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Background Assess HCV prevalence, screening, new infections and reinfections and their relationship to other STI screening and diagnosis in HIV+ MSM at an urban center. Methods Retrospective review of HCV and STI testing and diagnosis among HIV+ MSM with ≥1 visit January 1, 2016–October 31, 2018 at Montefiore’s Center for Positive Living and Medical Group outpatient sites. Demographics from local databases, clinical data from EPIC and chart review on select cases. Results 876 HIV+ MSM, median age 42, 80% virally suppressed. 850 (98.2%) had known HCV status. 36/850 (4.2%) HCV Antibody (Ab)+ at any point: 23 (2.7%) at baseline (6 dual MSM/IDU), 13 (1.5%) newly Ab+ (0 dual risk). 4/36 (11.1%) HCV RNA+: 1 of baseline Ab+, 3 in newly Ab+’s. Among new Ab+’s, 7 asymptomatic, 6 symptomatic, most commonly high liver tests. 3/13 (15.4%) were persistently viremic requiring therapy. 614/827 (74.2%) HCV Ab-’s were retested ≥1, 260 (31.4%) &gt;1x – average retesting interval 13 months. Among 36 HCV Ab+’s, 0 had reinfection. Testing and new STIs by HCV status is in Table 1. 2/13 (15.4%) with new HCV were not tested for gonorrhea or chlamydia (G/C) at any site. Acute syphilis was more common in new HCV+’s than HCV-’s (P =.002). HCV rescreening was higher in those tested for extragenital (EG) G/C vs. those not tested (Table 2), but up to 18.8% were not HCV retested despite EG testing done. 304/876 (34.7%) were ≤35 years of age. Testing and positive results for all four STIs were greater in those ≤35 (Table 3). Non-Hispanic (NH)-Black was the largest race/ethnicity and had the highest rate of new STI’s except pharyngeal chlamydia, rectal gonorrhea and acute syphilis (Table 4). Conclusion We found significant risk of HCV among HIV+ MSM in our cohort, with a prevalence of 2.7% and a 34-month incidence of 1.5%, with no reinfections. HIV+/HCV Ab- MSM were frequently retested for HCV but missed opportunities among sexually active individuals lead to delayed diagnoses of acute infection. Unexplained elevation of liver tests in sexually active HIV+ MSM should prompt immediate HCV testing, and more HCV Ab testing is indicated as part of STI screening in this group. Awareness should be raised about risk of acute HCV with new syphilis, and there is room to improve EG G/C testing. Disclosures All authors: No reported disclosures.

open forum infectious diseases

357. Hepatitis C (HCV) Testing and Diagnosis and Their Relationship to Sexually Transmitted Infection (STI) Screening and New Infections in an HIV+ Men Who Have Sex with Men (MSM) Outpatient Cohort