Progress towards ending HIV transmission in England by 2030

Background: England is committed to ending HIV transmission by 2030. The HIV Action Plan (2021) set an interim ambition to reduce HIV transmission by 80% to 600 new diagnoses first made in England by 2025. Here we present the progress between 2019 (baseline) and 2021, interpreted in the context of the COVID-19 pandemic. Method(s): People newly diagnosed with HIV were reported to the HIV and AIDS Reporting Section (HARS). The annual number of people having an HIV test in all sexual health services (SHS) including online testing were reported using GUMCAD. HIV diagnoses among people previously diagnosed abroad were excluded (25%). Result(s): New HIV diagnoses first made in England fell by 32% from 2,986 in 2019 to 1,987 in 2020, but plateaued in 2021 (2,023). Among gay/bisexual men, HIV diagnoses plateaued in 2021 (721) after a fall of 45% between 2019 and 2020, from 1,262 to 699. After a fall in HIV testing in 2020 (from 156,631 in 2019 to 144,800 in 2020), the number of people tested in 2021 (178,466) exceeded pre-COVID-19 levels. This suggests a decline in HIV incidence supported by a CD4 back calculation model (80% probability of a decline for the period 2019-2021), but at a slowing rate. Among heterosexual adults, new HIV diagnoses first made in England in 2021 also plateaued (798) following a 31% decrease (from 1,109 in 2019 to 761 in 2020). However, HIV testing coverage has not recovered to pre- COVID-19 levels (628,607 in 2019, 441,017 in 2020 and 489,727 in 2021). This provides no evidence of a fall in incidence in this population. Conclusion(s): A reduction by 360 new diagnoses first made in England year on year from 2022 onwards is required to meet the HIV Action Plan ambition. Despite an estimated 4,500 people with undiagnosed HIV and extremely high levels of antiretroviral therapy and viral suppression, PrEP access remains unequal. HIV testing numbers, which were affected by COVID-19 pandemic, have recovered in gay/bisexual men, but not among heterosexual adults. While the interim ambition is within reach for gay/bisexual men, PrEP and testing levels must be scaled up in heterosexual adults.

Psychological wellbeing and sleep in human immunodeficiency virus (HIV): a retrospective analysis of assessment and interventions within HIV services in the UK and Ireland (UKI)

Background: People living with HIV are disproportionately affected by psychological wellbeing and sleep issues which can detrimentally impact their quality of life, adherence and health outcomes. Despite monitoring and assessment being imperative to improve long-term health;evidence indicates a variation in incidence of this and absence in guidance for sleep issues. To support generation of evidence in this field, a market research study was designed to gain insights into current interventions for psychological wellbeing and sleep assessment within HIV services in UKI. Method(s): The study was managed by a market research agency where an online survey link was disseminated to healthcare professionals (HCPs) in multiple HIV centres across UKI. To ensure accuracy of data, HCPs randomly selected a maximum 20 patient notes reviewed between 2020 to 2022. No identifiable patient information was recorded or shared with resulting data presented at an aggregate level. Result(s): 39 clinics participated contributing 665 patient notes with demographics reflective of UKI population. Since Covid- 19 77% of HCPs perceived an increasing demand for mental health support with 64% stating they routinely assess mental health;however, the majority express issues with capacity and resourcing to sufficiently support these patients. 33% of patients included were identified as experiencing a decline in psychological wellbeing, the majority of which self-reported during face to face (F2F) routine appointments;14% of these patients had a PHQ9. 78% received support with the majority signposted to external resources. For those who did not receive support, the primary driver was patient request. 46% of services state they do not routinely assess for sleep issues. A lower proportion of patients (17%) were identified as having such issues;however, of those identified the primary method was self-reporting during F2F routine appointments. 6% of these patients had a PSQI. Of those who did not receive sleep support, a lack of guidance was the main cited reason. Conclusion(s): This study indicates high variation between local management of psychological wellbeing and sleep in HIV, in addition to key gaps in clinical guidance, identifying, managing and ongoing monitoring which is required to ensure long term health.

