with underlying comorbidity (diabetes, cardiovascular disease, respiratory disease, cancer or transplant), current smoking, gender or non-white race. Those who were > 70 years of age were less likely to have breakthrough infection compared to those aged 30-50 years; HR 0.652 [0.434, 0.979]. Those with lower RBD antibody levels were not more likely to have breakthrough infection. The strongest correlation of protection was receipt of a bivalent vaccine booster, HR 0.363 [0.265, 0.496]. Conclusion: Bivalent booster vaccines matching the circulating COVID strains had the greatest association with protection against first breakthrough infection. We could not identify a threshold RBD antibody level for protection. The elderly were less likely to have breakthrough infection possibly related to behavioral differences. Immunosuppressive Conditions Are Associated With Poor Outcomes in Patients Hospitalized for COVID-19 Vijeeth Guggilla , Jennifer Pacheco, Alexandre Carvalho, Anna Pawlowski, Grant Whitmer, Chad Achenbach, Theresa Walunas Northwestern University, Chicago, IL, USA Background: Immunosuppressed adults (primary immunodeficiency (PI), HIV (unsuppressed and poor immune recovery), and solid organ transplant) are more likely to have severe COVID-19 and poor outcomes. Less is known about outcomes of severe COVID-19 for adults with specific immunosuppressive conditions compared to immunocompetent adults. We hypothesized that outcomes for adults with certain immunosuppressive conditions hospitalized for COVID-19 would be significantly worse. Methods: We identified adults hospitalized for COVID-19 from 03/2020 to 05/2022 in EHR data from Northwestern Medicine (NM). Based on extracted diagnosis, lab, and procedure codes, we identified and categorized those with PI (antibody deficiency, combined immunodeficiency, common variable immunodeficiency, ataxia-telangiectasia, phagocyte deficiency, or complement deficiency), history of organ transplant (kidney, liver, heart, or lung), and HIV (defined above). Assessed COVID-19 outcomes included a seven-point ordinal severity scale based on maximum oxygen requirements during care (1 = Death), hospitalization length, and one-year cumulative incidence of death (all-cause). Regression and relative risk analyses were performed in R 4.2.0. Results: We included 10,713 adults hospitalized for COVID-19 at NM of which 214 had PI, 669 had history of organ transplant, and 183 had HIV (defined above). Patients with PI had a significantly higher mean hospitalization length of 11.8 days and a significantly lower mean maximum severity of 3.3 compared to 7.8 days and 3.9 in immunocompetent patients when controlling for obesity and T2DM. These effects were not significant when controlling for age. Patients with organ transplant had a significantly higher mean hospitalization length of 15.8 days when controlling for obesity, T2DM, and age, and a significantly lower mean maximum severity of 3.2 when controlling for obesity. Significantly higher mortalities were observed in PI and transplant (RR = 1.5, 95% CI 1.2 to 2.0; RR = 1.5, 95% CI 1.3 to 1.7), but these effects were not significant when controlling for age. There were no significant differences in any outcomes for patients with HIV. Conclusion: Our results suggest patients with PI or organ transplant hospitalized for COVID-19 may have worse clinical outcomes compared to immunocompetent patients. This contrasts with patients with HIV, who had similar outcomes to immunocompetent patients, suggesting that people with different immunosuppressive phenotypes may respond variably to severe COVID-19.

SF-36 by 81%. A higher frequency of participants with vs without long COVID reported problems in each of the five EQ-5D dimensions; mobility (24% vs 6%, p<0.001), self-care (8% vs 2%, p=0.007), usual activities (38% vs 6%, p<0.001), pain/discomfort (57% vs 14%, p<0.001), and anxiety/depression (41% vs 15%, p<0.001), with risk ratios of 2.75 to 6.18 (Figure 1A). Participants with vs without long COVID had lower scores on EQ-5D visual analogue scale, in which current health was self-rated from 0 (worst) to 100 (best) (median 85 vs 95, p<0.001). Participants with long COVID also had lower scores in each of the eight SF-36 domains (general health, physical functioning, physical role, bodily pain, vitality, social functioning, emotional role, and mental health; all p<0.001) (Figure 1B) and composite physical and mental component scores (both p<0.001). Conclusion: Long COVID is associated with worse HrQOL outcomes across multiple domains, highlighting the need to develop preventative and therapeutic interventions for this condition.

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Poster Abstracts

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Predictors of Breakthrough COVID-19 Infection From the STOPCoV Cohort Sharon Walmsley , Majid Nabipoor, Leif Erik Lovblom, Rizani Ravindran, Roaya M. Dayam, Dorin Manase, Karen Colwill, Anne-Claude Gingras, for the StopCov Research Team University of Toronto, Toronto, Canada Background: Our current understanding of the human immune response to SARS-CoV-2 does not enable us to quantify the degree of protection COVID-19 vaccines confer against infection and transmission especially with emerging variants. Methods: The STOPCoV (Safety and effectiveness of Preventative COVID Vaccines) study is an ongoing prospective decentralized study with the primary aim of comparison of the antibody responses to COVID vaccines in those aged > 70 years relative to a younger cohort aged 30-50 years. In this analysis, we assessed predictors of breakthrough COVID-19 infection during the Omicron BA5/EG5/XBB waves in Ontario, Canada. Antibodies were eluted from self-collected dried blood spots (DBS) tested by Enyzme linked Immunosorbent Assay for antibodies (IgG) against the receptor binding domain (RBD) and nucleocapsid proteins (NP). Values were converted to WHO BAU/ ml International Standards. Monthly data captured vaccine boosters and

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