ABSTRACT
Passive immunization with mAbs has been employed in COVID-19. We performed a systematic review of the literature assessing the endogenous humoral immune response against SARS-CoV-2 in patients treated with mAbs. Administration of mAbs in seronegative patients led to a reduction in both antibody titres and neutralizing activity against the virus.Copyright © 2022
ABSTRACT
The SARS-CoV-2 is the betacoronavirus responsible for the coronavirus disease 2019 (COVID-19) pandemic. Severe COVID-19 affects approximately 10-15% of patients and results in prolonged morbidity and mortality. Little is known about the immunophenotypic changes of the lung parenchyma driven by the viral infection in patients who die of severe COVID-19. Ultrasound-guided lung biopsies (LB) were collected (IRB approval#1561/21) within few hours from death in 15 severe COVID-19 patients between November 2020 and January 2021, in two patients who underwent lung transplantation after COVID-19 and in one patient who had surgery for bacterial superinfection during COVID-19 disease. All samples underwent histologic and immunohistochemistry evaluation and molecular profiling using the nCounter Host Response and Coronavirus Panel plus. As controls, lungs from end-stage usual interstitial pneumonia (UIP;n=9) and from lobectomy for lung cancer (Norm;n=5) were used. Eleven lungs (61%) were positive for SARS-CoV-2 RNA. Signs of diffuse alveolar damage (DAD) were observed in 6 patients (30%). COVID-19 lungs showed a marked macrophage infiltration with M2 polarization compared with controls. Globally, COVID-19 lungs showed distinct molecular profiles from UIP or Norm lungs. Specifically, a marked upregulation of interferon-genes that was directly correlated with SARS-CoV-2 genes was seen in COVID-19 lungs. COVID-19-specific genes signatures (Log2FC >1.5;adj p<0.05) obtained using VENN diagram showed impairment of the STAT3-pathway accompanied by the upregulation of the NFkB signaling. Results herein provide new insights into lung alterations induced by severe COVID-19 and suggest novel potential targets for therapeutic intervention.
ABSTRACT
Recent advances in biosensing analytical platforms have brought relevant outcomes for novel diagnostic and therapy-oriented applications. In this context, 3D droplet microarrays, where hydrogels are used as matrices to stably entrap biomolecules onto analytical surfaces, potentially provide relevant advantages over conventional 2D assays, such as increased loading capacity, lower nonspecific binding, and enhanced signal-to-noise ratio. Here, we describe a hybrid hydrogel composed of a self-assembling peptide and commercial agarose (AG) as a suitable matrix for 3D microarray bioassays. The hybrid hydrogel is printable and self-adhesive and allows analyte diffusion. As a showcase example, we describe its application in a diagnostic immunoassay for the detection of SARS-CoV-2 infection. © 2023, The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature.
ABSTRACT
Aim: Delays in the screening programs for colorectal cancer and the reluctance of patients to seek medical attention due to the outbreak of SARS-CoV- 2 could have resulted in more advanced cancers at diagnosis. The aim of this study was to compare the oncologic outcomes of patients with colorectal cancer in Italy between the pandemic and pre-pandemic periods. Method(s): A retrospective multicentre cohort study of 17,938 patients who underwent surgery for colorectal cancer from March 2020 to December 2021 (pandemic period: 7796 patients, 43.5%) and from January 2018 to February 2020 (pre-pandemic period: 10,142 patients, 56.5%) in 81 centres. The primary outcome was advanced stage at diagnosis. Secondary outcomes were T4 stage, M stage, aggressive biology, stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. Result(s): At the logistic regression, the SARS-CoV- 2 pandemic period was significantly associated with an increased rate of advanced stage (OR 1.07, 95% CI 1.00-1.13, p = 0.034), distant metastases (OR 1.10, 95% CI 1.00-1.21, p = 0.050), aggressive biology (OR 1.32, 95% CI 1.15-1.53, p < 0.001), and stenotic lesions (OR 1.16, 95% CI 1.02-1.31, p = 0.028). Conclusion(s): The present study reports a significant correlation between the SARSR-CoV- 2 pandemic and the worsening of the oncologic outcomes in patients undergoing surgery for colorectal cancer, and might predict a potential reduction of survival of these patients. An adequate large-scale response is necessary to reduce the impact of the pandemic on colorectal cancer patients' survival.