Mortality among people with HIV in the UK in 2021: findings from the National HIV Mortality Review

Background: The National HIV Mortality Review (NHMR) was launched by UK Health Security Agency (UKHSA) and British HIV Association to better recognise causes of death and preventable death, and to describe end-of-life care, among people with HIV. Method(s): UK HIV services submitted data on all known deaths among people with HIV under their care in 2021 through a secure online form. Cause of death was categorised by an epidemiologist and four clinicians using the Coding Causes of Death in HIV protocol. Result(s): In 2021, 101 services reported 606 deaths among people with HIV to NHMR. In 2019, 74 services reported to the NHMR while 121 reported in 2020. Median age at death was 58 [interquartile range (IQR): 56-59] and most (76%) were male. Death cause was ascertainable for 78% (n=475), with the most common being non-AIDS-related cancers (26%), followed by non-AIDS-defining infections (19%), cardiovascular disease (16%), AIDS (9%), substance misuse (8%), respiratory disease (4%), accident/suicide (3%), liver disease (2%) and other causes (11%). COVID- 19 caused or contributed to 11% of all deaths. Thirtythree people (5%) died within a year of HIV diagnosis, 90% of these were diagnosed late (CD4<350 cells/mm3), 80% very late (CD4<200 cells/mm3), 54% diagnosed with AIDS and 33% had documented missed opportunities for earlier diagnosis. Viral suppression (<200 copies/mL) (87%) and treatment coverage (98%) was high with the median time on treatment 13 years [IQR: 8-20]. Common lifestyle risk factors in the preceding year included smoking (33%;n=179), excessive alcohol use (20%;n=103). Other factors included drug use (non-injecting and injecting) and opioid substitution therapy. Death had been expected for 298 (49%) individuals, of whom 230 had discussed end-of-life care and 108 had a documented advanced end-of-life care plan in place. Conclusion(s): Over half of people living with diagnosed HIV are aged over 50. Most deaths were not AIDS related however, one in eleven people with diagnosed HIV in the UK died from AIDS. Of people that died within a year of diagnosis, one in three had documented missed opportunities for earlier HIV diagnosis.

Micro-eliminating HCV in 8 diverse prisons that serve a general population of 3.7 million in the Yorkshire region of England

Background: National Health Service England (NHSE) plans to eliminate Hepatitis C (HCV) by 2025. With a reported HCV prevalence of about 6% in male prisons, and about 12% in female prisons, secure environments are an essential component of this elimination plan. Yorkshire is a region in England with a general population of about 3.7 M. PPG is the provider of healthcare to 9 prisons in Yorkshire, with approximately 6,000 residents, many of whom are current, or previous, substance users. Description of model of care/intervention: To support NHSE in the elimination of HCV, a partnership between Gilead Sciences, Practice Plus Group (PPG) and the Hepatitis C Trust (HCT) was formed in 2019. This partnership works with prison and hospital teams to optimise test and treat pathways for new prison admissions. In addition, whole prison HCV Intensive Test and Treat events (HITT programmes) were run in targeted prisons to ensure testing of residents who were incarcerated before these optimisations were implemented. Effectiveness: HCV screening, within 7 days of prison entry, increased from 27% in May 2019 to 93% in January 2022. This increase was achieved despite COVID-19 restrictions remaining in place since March 2020 across all English prisons. In addition, HITT programmes were used to test residents who were missed at prison entry. The overall result is that 8/9 prisons have achieved microelimination status, as defined by: >= 95% of prison residents tested within the previous 12 months, >= 90% of RNA positive patients treated or initiated on treatment and presence of a robust system to review ongoing testing and treatment performance to ensure these targets are maintained. Conclusion and next steps: Micro-elimination of HCV will now need to be maintained in these prisons by ensuring the uptake of HCV testing remains>95%. Plans are in place to micro-eliminate the final prison-which is a high-security prison presenting unique challenges to HCV micro-elimination.

