Unique Differentiation and Homing Features of T Cells in Individuals with Long Covid

Background: A significant portion of individuals experience persistent symptoms months after SARS-CoV-2 infection, broadly referred to as Long COVID (LC). Although the frequencies of subsets of SARS-CoV-2-specific T cells have been shown to differ in individuals with LC relative to those with complete recovery, a deep dive into phenotypic and functional features of total and SARSCoV- 2-specific T cells from individuals with LC has yet to be performed. Method(s): Here, we used CyTOF to characterize the phenotypes and effector functions of T cells from LIINC cohort. The median age was 46, the cohort was 55.8% female, and 9/43 had been hospitalized. Participants were reported a median of 7 LC symptoms at 8 months. SARS-CoV-2-specific total antibody levels were also measured in concurrent sera. Manual gating was used to define T cell subsets, SPICE analyses for polyfunctionality, T cell clustering for phenotypic features, and linear regression for correlation. Permutation tests, Student's t tests, and Welch's t test were used for statistical analysis. Result(s): SARS-CoV-2 total antibody responses were elevated in the LC group (p=0.043), and correlated with frequencies of SARS-CoV-2-specific T cells in those without LC (r=0.776, p< 0.001) but not those with LC. While the frequencies of total SARS-CoV-2-specific CD4+ and CD8+ T cells were similar between individuals with and without LC, those from individuals without LC tended to be more polyfunctional (co-expressing IFNgamma, TNFalpha, IL2, and/or MIP1beta). CD4+ T cells from individuals with LC harbored higher frequencies of Tcm (p=0.003), Tfh (p=0.037), and Treg subsets (p=0.0412), and preferentially expressed a variety of tissue homing receptors including CXCR4 and CXCR5 (p=0.037). SARS-CoV-2-specific CD4+ T cells producing IL6, albeit rare, were observed exclusively among those with LC (p=0.016). In addition, participants with LC harbored significantly higher frequencies of SARS-CoV-2-specific CD8+ T cells co-expressing exhaustion markers PD1 and CTLA4 (p=0.018). Conclusion(s): Long COVID is characterized by global phenotypic differences in the CD4+ T cell compartment in ways suggesting preferential migration of these cells to inflamed mucosal tissues. Individuals with LC also harbor higher numbers of exhausted SARS-CoV-2-specific CD8+ T cells, potentially implicating viral persistence. Finally, our data additionally suggest that individuals with LC may uniquely exhibit an uncoordinated T cell and antibody response during COVID-19 convalescence.

Switch from intravenous to subcutaneous maintenance infliximab in real world IBD cohort

Background: During the COVID-19 pandemic, there has been concern regarding patients attending hospitals for intravenous (IV) infusions due to increased COVID-19 exposure risk and demand on hospital resources. Data on switching patients from escalated dosing of IV infliximab (IFX) are limited. We describe a real-world experience of electively switching a cohort of patients on maintenance IV IFX for inflammatory bowel disease (IBD), at both standard and escalated dosing, to subcutaneous CT-P13 (Remsima). Method(s): Adult patients with IBD on IV IFX at Royal Adelaide Hospital were invited to switch to fortnightly dosing of subcutaneous IFX. We collected demographic data using medical records, and prospectively measured clinical assessment scores (CDAI/HBI for Crohn's disease (CD) and partial Mayo/SCCAI for Ulcerative Colitis (UC)), faecal calprotectin (FCal), CRP and trough IFX levels prior to switching to subcutaneous IFX, and at 6 months post switch. Clinical remission was defined as CDAI<=150/HBI<=4 (CD) or partial Mayo<=3 (no subscore>1)/ SCCAI<=2 (UC). Result(s): 29 patients were switched from IV IFX to subcutaneous CT-P13 between March 2021 and May 2022 (see Table 1 for baseline demographics). 23 had Crohn's disease (79%). 10/29 patients (31%) were on intensified IV dosing at baseline prior to switch. The majority of patients, 25/29 (86%) were in remission pre-switch. Of 19 patients with paired trough IFX levels, these increased significantly from baseline to 6 months post-switch (5.9mg/ml to 13.9mg/ml, respectively (p=0.0003), see Fig 1). The median FCal did not change pre-vs post switch (73mcg/g vs 80mcg/g, p=0.540), see Fig 2). Median CRP did not change pre-vs. post switch (1 mug/ml vs 2 mug/ml). Clinical assessment scores remained stable pre-vs. post-switch (CDAI 31 vs 31, (p=0.316) see Fig 3;HBI. 1 vs 2 (p=0.940);partial Mayo 0 vs 0, (p>0.999);and SCCAI 1 vs 2 (p=0.5000)). Regarding the subset of patients on escalated dosing at baseline, all patients were in clinical remission at 6 months post-switch. There was no significant change in IFX levels (8.4 vs 13.3, p=0.253). FCal did not significantly change (76mcg/g vs 79mcg/g (p=0.563), nor did median CDAI (37 vs 21 (p=0.5312) and median HBI (2 vs 2 (p=0.750)). Overall, only 1/29 (3%) patients were not in remission at 6 month follow-up. No patients in required steroids or surgery. Of the 9 patients with perianal disease, none had a flare. All patients with weight>100kg (n=4) remained in remission. Conclusion(s): Switching patients from IV to subcutaneous IFX delivered stable clinical outcomes in this real world cohort, with no change in disease biomarkers and clinical indices. IFX levels increased overall and all patients on escalated IV dosing were in clinical remission at 6 months post-switch.