ABSTRACT
In SARS-CoV-2 pandemic scenario, the identification of rapid methods to detect antibodies against coronavirus has been a wide and urgent issue. Epitope mapping on peptide microarrays is a rapid way to identify sequences with a high immunoreactivity. The process begins with a proteome-wide screening, based on immune affinity;the use of a high-density microarray is followed by a validation phase, where a restricted panel of probes is tested using peptide microarrays;peptide sequences are immobilized through a click-based strategy.COVID-19-positive sera are tested and immuno-domains regions are identified on SARS-CoV-2 spike (S), nucleocapsid (N) protein, and Orf1ab polyprotein. An epitope on N protein (region 155-171) provided good diagnostic performance in discriminating COVID-19-positive vs. healthy individuals. Using this sequence, 92% sensitivity and 100% specificity are reached for IgG detection in COVID-19 samples, and no cross-reactivity with common cold coronaviruses is detected. Overall, epitope 155-171 from N protein represents a promising candidate for further development and rapid implementation in serological tests.
ABSTRACT
Recent advances in biosensing analytical platforms have brought relevant outcomes for novel diagnostic and therapy-oriented applications. In this context, 3D droplet microarrays, where hydrogels are used as matrices to stably entrap biomolecules onto analytical surfaces, potentially provide relevant advantages over conventional 2D assays, such as increased loading capacity, lower nonspecific binding, and enhanced signal-to-noise ratio. Here, we describe a hybrid hydrogel composed of a self-assembling peptide and commercial agarose (AG) as a suitable matrix for 3D microarray bioassays. The hybrid hydrogel is printable and self-adhesive and allows analyte diffusion. As a showcase example, we describe its application in a diagnostic immunoassay for the detection of SARS-CoV-2 infection.
ABSTRACT
Background: Rheumatic musculoskeletal diseases (RMD) are pathological conditions characterized by an impaired immunological system that is determinant both in the pathogenesis and in the inadequate response to infections. The use of disease-modifying anti-rheumatic drugs (DMARDs), which include conventional synthetic (cs) or biologic and targeted synthetic (b/ts) DMARDs, contribute to compromise immunological reactivity. Objectives: To analyze the immune response to SARS-CoV-2 in patients with rheumatoid arthritis (RA) or spondyloarthritis (SpA) receiving treatment with DMARDs and to investigate the effect of the different classes of drugs on humoral and cellular response. Methods: Patients were tested for anti-SARS-CoV-2 IgG, IgM and IgA antibodies to nucleoprotein (N) and receptor-binding domain (RBD) through ELISA and neutralization assays. Then, we performed a fow cytometry analysis of monocytes, NK cells, B and T lymphocytes from PBMCs of serologically positive patients. We also included a cohort of non-RMD individuals recovered from COVID-19 as a reference group of non-immunosuppressed subjects. A frst recruitment occurred in May-June 2020 (T1) and a second recruitment, 3-4 months after (T2), allowed to evaluate the persistence of the antibody response over time and to investigate the cellular immune response to SARS-CoV-2 in RMD patients having resolved the infection. Results: During T1, 358 patients with RA (n=200) or SpA (n=158) were recruited. Mean age was 52.8, 64% were female. All patients were treated with DMARDs, 299 with b/tsDMARDs and 59 received csDMARDs alone. One third was also receiving corticosteroids (CS). At T2, 36 subjects were recruited. We found a seroprevalence rate of 18.4%, which did not signifcantly differ between RA and SpA groups, and between patients treated with b/ts-DMARD or csDMARDs, either alone or in combination with CS (Table 1). Antibody levels of RMD patients were lower than non-RMD individuals (Figure 1), with CTLA4-Ig-treated patients having the lowest IgG levels. This difference was less marked in symptomatic RMD patients. 72% of seropositive patients elicited neutralizing sera. Despite an overall decrease in anti-RBD and anti-N titers, more than two-third of patients maintained antibodies titers above positivity threshold at T2. Concerning cellular response, we found that CD8+ T-cells frequency was overall comparable between RMD and non-RMD convalescents, and did not differ in b-or cs-DMARD treated ones. Conversely, CD4+ T-cell frequencies were signifcantly lower in RMD patients, especially those treated with anti-IL6R and CTLA4-Ig. B-cell subpopulations (class-switched, memory, and IgG+ memory B-cells) had sustained frequencies in anti-TNFα treated patients, while they had a trend of reduction in patients treated with anti-IL6R and CTLA4-Ig. Conclusion: Our data provide a comprehensive picture of the humoral and cellular immune responses to SARS-CoV-2 infection in RMD patients. We showed that DMARDs treatments did not alter a successful antibody response to the virus and did not hamper the antibody neutralizing ability. However, the magnitude of antibody response was slightly reduced compared to non-RMD individuals, especially in patients receiving CTLA4-Ig. We did not observe marked differences in the B-and T-cell populations between RMD patients compared to non-RMD individuals. However, in patients receiving anti-TNFα we found a higher relative abundance of effector adaptive population compared to other bDMARDs.