An Evaluation of Surgical Management Including Breast Reconstruction During the COVID 19 Pandemic at a Community-Based Academic Hospital

INTRODUCTION: The COVID 19 pandemic caused unprecedented changes in treatment of breast cancer. The aim of this IRB approved retrospective study was to assess trends in surgical management and reconstructive choice after mastectomy during the pandemic. Even as an epicenter at the start of COVID, our hospital prioritized the treatment of breast cancer patients facilitating timely care within accepted standards. METHOD(S): We compared female patients with breast cancer (BC) treated with either lumpectomy (L) or mastectomy (M) during a 12-month period in 2017 and 2020-2021. We stratified based on no reconstruction (NR) versus surgical reconstruction (R), reconstruction using autologous tissue (AT) or tissue expander/implant (TE/I), and age above or below 60 years (< 60, >60). RESULT(S): 399 total patients were treated surgically in 2017 and 2020. In 2017, there were 50 M and 115 L (30.3%/69.7%) versus in 2020, 113 M and 121 L (48.3%/51.7%). In 2017, 9 patients had NR (18.0%) while in 2020, 37 had NR (32.7%). In 2017, 41 had R (82.0%), with 24 receiving AT (58.5%) and 17 had TE/I (41.5%). In 2020, 76 had R (67.3%), with 34 receiving AT (44.7%) and 42 had TE/I (55.3%). For age < 60, 29 had R (70.7%) and 2 had NR (22.2%) in 2017;51 had R (67.1%) and 16 had NR (43.2%) in 2020. For age >60, 12 had R (29.2%) and 7 had NR (77.8%) in 2017;25 had R (32.9%) and 21 had NR (56.8%) in 2020. These data show a 13.8% shift towards TE/I over AT with a 14.7% increase in NR. CONCLUSION(S): Breast cancer patients were prioritized and surgically treated within quality standards. With the changes in availability of hospital resources, staff, and limiting viral exposure, mastectomy rates versus lumpectomy increased dramatically. These trends were possibly due to avoidance of daily facility trips for radiation treatment. Tissue expander/implant rates increased substantially possibly from avoidance of prolonged versus overnight hospital stay. Mastectomy without reconstruction also increased and future studies are needed to determine the number of delayed reconstruction in this group.

Prevalence of pulmonary hypertension in patients with COVID-19 related lung disease listed for lung transplantation: A UNOS registry analysis.

COVID-19 related lung disease (CRLD) has emerged as an indication for lung transplantation (LT) in highly select patients. The prevalence and prognostic implication of coexisting pulmonary hypertension (PH) in patients with CRLD listed for LT is not known. Adult patients in the United Network for Organ Sharing database listed for LT for COVID-19 related acute respiratory distress syndrome or fibrosis through March 2022 were identified. The prevalence and impact of precapillary PH on pre- and posttransplantation survival was determined. Time-to-event analysis was used to compare outcomes between those with and without precapillary PH. We identified 245 patients listed for LT for CRLD who had right heart catheterization data available at the time of registry listing. Median age of the cohort was 54 years (interquartile range [IQR]: 46, 60), 56 (22.9%) were female, and the median lung allocation score was 81.3 (IQR: 53.3, 89.4). The prevalence of precapillary PH at the time of transplant listing was 27.9%. There was no significant difference in pretransplant mortality in patients with and without precapillary PH (sHR: 0.5; 95% confidence interval [CI]: 0.1-1.7, p = 0.261). A total of 187 patients ultimately underwent LT; of those, 60 (31.0%) were identified as having precapillary PH during the waitlist period. Posttransplantation survival was similar between patients with and without pretransplant precapillary PH (hazard ratio: 0.96; 95% CI: 0.2-3.7, p = 0.953). We observed a high rate of concomitant precapillary PH in patients listed for LT for CRLD. Though common, coexisting precapillary PH was not associated with a significant difference in either pre- or post-transplantation outcomes.

Nature and well-being: The association of nature engagement and well-being during the SARS-CoV-2 pandemic

Numerous studies have shown the positive association between nature engagement and well-being. During the early phases of the SARS-CoV-2 pandemic, nature engagement changed dramatically as mental health and well-being declined across the globe. This study examines how psychological connection to nature and engagement with nature in various forms is associated with well-being during the SARS-CoV-2 pandemic. Specifically, we examine which types of nature engagement (i.e. with nearby nature, through nature excursions and media-based) are more strongly associated with well-being based on measures of loneliness, rumination, pandemic emotional impact and mental health. We employed a cross-sectional online survey of adults (N = 3282) residing in the United States, 25% of whom report seldom spending time in nature. Our findings revealed that the psychological construct of connection to nature was associated with less loneliness and greater mental health. Overall, nature engagement was a consistent predictor of well-being, but different types of activities predicted varying outcomes on our four dependent variables. Greater engagement with nearby nature during the pandemic was associated with less rumination, less pandemic emotional impact and better mental health while nature excursions (e.g. camping, backpacking) and media-based nature engagement were associated with greater loneliness, more emotional impact from the pandemic and worse mental health. In addition, nature engagement via media was associated with greater rumination. Our findings suggest that promoting opportunities to increase engagement with and access to nearby nature is associated with better human well-being, especially during challenging events, and should be part of a multi-pronged approach for coping with the next public health crisis. Read the free Plain Language Summary for this article on the Journal blog. © 2023 The Authors. People and Nature published by John Wiley & Sons Ltd on behalf of British Ecological Society.