Quality, safety and equity of care outcomes for inflammatory bowel disease patients at four tertiary referral centres in Australia using a cloud based management system Crohn's Colitis Care (CCCare): A real world observational study

Background: Inflammatory bowel disease (IBD) is a global problem and Australia has amongst the highest prevalence rates. This study looked to assess the quality, safety and equity of care across four specialised IBD centres in Australia over a 12-month period using the cloud-based IBD clinical management system called Crohn's Colitis Care (CCCare). This study aimed to define existing care at each centre and the range of performance across each centre to propose potential benchmarks for optimal quality IBD care. Method(s): The study was conducted across four tertiary IBD centres in Australia (Centres A, B, and C were public hospitals and D was a private centre). De-identified data within the backend CCCare research registry was audited between 1st of July 2021 to 31st August 2022. People with IBD who had a clinical assessment documented within the platform during this 12-month period were included. We assessed quality of IBD care using disease activity based on patient reported outcome measures (PROMs), biomarkers and endoscopy;surgery rates;health maintenance indicators including vaccination and skin cancer screening rates and;key performance indicators including steroid use, smoking rates and current opioid use. Safety of care was assessed using adverse events from therapy and hospital admission due to therapeutic complications. Equity of care examined education levels and ethnicity. Result(s): A total of 1889 patients were included. 63% had Crohn's disease and 37% had ulcerative colitis. 51% of the cohort was female. The median age was 39 years (IQR 30-53) and the median disease duration was 8.4 years (IQR 3.3-15.7) (Table 1). Current steroid use was between 6% to 15.4%. Faecal calprotectin (FCP) remission rates (250mug/mg) were between 65-84% and patient reported outcome (PRO-2) remission rates were between 76-88% with the highest rates observed at Centre D (Figure 1). 74 patients underwent a surgical procedure. COVID-19 vaccination rates were between 40.1% to 88.8% with the highest rates once again observed at Centre D. 3% of the cohort was documented as currently using opioid medications. 12.2% were recorded as currently smoking at Centre A compared to 2.6% at Centre D. 55 medication related adverse events were recorded and 94 patients had a hospital admission during the study period. Conclusion(s): This study showcases how CCCare can readily provide researchers with granular, real-world data to audit the quality of IBD care at 4 specialised centres in Australia over a 12-month period. While there were some differences (higher vaccination rates, lower smoking and steroid use rates at Centre D), quality and safety of care was still fairly uniform across the various sites and can serve as a standard of care for IBD patients in Australia.