ABSTRACT
The context of contemporary work scenarios features constant change and innovation in the field of information and communication technologies, which result in frequent work transitions and job insecurity. Such circumstances are highly threatening to the well-being of workers. Moreover, the instability and precariousness of the labour market are aggravated by the current crisis of the COVID-19 pandemic. Individuals are facing increased critical life and professional challenges and are being asked to take personal responsibility for the direction of their personal and work lives. In this complex context, career counseling needs to be revitalised in strength-based prevention perspectives. Life Project Reflexivity (LPR) addresses future professional and life plans and represents a critical construct for career counseling. The present study among Italian university students in transition to the labour market analysed the relationships between LPR and well-being while controlling for the 'Big Five' personality traits. The Big Five Questionnaire, the Life Project Reflexivity Scale and measures of both hedonic and eudaimonic well-being were administered to 278 university students of the University of Florence. LPR and its dimensions of authenticity, no acquiescence and clarity/projectuality explained the incremental variance beyond personality traits with respect to both hedonic and eudaimonic well-being, with specific reference to meaning in life. Among the three dimensions of LPR, authenticity was the most promising in this study. These results offered new perspectives for career counseling by supporting a strength-based prevention process for constructing sustainable decent work and life. ©2022 Birlesik Dunya Yenilik Arastirma ve Yayincilik Merkezi. All rights reserved.
ABSTRACT
Background and Aims: SARS-CoV-2 mRNA vaccines have been approved to prevent COVID-19. We assessed immunogenicity, effectiveness and safety of vaccines in patients with compensated and decompesated cirrhosis. Method: This is a prospective single center study assessing humoral and cellular responses in cirrhotics compared to healthy controls, incidence post-vaccination SARS-CoV-2 infections and adverse events (AEs). Antibodies against the spike- and nucleocapside-protein (anti-S and anti-N) were tested at baseline, 21 days after the first and second doses and during follow-up. Spike-specific T-cells quantity assessment was longitudinally conducted by the stimulation of whole blood with peptides covering the SARS-CoV-2 spike protein, followed by IFN-γ and IL-2 measurement. Results: 182 cirrhotics (61 years, 75% males, 45% viral-related, 74% Child-Pugh A, 31% HCC, 85% COVID-19 naïve) and 38 healthy subjects were enrolled. Previous SARS-CoV-2 infection predicted higher anti-S titres at all time points after vaccination, in both groups. COVID-19 naïve cirrhotics showed significantly lower anti-S titres compared to controls [998.5 (0.4-12,500) vs 1,520 (259-12,500) U/mL, p=0.048], anti-S titres significantly decreased after a median of 133 (70-182) days [536 (0.4-8,777) U/mL, p<0.0001] and were lower in decompensated vs compensated cirrhosis [632 (0.4-12,500) vs 1,377 (0.4-12,500) U/mL, p=0.028]. By multivariable analysis in COVID-19 naïve cirrhotics, independent predictors of lower anti-S were active HCC, immunocompromised conditions, BNT162b2 and lower anti-S after first dose. The spike-specific T-cell response was evaluated in 14 cirrhotics, showing a heterogeneous magnitude of response, but on average the quantity and kinetics of decline of the spike-specific cellular responses diverged in cirrhotics compared to controls, with lower concentrations of both IFN-γ and IL-2. During follow-up, 4/133 (3%) COVID-19 naïve cirrhotics tested positive for anti-N, all asymptomatic. Neither unexpected nor severe AEs emerged. Conclusion: Humoral and cellular responses to SARS-CoV-2 mRNA vaccines appeared suboptimal in patients with cirrhosis, however the rate of post-vaccination infection seems low.