Seroepidemiologic Investigation of a COVID-19 Outbreak Aboard a U.S. Navy Ship

The crew of USS Kidd experienced a COVID-19 outbreak identified in April 2020. This is the earliest documented COVID-19 study with RT-PCR, serology, and pre-exposure test data on the entirety of the exposed population (n=333). Case definitions included 121 confirmed (36.3% of crewmembers) and 18 probable (5.4% of crewmembers) based on laboratory diagnostic test results. At the time of testing positive, 62 (44.6%) cases reported no symptoms. Hispanic ethnicity (AOR: 2.71, CI: 1.40-5.25) and non-smoker status (AOR: 2.28, CI: 1.26-4.12) were identified as statistically significant risk factors. This study highlights the value of rapid, onboard diagnostic testing to quickly identify an outbreak and enumerate cases, as well as the serological testing to flag potential cases missed with standard viral case identification methodologies.

Evaluation of telephone consultations prior to Mohs surgery: the importance of informed consent

The updated General Medical Council (GMC) guidance on consent (2020) states that 'decision making is an ongoing process focused on meaningful dialogue: the exchange of relevant information specific to the individual patient'. In the UK there are several barriers to this process in dermatology, including short clinic appointments and loss of continuity of care (the surgeon may not have seen the patient in clinic). Many barriers have been exacerbated by the COVID-19 pandemic with the additional challenges of telephone consultations. In light of the GMC guidance we conducted a survey to see what patients recalled of their clinic discussion prior to surgery. Seventy-six responses were received over 2 weeks from patients attending day surgery. The results showed that although the majority of patients received an information sheet on skin surgery there were significant inconsistencies in what was discussed in clinic with regard to alternative options, risks and benefits of surgery and the likely repair. We addressed the problem of inadequate preparation for complex surgery by implementing a new process for patients awaiting Mohs surgery. A senior registrar on the Mohs team contacted patients by telephone 2-3 days before surgery. During the telephone call the process of Mohs surgery, the risks and benefits (including the risk of attending the department during the COVID-19 pandemic), and alternative options to Mohs were discussed. The repair options were discussed in detail. Patients were also advised on transport, provision of victuals, postoperative wound care and the potential necessity of future appointments. The telephone calls lasted 5-12 min (average 6 min 48 s). When patients attended for surgery they were asked to complete a patient survey to evaluate their telephone consultation. Seventeen responses were received from the second survey over 2 weeks. Fifteen patients recalled alternative options to Mohs surgery being discussed prior to attending surgery and 15 recalled the risks of surgery being discussed. All patients recalled discussing the potential options for repair, and all patients felt that they had received adequate information prior to attending their surgical appointment. On a scale of 1-5 (1 being very uncertain and 5 being very confident) patients were asked to rate their confidence in the procedure after their telephone call with the surgeon. The majority rated 5 (n = 13), three scored 4 and one scored 2. Shared decisionmaking and fully informed consent is critical to effective patient care. It is particularly important prior to complex skin surgery such as Mohs, and patients should have the opportunity to discuss their procedure with a Mohs specialist before surgery. We demonstrated that a telephone call before surgery is an effective and time-efficient method that ensures patients are fully informed and increases their confidence in the procedure.

