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Background Compared with the general population, PLWH have higher rates of tobacco use. We performed a prospective single-arm pilot study of the real-world feasibility of integrating an ambulatory smoking cessation decisional algorithm in our HIV clinic. We hypothesized that patients with drug and alcohol abuse would have a smaller change in smoking related behaviors. Methods Participants were PLWH attending our clinic and smoking at least 5 cigarettes/day regardless of their motivation to quit (N = 60). Each participant had an initial visit and two phone visits (+1 and +3 months). Participants completed surveys via computer during the first visit and by phone in the follow-ups. Additional clinical data were collected via chart review. Results Participants had a mean age of 48, were mostly African-American (72%) and male (67%) with well-controlled HIV (mean CD4 622, undetectable viral load in 70%). The mean AUDIT score to assess for alcohol abuse did not change over the. three time points (7.1;7.2;7.6, median 4;5;5). A score of 8 or higher indicates harmful alcohol consumption and 23% of patients met the criteria. Lifetime self-reported treatment for substance abuse was high (35%). DAST score for assessing substance abuse was used and mean scores decreased slightly over time (2.3;1.2;0.93, median 2;0;0). A score of 6 or higher indicates a substance use disorder and 15% met that criterion at baseline, 3% at 3 months. Chart review had similar results with 18% having a diagnosis of substance abuse and 20% with alcohol abuse. Overall participants (n = 60) showed a decrease in tobacco use, with an average of 14 cigarettes/day at baseline and 7 cigarettes/day at 3 months (P = 0.001). Patients with a diagnosis of substance abuse had a baseline average of 12 cigarettes/day and 6 cigarettes/day at 3 months (reduction 6). For those with an alcohol abuse diagnosis, baseline was 16 cigarettes/day and at 3 months, 10 cigarettes/day (reduction 6). The change over time was not significantly different between the groups. Conclusion People living with HIV who smoke are a complex group of patients who commonly have concurrent or historical substance and alcohol abuse. A substance and alcohol abuse diagnosis did not impact the decrease in tobacco use seen with implementation of a decisional algorithm. Disclosures All authors: No reported disclosures.

open forum infectious diseases

604. Impact of Substance and Alcohol Abuse on Smoking-Related Behaviors When Using a Smoking Cessation Decisional Algorithm Among People Living with HIV (PLWH)