ABSTRACT
The purpose of this presentation is to report accomplishments of a 3-year [5/1/2018-4/30/2021] Bristol-Meyers Squibb Foundation-funded collaboration between UC Davis and the Health and Life Organization (HALO), a Federally Qualified Health Center Look-Alike in increasing cancer screenings and cancer prevention/control behaviors among Asian Americans. HALO was selected for this study becuase it is the largest health system serving Asian Americans in Sacramento Co., CA. About one-third of their patients (9000) are Asian [primarily Hmong and other SE Asains). The hypothesis we tested was based on UC Davis's prior completed research that bilingual/bicultural Hmong lay health workers significantly increased screenings for HBV and colorectal cancer screening in randomized controlled community trials among Asians who largely had limited English proficiency. Our premise was to apply this concept to a clinical setting through HALO's bilingual/bicultural medical assistants (MAs). By comparing baseline (prior to the initiation of our funding) to 3 years of collaboration, we observed an overall 13.3% increase (surpassing our 10% goal) in cancer screenings & prevention/control behaviors. The largest percentage increases were in mammography (20.3%), colorectal cancer screening (11.6%), and Pap tests (7.9%).vaccination (2.8%). Since this was our first collaboration, much was shared through our monthly UCD-HALO leadership meetings where adjustments were made. A major adjustment was to learn that the electronic health systems used by community health centers such as HALO were not intended for reseearch purposes. While primary care provider time was less flexible, we found that MAs who reflect the HALO patient population were very receptive to training. We provided training through 10 Saturday academies, in-person and later delivered virtually during the COVID-19 pandemic. All of the topics related to the above metrics as well as other topics such as cultural competence, resources for patients, and optimizing patient workflows. Effectiveness of these academies were documented through gains in average scores from pre-tests [58%] to post-tests [84%] and qualitative feedback. Fifity-eight participants attended. More rigorous evaluation approaches to link our efforts to the impact of our work would have been preferred, but would have needed to be more resource-intensive. However, we anticipate that the equipping of MAs in new competencies and tools we provided for patients in various languages as infographics will be the bases for sustained effectiveness. Another measure of success was that this collaborative contributed to the receipt of a major Federal grant to eliminate perinatal HBV transmission through HALO. A UC Davis You-Tube style interactive modules as refresher materials and for new MAs will be another means of sustaining impact.
ABSTRACT
Introduction: Registration studies have shown high efficacy of BNT162b2 mRNA COVID-19 vaccine. We evaluated vaccine effectiveness (VE) of BNT162b2 mRNA COVID-19 vaccine in a cohort of healthcare workers (HCWs) of a large hospital in Milan, Lombardy, Italy. Material and Methods: Follow-up started on 27 December 2020 (beginning of the vaccination campaign). HCWs without history of SARS-CoV-2 infection before the start date and with at least a nasopharyngeal test afterwards were included. Vaccination was treated as a time-dependent variable. For selected periods after vaccination we calculated incidence rate ratios (IRR) and 95% confidence intervals (CI) of infection with a Poisson regression model adjusted for gender, age, occupation, and 30-day periods, and then VE as (1 – IRR)x100 using unvaccinated person-time as reference. Databases were closed on 27 September 2021. The study was approved by the hospital’s ethics committee (Milano Area 2, Prot. No. 828_2021bis). Results and Conclusions: We included 3,809 HCWs, 131 still unvaccinated and 3,678 vaccinated (3,576 with two doses). We identified 134 infections (62% symptomatic). Adjusted VE was 77% (CI: 43-91) from day 14 after the first vaccine dose and 87% (CI: 79-92) at least 7 days after the second dose. After full vaccination schedule VE was 89% (CI: 82-94) for symptomatic and 77% (CI: 45-90) for asymptomatic infections. In conclusion, we found high effectiveness of BNT162b2 vaccine in reducing incidence of both symptomatic and asymptomatic infections. The follow-up is continuing to assess long-term effectiveness, also considering emerging SARS-CoV-2 variants.