Empirical Evidence to Support a Nudge Intervention for Increasing Online Engagement in Higher Education

Student engagement is recognised as being a critical factor linked to student success and learning outcomes. The same holds true for online learning and engagement in higher education, where the appetite for this mode of learning has escalated worldwide over several decades, and as a result of COVID-19. At the same time teachers in higher education are increasingly able to access and utilise tools to identify and analyse student online behaviours, such as tracking evidence of engagement and non-engagement. However, even with significant headway being made in fields such as learning analytics, ways in which to make sense of this data, and to utilise data to inform interventions and refine teaching approaches, continue to be areas that would benefit from further insights and exploration. This paper reports on a project that sought to investigate whether low levels of student online engagement could be enhanced through a course specific intervention strategy designed to address student engagement with online materials in a regional university. The intervention used course learning analytics data (CLAD) in combination with the behavioral science concept of nudging as a strategy for increasing student engagement with online content. The study gathered qualitative and quantitative data to explore the impact of nudging on student engagement with 187 students across two disciplines, Education and Regional/Town Planning. The results not only revealed that the use of the nudge intervention was successful in increasing the levels of engagement in online courses but also revealed that the prerequisites for nudging were needed in order to increase success rates. The paper points to the value for the broader awareness, update, and use of learning analytics as well as nudging at a course, program, and institutional level to support student online engagement. © 2023 by the authors.

Early Clinical Development of Lufotrelvir as a Potential Therapy for COVID-19

Lufotrelvir was designed as a first in class 3CL protease inhibitor to treat COVID-19. Development of lufotrelvir was challenged by its relatively poor stability due to its propensity to epimerize and degrade. Key elements of process development included improvement of the supply routes to the indole and lactam fragments, a Claisen addition to homologate the lactam, and a subsequent phosphorylation reaction to prepare the prodrug as well as identification of a DMSO solvated form of lufotrelvir to enable long-term storage. As a new approach to preparing the indole fragment, a Cu-catalyzed C-O coupling using oxalamide ligands was demonstrated. The control of process-related impurities was essential to accommodate the parenteral formulation. Isolation of an MEK solvate followed by the DMSO solvate ensured that all impurities were controlled appropriately. © 2023 American Chemical Society.

Editorial: The society for environmental geochemistry and health (SEGH): 50 years and beyond.

When the SEGH international board released a short editorial paper back in 2019, we described an aim to increase the membership offering, whilst improving the diversity of input regionally, by scientific discipline and to ensure greater and more regular contact across the regions from 2020 onwards. Wider aspirations described in 2019 (Watts et al. 2019) are discussed within this short communication at the end of 2021 to evaluate progress made. In particular, how the SEGH community adapted to the unprecedented circumstances that have challenged each and every one of us throughout the COVID-19 pandemic since early 2020 and are likely to influence our activities for the foreseeable future.

Educators' experiences of pivoting online: unearthing key learnings and insights for engaging students online

The impact of the COVID-19 pandemic meant that online teaching in higher education became the default. Educators were, and often now continue to be, required to pivot to online teaching, necessitating them to adapt their teaching delivery, effectively engage students online, and apply existing skills to new and unfamiliar pedagogical contexts. This paper presents a small international case study, investigating the experiences of a diverse group of educators who wanted to learn about engaging students because their higher education institutions were pivoting to online teaching. Following the educators' involvement in professional learning about a particular online engagement framework, the educators used their learning in their planning and online teaching. Data extracted from a deductive coding exercise augmented by qualitative data gleaned from semi-structured interviews was used to explore how the educators enhanced the engagement strategies they implemented in their courses. The findings indicate the types of learning processes used by the educators and how they applied their learning to online teaching. The deductive analysis suggests that the strategies the participants revealed worked well in their online practice correspond with the strategies delineated in the framework.

Lessons learned from the Global Polio Eradication Initiative: A roadmap for the international COVID-19 vaccination campaign

The COVID-19 vaccine is lauded by many as one of the greatest accomplishments in modern medicine, with the potential to definitively contain the deadliest pandemic of the last century. With the vaccine rollout now underway in the developing world, a robust, methodical, and swift global distribution effort is required to ensure that it will be done in an equitable manner. Taking into account the vast geographic, socioeconomic, cultural, and political diversity of countries around the world, global vaccination efforts have historically required multifaceted, time consuming, and labor-intensive approaches to be effective. However, with over 33 years of experience from the Global Polio Eradication Initiative – an international health initiative aimed at eradicating poliomyelitis – the COVID-19 vaccination campaign does not have to be approached blindly. Using lessons learned from the Global Polio Eradication Initiative, this paper aims to identify the supply-and demand-side barriers to the success of the international COVID-19 vaccination effort, and ways each can be overcome. Most notably, health systems shortcomings, political and cultural messaging, and civil unrest and violent conflict serve as daunting obstacles to the success of the COVID-19 vaccination campaign. The Global Polio Eradication Initiative has been able to overcome many of these same obstacles with innovative strategies such as context-specific microplanning, robust health surveillance systems, and community-centered education and advocacy programs. Ultimately, while the Global Polio Eradication Initiative is still fighting the battle of polio eradication, it has provided a roadmap for the COVID-19 vaccination campaign to be executed in a more swift and equitable manner. © 2022 Kamuzu University of Health Sciences.