SCREENING OF US VETERANS AT HIGH RISK FOR OUTCOMES FOLLOWING COVID-19 BY FRAILTY STATUS

Frailty increases risk of adverse outcomes in the presence of stressors such as COVID-19 infection. We examined the association between different levels of frailty and outcomes following COVID-19 infection. This is a retrospective cohort study of US Veterans aged ≥50 years, active Veterans Health Administration (VHA) care users, and tested positive for COVID-19 between 02/15/2020 and 09/30/2021. VHA frailty index (VA-FI) was calculated from one year prior to the COVID-19 testing and divided into three groups: robust (≤0.1), prefrail (0.1-0.2), and frail (>0.2). The risk of hospitalization, ICU admission, ventilator use, and in-hospital mortality were calculated using logistic regression adjusted by age, sex, body-mass-index, and race. The performance of VA-FI in predicting outcomes was compared to age or Charlson comorbidity index (CCI) using area under the curve (AUC). Of 204,426 COVID-19 positive Veterans, 32,965 were hospitalized (age: 71.4±10.4 years, BMI: 29.5±7.1 kg/m2). We observed higher odds of hospitalization (frail, adjusted odds ratio (aOR)=8.64;prefrail, aOR=2.57), ICU admission (frail, aOR=1.58;prefrail, aOR=1.32), ventilator use (frail, aOR=1.97;prefrail, aOR=1.57), and mortality (frail aOR=2.15;prefrail, aOR=1.55) in frail and prefrail compared to robust Veterans. We observed that VA-FI had higher AUC in predicting hospitalization (AUC 0.75) independent of age (0.59) and CCI (0.63). Veterans with COVID-19 who were frail and prefrail had a higher risk of hospitalization, ICU admission, ventilator use, mortality compared to robust. VA-FI may be a useful tool at the time of COVID-19 diagnosis to triage patients at risk for adverse outcomes.

Inpatient Oncology Tele-Palliative Care During a COVID-19 Surge: The Experiences of an Interdisciplinary Team

Background/Purpose: In spring 2020, New York City was a global hotspot for COVID-19 and the inpatient palliative care (PC) service at our comprehensive cancer center was rapidly transitioned to a fully virtual platform. We aimed to explore PC specialists perceived self-efficacy in meeting the psychosocial needs of acute care oncology inpatients using telehealth during the first surge of COVID-19. Methods: We used a single-site qualitative design and convenience sampling of interdisciplinary PC specialists with at least 1 year of PC experience prior to the telehealth transition. In-depth semistructured interviews were conducted via Zoom and lasted one hour. Following interview transcription, interdisciplinary coding team members used an applied thematic text analysis approach. Each coder independently reviewed, synthesized, and interpreted interview content and then convened as a group to refine the codebook and reach consensus on recurring themes. Results: Eleven PC specialists participated: social worker (n = 1);pharmacist (n = 1);chaplain (n = 1);physician assistant (n = 1);physicians (n = 4);and nurse practitioners (n = 4). One-third had previous telehealth experience and n = 7 was “not at all comfortable” or “somewhat comfortable” with delivering telehealth prior to the virtual platform transition of the PC service. Major themes included telehealth barriers and positives;perceived self-efficacy;clinician distress;impact on the quality of relationships with patients, families, oncology teams, and PC colleagues;and barriers and facilitators to coping and self-care. Participants provided explicit service- and system-level recommendations to improve the quality of tele-PC consultation during future health crises. Conclusions and Implications: Study findings describe personal and professional experiences related to a resource-constrained infrastructure during COVID-19 and myriad consequences of PC specialists feeling ineffective at fulfilling their roles. Cancer centers should integrate PC specialist recommendations for future telehealth services to guide care delivery in the context of crisis. Additional research must be conducted to explore the long-term impact of COVID-19 related tele-PC on both specialists and care recipients.

Cancer Caregivers' Perceptions of a Virtual Meaning- Centered Psychotherapy for Caregivers (MCP-C)