ABSTRACT
Introduction Randomized controlled trials showed efficacy of vaccines against coronavirus disease 19 (COVID-19). There is the need to quantify vaccine effectiveness in real-word contexts, including people at high risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), such as health care workers (HCWs). Objectives To evaluate vaccine effectiveness among hospital HCWs. Methods We performed a cohort study among HCWs of a large University hospital in Milan, Lombardy, Italy by merging routinely collected data on demographics, COVID-19 vaccination, and polymerase chain-reaction (PCR) tests performed on nasopharyngeal swabs. Follow-up started on December 27, 2020 (start of vaccination campaign). We included HCWs never PCR-positive before the start date and with at least a PCR test afterwards. Vaccination was treated as a time-dependent variable by calculating person-years (PY) at risk before and after vaccine doses. Subjects contributed PY until first positive PCR test (cases) or last test for never positive HCWs (to avoid immortal time bias). We calculated infection rates (cases per 1000 PY), rate ratios (RR, with a Poisson regression model adjusted for gender, age, occupation and 30-day periods), vaccine effectiveness (VE = (1-RR)x100) and 95% confidence intervals (CI) taking never vaccinated HCWs as reference. Results As of May 10, there were 3,152 vaccinated (97% with BNT162b2, 140 with one dose, 2,679 with two doses) and 333 non-vaccinated. We counted 29 infected cases (rate 385) among non-vaccinated, 6 (rate 65) from day 14 after the first dose (VE 79%, CI 49-92%), and 24 (rate 65) from day 7 after the second dose (VE 89%, CI 80-94%). Most cases after vaccination were asymptomatic or mildly symptomatic. Conclusion In these preliminary analysis we found high effectiveness of COVID-19 vaccine in HCWs in our hospital. Further work is needed to assess long-term effectiveness and to better plan future preventive strategies among this high-risk occupational group.
ABSTRACT
There is no doubt that metropolitan areas are, and will increasingly be, the engines of economic growth and fertile grounds for the development of technology, creativity and innovation and this will need a shift in the future cities planning and management especially regarding the increase in green areas. This must be done through a regeneration process that should refer to the 17 objectives of sustainable development that are frequently neglected in regeneration programs and this is likely to result in unsustainable urban renewal in many cities. Three main challenges for sustainable urban regeneration can be identified: - environmental (climate change, carbon emissions and use of resources), - social (inequality, cohesion and health), - institutional (governance). We need to promote the start of a real "green revolution", a revolution that, through the increase in plant cover, will make our cities a better place, doing it with an inclusive approach. The "green" city cannot therefore remain only a set of , portable, stereotyped ideas because it must be the place that will constitute the territory of activity of our life.
ABSTRACT
Patients with Covid-19 frequently develop atypical thyroiditis coexisting with non-thyroidal illness syndrome (Muller et al LancetD& E 2020). We analysed thyroid dysfunction: 1) in relation to Covid-19 disease severity;2) observing its evolution over time. Baseline assessment of 179 patients hospitalised in sub-intensive care units for Covid-19 disease, without known history of thyroid dysfunction or amiodarone therapy, with thyroid function and inflammatory markers measured at hospital admission. Thyroidultrasound (thyroid-US) and thyroid autoantibodies measurement were performed in 65 patients after they became SARS-CoV-2 negative, of whom 14 were also studied with radioisotope thyroiduptake (99mTc or I123) since showing focal-hypoechoic-areas. 46 patients were re-evaluated at 6 months of follow-up. Patients on steroid treatment started before hospitalization (N = 62) were excluded due to its lowering effect on TSH. At baseline 11/117 patients (9.4%) had thyrotoxicosis (low TSH and/or high FT4);23/117 (19.7%) had low TSH and required a more intensive oxygen support during hospitalization (P = 0.02). TSH positively correlated with lymphocyte count (P < 0.01). FT3 correlated negatively with length of hospitalization (P = 0.04) and death rate (P = 0.03). Only 7.7% patients had detectable TgAb/TPOAb and none TRAb. Thyroid-US showed focal-hypoechoic-areas in 28% patients, of whom thyroid-uptake was focally-reduced in 57%, diffusely-reduced in 14% and normal in 28%. Importantly, focalhypoechoic-areas were more frequent among patients with baseline low TSH compared with normal TSH (P = 0.03). Furthermore, patients with focal-hypoechoic-areas had higher baseline FT4 (P = 0.02) and IL-6 (P = 0.02) than those without. Thyroid function and inflammatory markers had normalized at 3 months and remained normal thereafter. At 6 months focalhypoechoic-areas persisted in the majority of patients, often reduced in size;thyroid-uptake was repeated in 8 patients and resulted increased in 7 (87.5%). Thyroid dysfunction during moderate-to-severe Covid-19 disease was mild and transient and correlated with increased death rate and length of hospitalization;low TSH correlated with lymphopenia and was associated with increased need of oxygen support during hospitalization. Focal-hypoechoic-areas at thyroid-US persisted up to 6 months in nearly 1/3 of patients and correlated with thyroid and inflammatory parameters at hospital admission, confirming a key role of thyroiditis in Covid-19 related thyroid dysfunction;long-term effects are unknown.