Describing the immune response kinetics to mRNA COVID-19 vaccines among previously SARS-CoV-2-infected and -uninfected nursing home residents, a prospective longitudinal observational cohort evaluation-Georgia, October 2020 - September 2021

Background. To describe post-COVID-19 vaccination [fully vaccinated (FV) and first booster] immune response and occurrence of reinfection ( >90 days from prior infection) in nursing home residents (NHr) with/without evidence of prior SARS-CoV-2 infection. Methods. In a longitudinal prospective cohort of 36 NHr from 3 NHs, interviews, chart ions, and specimens [blood and anterior nasal swabs (ANs)] were collected at baseline and monthly visits. ANs underwent molecular and BinaxNOWTM antigen testing. Quantitative Meso Scale Discovery platform tested blood specimens for anti-spike (S) protein and anti-nucleocapsid (N) antibodies. In addition, in a subset (n=13), S-specific memory B cells (MBCs) were tested with ELISpot assays. Results. The cohort's median age was 72 years;46% male, 64% White Non-Hispanic, 80% had >=3 comorbidities, and 29 (81%) had prior SARS-CoV-2 infection. Of 36, 76% received Pfizer-BioNTech and 24% Moderna homologous vaccine. The median distribution of anti-S IgG concentrations among those with prior infection increased 15-30 days post-FV, remained stable for 90 days, and declined by 120 days. The anti-S IgG remained above the estimated vaccine effectiveness (VE) thresholds published [Pfizer-BioNTech (95% VE: 530 BAU/ml), Moderna (90% VE: 298 BAU/ml)]. Among those without previous infection, anti-S IgG declined after 60 days and stayed near the VE thresholds until a recent infection/booster. Age, sex, and comorbidities had no appreciable impact on anti-S IgG. From enrollment to November 2021, 1of 29 had reinfection. From December 2021 to January 2022, 2 of 7 had a new infection, and 4 of 29 had reinfection, as shown by anti-N IgG rise. Persistently low numbers of total and anti-S MBC were seen across the evaluation, even with post-booster anti-S MBC rise. There was an immediate rise in anti-S IgG concentrations in all participants post-booster, irrespective of recent infection. Conclusion. These findings from a NH convenience cohort suggest that prior SARS-CoV-2 infection has a pronounced immunomodulatory enhancing effect on the magnitude and duration of FV immune response. The decline of anti-S antibodies post-FV and rise after booster supported the booster recommendation in this cohort. The low MBC counts indicate immunosenescence in this high-risk population.

College Students' Belonging and Loneliness in the Context of Remote Online Classes during the COVID-19 Pandemic

The COVID-19 pandemic has drastically affected how higher education operates, but relatively little is known about its effects on students enrolled in remote online classes. Across two data collection timepoints, we sought to examine college students' experiences, focusing particularly on their sense of belonging/loneliness, their course formats, and their experiences in the pandemic. Though some findings differed between data collected in fall 2020 and in spring 2021, we generally found that students' belonging/loneliness was linked with their class format, aspects of their virtual classes, social contact, and experiences in the pandemic. This research demonstrates the importance both of understanding students' experiences in general and of continuing to study students' experiences as we progress from one stage of the pandemic to the next. © 2022, The Online Learning Consortium. All rights reserved.

