Abstract Background Hepatitis B virus (HBV) and HIV co-infection is associated with high morbidity and mortality, but data and guidelines vary in terms of the best vaccination, re-vaccination, and monitoring practices. The purpose of this study was to evaluate the current HBV monitoring and vaccination practices of physicians who care for patients living with HIV. Methods A Web-based survey was distributed to the University of California San Diego (UCSD) Infectious Diseases division via the UCSD ID listserv, Infectious Disease Society of America (IDSA) members via the IDea Exchange listserv, and to ID and HIV social network members via Twitter and Facebook. The survey consisted of demographic questions followed by two sets of case-based questions. The case questions focused on type, timing, and dosage of HBV vaccination administration among people living with HIV, HBV monitoring post-vaccination, and clinical approach to patients with isolated hepatitis B core antibody. Results A total of 67 clinicians from 24 states completed the survey (Table 1). Most (55%) provide care for more than 20 patients living with HIV per month. The majority of participants (82%) would not defer HBV vaccination until HIV virologic suppression. Almost half of participants (43%) indicated they would use Heplisav-B over older HBV vaccine formulations (Energix-B or Recombivax-HB) for initial vaccination of susceptible patients. The majority (88%) would repeat a vaccination series if the patient does not seroconvert; 23% would repeat with a standard dose series of Energix-B or Recombivax-HB, 24% with a double dose series of Energix-B or Recombivax-HB, and 45% would repeat with Heplisav-B. Approach to management of a patient living with HIV with isolated hepatitis B core antibody was varied. The majority would check a HBV DNA level (42%), while 25% would initiate a vaccination series and 24% would not pursue further intervention (Table 2). Table 1: Clinician Demographics Table 2: HBV Vaccination Practices of Physicians Caring for People Living with HIV Conclusion This study provides insight into current HBV vaccination and monitoring practices of physicians who care for patients with HIV. The results revealed varied practice preferences and opportunities for improvement through standardization. Additional research is needed to elucidate the impact these various practices have on patient outcomes and healthcare expenditure. Disclosures All Authors: No reported disclosures

This survey study evaluates how clinicians approach hepatitis B virus (HBV) vaccination and monitoring in patients with HIV. Providers have clinical practices that vary greatly from one another and from current guidelines, especially for patients who do not seroconvert after initial HBV vaccination and for patients with isolated hepatitis B core antibody.

In complex decision tasks the decision maker frequently constructs a summary representation of the relevant evidence in the form of a causal explanation and relies on that representation, rather than the "raw" evidence base, to select a course of action from a choice set of decision alternatives. We introduce a general model for this form of decision making, called explanation-based decision making, because of the central roleplayed by the intervening evidence summary. Several original empirical studies of judicial decision making, a prototype of the class of explanation-based decision tasks, are reviewed and the findings are adduced in support of the explanation-based decision model. In legal decision making tasks subjects spontaneously construct evidence summaries in the form of stories comprising the perceived underlying causal relationships among decision relevant events. These explanations are primary mediators (i.e., causes)of the subjects' decisions.

Does categorization involve more than the similarity of an item to a category prototype or other category members? Rips (1989) argues yes, because categorization and similarity ratings sometimes diverge, indicating that they are based on different factors. However, Smith and Sloman (1994) suggest that such categorization/similarity dissociations may be limited to special conditions. We examined the effect of causal relationships between category attributes on categorization and similarity, and found that causal knowledge had a much larger effect on categorization than on similarity. This result was obtained with stimuli rich in characteristic attributes and without participants thinking aloud, that is, in just those conditions where Smith and Sloman found categorization to be solely similarity-based. Thus, the categorization/similarity dissociation demonstrated by Rips is alive and well, and the need for an account of categorization that goes beyond similarity is again highlighted.

The effect of knowledge about causal relationships between category attributes on categorization decisions was investigated. Participants were taught that category attributes were causally related in either a common-cause or a common-effect causal pattern. The weight given to attributes during subsequent categorization depended on the causal pattern: In the common-cause condition the common cause was weighted most heavily, whereas in the common-effect condition the common-effect was weighted most heavily. Participants also attended to correlations between causally related features, generating lower categorization ratings if a cause-effect relationship was violated. Participants displayed a wide variety of different strategies in making categorization decisions, including ones that employed higher-order configural information involving more than two attributes. There was no effect of the "kmd" of the category (biological kind, nonliving natural kind, or artifact) on categorization decisions, and kind of category did not interact with causal pattern.

Making judgments by relying on beliefs about causal relations is a fundamental aspect of everyday cognition. Recent research has identified two ways that human reasoning seems to diverge from optimal standards; people appear to violate the Markov Assumption, and do not to “explain away” adequately. However, these habits have rarely been tested in the situation that presumably would promote accurate reasoning – after experiencing the multivariate distribution of the variables through trial-by-trial learning, even though this is a standard paradigm. Two studies test whether these habits persist 1) despite adequate learning experience, 2) despite incentives, and 3) whether they also extend to situations with continuous variables

The association between nasopharyngeal (NP) SARS-CoV-2 viral loads and clinical outcomes remains debated. Here, we examined the factors that might predict the NP viral load and the role of the viral load as a predictor of clinical outcomes. A convenience sample of 955 positive remnant NP swab eluent samples collected during routine care between 18 November 2020 and 26 September 2021 was cataloged and a chart review was performed. For non-duplicate samples with available demographic and clinical data (i.e., non-employees), an aliquot of eluent was sent for a droplet digital PCR quantification of the SARS-CoV-2 viral load. Univariate and multivariate analyses were performed to identify the clinical predictors of NP viral loads and the predictors of COVID-19-related clinical outcomes. Samples and data from 698 individuals were included in the final analysis. The sample cohort had a mean age of 50 years (range: 19-91); 86.6% were male and 76.3% were unvaccinated. The NP viral load was higher in people with respiratory symptoms (p = 0.0004) and fevers (p = 0.0006). In the predictive models for the clinical outcomes, the NP viral load approached a significance as a predictor for in-hospital mortality. In conclusion, the NP viral load did not appear to be a strong predictor of moderate-to-severe disease in the pre-Delta and Delta phases of the pandemic, but was predictive of symptomatic diseases and approached a significance for in-hospital mortality, providing support to the thesis that early viral control prevents the progression of disease.

Background

The relationship between the viral kinetics of SARS-CoV-2 and clinical outcomes remains unclear.

Methods

A convenience sample of 955 remnant nasopharyngeal swabs collected during routine care between 11/18/20 and 9/26/21 were analyzed using digital PCR and associated clinical data extracted from the medical record. 18 individuals had >1 sample within 30 days of onset of symptoms.

Results

Paired samples were an average of 6 [range: 0-13] days apart. Four individuals sampled twice on the same day had a median 0.52 log₁₀ viral load difference between samples. Of the remaining, 12 individuals had a decrease in viral load over time, with an average decay of -0.23 log₁₀/day.

Conclusions

Our study found a similar rate of viral decay to others, but did not find associations between viral kinetics and clinical outcomes. Larger studies would be useful to support the use of this measurement as a surrogate endpoint for therapeutic studies.