ABSTRACT
Background and aims: Although COVID-19 infection predominantly manifests with respiratory symptoms, recent studies have also reported the occurrence of neurological involvement in the acute phase as well as in the follow-up of recovered subjects Methods: Our study focuses on assessing the prevalence of neurological sequelae in COVID-19 patients hospitalized at Ospedale Maggiore Policlinico in Milan. Seventy-five COVID-19 recovered subjects followed a general follow-up protocol including pneumological, infectious and cardiovascular assessment 5-10 months after the onset of SARS-CoV2 infection;among them, a subset of 53 patients was evaluated through a self-administered 18-item questionnaire developed ad-hoc addressing sensory, motor and cognitive neurological symptoms. Results: Collected data has shown that 77.4% patients developed at least one neurological sequela, and 46.3% presented with more than three symptoms. Among symptomatic patients, the most prevalent manifestations were insomnia (65.9%) and daytime sleepiness (46.3%), followed by walking difficulties (31.7%). Other less frequent symptoms were headache (15.1%), hyposmia and hypogeusia (15.1%), and tremor (9.4%). Prevalence of symptoms 18-item questionnare showing the distribution of neurological manifestations Conclusion: Post-COVID-19 manifestations are reported in about 90% of recovered patients. This preliminary study suggests that neurological findings represent a significant part of such manifestations. We are currently expanding the questionnaire to a larger cohort of patients and correlating our findings with patients' demographical and clinical features, as well as with the severity of the previous SARSCoV2 infection. Currently, the same questionnaire is also being validated and administered to age-and sex-matched healthy controls who have not developed symptoms suggestive of Covid-19, and a cohort of non-COVID-19 hospitalized patients.
ABSTRACT
Background: It has been observed that lockdown restrictions during COVID-19 pandemic may have had a negative impact on HIV epidemic goals with disruption in care. We aim to analyse the trends in non-viral suppression for PLWH during and after the lockdown for COVID-19 pandemic in Italy compared to 2019. Methods: We included all participants in the ICONA cohort for whom there was ≥1 viral load (VL) in the window Nov 2019-Jan 2020 and with most recent VL≤50 copies/mL (exposed to lockdown), and over Nov 2018-Jan 2019 (not exposed). New enrolments in the study period were excluded. At population level and separately by year, we calculated proportion with VL≤50 copies/mL at each month over March-September and we performed an intermittent time series (ARIMA) model centred in March. In addition, we defined an individual outcome using the first VL over May-September (>50 vs. ≤50 copies/mL), comparing proportion with VL>50 copies/mL between exposed and not exposed by means of logistic regression models. PLWH with missing VL in the outcome window were excluded from the analysis. We also performed an alternative analysis in which censoring bias was minimised using inverse probability of weighting. Sensitivity analyses were performed after restricting to clinical sites with electronic linkage with laboratory data and to the subset of PLWH under follow-up in both years. Results: A total of 3,684 PLWH were included (2019=2,948;2020=736). PLWH exposed to lockdown were significantly older, less frequently MSM, non-Italian, had a higher CD4+ count and more frequently resident in north of Italy. The mean proportion of VL<50 copies/mL was 97% at March 2020 (ref.), 99% before March 2020, 82% at April 2020 (ARIMA estimates -21% 95% CI:-28%;-14%;P=0.01) and 97% after April 2020. In the 2019, the same proportions were 100%, 98%, 95%, and 97% with evidence for a lower drop in April (-6%, 95% CI:-8%;-3%, p=0.02). The results of the logistic regression model are reported in Table 1. When restricting to sites with electronic VL linkage and to those followed-up in both years the IPW OR of 2020 vs. 2019 were 1.23 (0.69-2.18) and 1.03 (0.48-2.19), respectively. Conclusion: We found little evidence for a difference in the proportion of PLWH with a VL>50 copies/mL, following stable suppression, in the period post lockdown due to COVID-19 as compared to the previous year. Although selection bias was minimized, reasons for a missing VL should be further investigated.