DISSEMINATED INVASIVE ASPERGILLUS MASQUERADING AS AMIODARONE-INDUCED THYROTOXICOSIS

SESSION TITLE: Rare Pulmonary Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: Aspergillus is a group of opportunistic endemic fungal species that causes pathology within the respiratory tract and sinuses of individuals with predisposing factors, such as immunosuppression. While less frequently discussed, aspergillosis thyroiditis represents the most common fungal thyroiditis. We present a case of this condition that was misdiagnosed as amiodarone induced thyrotoxicosis. CASE PRESENTATION: A 54-year-old male was evaluated in outpatient pulmonary clinic after a chest CT revealed new upper lobe mass-like pleural based infiltrates with accompanying symptoms of dyspnea on exertion and fevers. His medical history was significant for orthotopic heart transplant 6 months ago due to a combination of non-ischemic cardiomyopathy with further decompensation from COVID-19 infection. After transplant, he was diagnosed with thyrotoxicosis secondary to amiodarone that was being treated with prednisone and methimazole. Given the concern for infection on imaging, he was admitted to the hospital and underwent urgent bronchoscopic evaluation. During the procedure, he was noted to have severe extrinsic tracheal compression. His neck imaging was consistent with a nodular goiter. The BAL revealed Aspergillosis fumigatus and he was subsequently treated with isavuconazium. Given the compression on the trachea and persistent dyspnea, the decision was to pursue total thyroidectomy. Surgery occurred 2 months after treatment was initiated for the Aspergillosis and with improvement on serial chest CTs. Pathologic examination of the thyroid tissue revealed extensive invasive aspergillus with abscesses involving both lobes. DISCUSSION: Aspergillus infection leading to disseminated disease typically occurs in individuals that have a compromised immune system such as seen in malignancy, solid organ transplant, chronic steroid use, and poorly controlled diabetes mellitus. Recently, it has been cited that up to 15% of hospitalized COVID-19 patients requiring intensive care develop aspergillus infection. After initial aspergillosis infection has been established, the thyroid gland is a site for dissemination due to its rich vascular supply. In addition, due to the angioinvasive properties of the pathogen, the fungus can breakdown tissue planes and easily travel from its site of origin. Thereby a primary infection in the respiratory tract can lead to dissemination to the neck structures due to its proximity. When thyroid invasion occurs, the common complaints are neck pain and swelling. Thyroid laboratory findings encompass the full spectrum including hyperthyroidism, hypothyroidism, and euthyroid. Given these non-specific findings, clinicians need to be conscious of this disease entity. CONCLUSIONS: In patients with immunocompromising conditions, findings of neck pain, swelling, and abnormal thyroid laboratory values should broaden the differential for clinicians to include aspergillosis thyroiditis. Reference #1: Alvi, Madiha M et al. "Aspergillus thyroiditis: a complication of respiratory tract infection in an immunocompromised patient.” Case reports in endocrinology vol. 2013 (2013): 741041. doi:10.1155/2013/741041 Reference #2: Marui, Suemi, et al. "Suppurative thyroiditis due to aspergillosis: a case report.” Journal of Medical Case Reports 8.1 (2014): 1-3. Reference #3: Kuehn, Bridget M. "Aspergillosis Is Common Among COVID-19 Patients in the ICU.” JAMA 326.16 (2021): 1573-1573. DISCLOSURES: No relevant relationships by A. Whitney Brown, value=Honoraria Removed 04/03/2022 by A. Whitney Brown No relevant relationships by A. Whitney Brown, value=Honoraria Removed 04/03/2022 by A. Whitney Brown No relevant relationships by A. Whitney Brown, value=Consulting fee Removed 04/03/2022 by A. Whitney Brown No relevant relationships by Kristen Bussa Advisory Committee Member relationship with Boehringer Ingelheim Please note: 2019-2021 Added 04/03/2022 by Christopher King, value=Consulting f e Advisory Committee Member relationship with Actelion Please note: 2019-2022 Added 04/03/2022 by Christopher King, value=Consulting fee Advisory Committee Member relationship with United Therapeutics Please note: 2019-2022 Added 04/03/2022 by Christopher King, value=Consulting fee Speaker/Speaker's Bureau relationship with Actelion Please note: 2019-2022 Added 04/03/2022 by Christopher King, value=Consulting fee Speaker/Speaker's Bureau relationship with United Therapeutics Please note: 2020-22 Added 04/03/2022 by Christopher King, value=Consulting fee No relevant relationships by Haresh Mani No relevant relationships by Mary Beth Maydosz No relevant relationships by Alan Nyquist No relevant relationships by Anju Singhal No relevant relationships by Amy Thatcher