Background/Purpose: Caregivers of patients with Glioblastoma Multiforme (GBM) are at risk for existential distress due to complex care needs and patients' poor prognoses. We developed Meaning- Centered Psychotherapy for Cancer Caregivers (MCP-C) to assist caregivers in connecting to a sense of meaning and purpose despite challenges. The COVID-19 pandemic has exacerbated caregivers' distress and the need for caregiver-targeted services, but pandemicrelated precautions have prevented the delivery of care in-person. The purpose of this study was to evaluate the feasibility and acceptability of delivering MCP-C over telepsychiatry. Methods: This study was part of a RCT of MCP-C versus Enhanced Usual Care among 60 caregivers of patients with GBM >18 years old who scored >4 on the Distress Thermometer. Before March 2020, MCP-C sessions were delivered in-person, then shifted to telepsychiatry due to COVID-19. At baseline, caregivers reported their preference for treatment delivery modality and location. Posttreatment, nine caregivers (five with sessions in-person, four over telepsychiatry) completed qualitative interviews providing feedback which were transcribed and analyzed using an inductive thematic analytic approach. Results: Half of participants (51.7%) preferred to receive psychosocial support through a combination of in-person and virtual methods;48.3% preferred support to take place from their home. Twenty-one caregivers completed sessions in-person and nine virtually;63.3% completed all seven sessions of MCP-C. Caregivers felt in-person and telepsychiatry sessions were equally as valuable, though they reported telepsychiatry was more convenient and was the reason several caregivers ultimately enrolled. Conclusions and Implications: Caregivers of patients with GBM endorsed favorable perceptions MCP-C delivered over telepsychiatry. Virtual delivery was feasible and more acceptable to caregivers by eliminating traditional barriers to care. A larger randomized-controlled trial comparing in-person and virtual MCP-C is needed to evaluate the efficacy of MCP-C delivered over telepsychiatry.

Lower SARS-CoV-2 IgG and Pseudovirus Neutralization Titers Post-mRNA Vaccination among People Living with HIV

Background. Limited data are available on whether there are differences in the immune response to SARS-CoV-2 vaccination by HIV status or by mRNA vaccine type. Methods. We saved residual outpatient laboratory samples of all previously mRNA-vaccinated individuals in the adult medicine clinics of a public hospital with a large outpatient HIV clinic during May 2021, and then excluded individuals with prior SARS-CoV-2 infection. We next 1:1 matched 100 PLWH to 100 outpatient HIVnegative adult medicine patients receiving care for chronic medical conditions on days since completion of second vaccination (minimum 10), sex, age +/-5 years, and the type of mRNA vaccine received. We defined a non-response as reciprocal pseudovirus neutralizing titer< 10 and anti-RBD IgG< 10 relative fluorescent units, and compared non-response by HIV status using mixed models. Results. In each matched group there were 13 women;25 received the mRNA-1273 vaccine and 75 received the BNT162b2 vaccine;the median age was 59. The median time from second vaccination was 35 days (IQR: 20-63). Among PLWH, the median CD4+ T-cell count was 511 (IQR: 351-796) and 5 individuals had HIV RNA > 200. We found 2.4-fold greater odds of pseudovirus neutralizing antibody non-response among PLWH compared to people without HIV (95% CI=1.1-5.4). Although few individuals in each group did not mount an IgG response (12 among PLWH vs. 5;p=0.08), continuous anti-RBD IgG concentrations were 43% lower among PLWH (95% CI=0.36-0.88). Among PLWH, when adjusting for age, sex, and days post-vaccination, each 100-cell increase in CD4+T-cell count was associated with 22% higher neutralizing antibody titers (GMR 1.22;95% CI=1.09-1.37). Unsuppressed HIV RNA >200 was associated with 89% lower neutralizing antibody titers (GMR 0.11;95% CI=0.01-0.84). Receipt of the BNT162b2 vs. mRNA-1273 vaccine was associated with 77% lower neutralizing titers (GMR 0.23;95% CI=0.08-0.65) among PLWH. Post-mRNA Vaccination SARS-CoV-2 IgG Concentrations and Pseudovirus Neutralizing Titers by HIV Status and Vaccine Conclusion. PLWH had lower than expected response to mRNA SARS-CoV-2 vaccines, with the highest non-response among those with low CD4+ counts, unsuppressed HIV RNA, and those who received the BNT162b2 vaccine. Immunization strategies to improve immune responses among PLWH should be studied, and may include booster vaccination or preference of the mRNA-1273 vaccine in this group.

PERCEPTIONS OF COVID-19 IN THE EOSINOPHILIC ESOPHAGITIS POPULATION

Background: The medical and psychological impacts of the COVID-19 pandemic on individuals affected by eosinophilic esophagitis (EoE) remain largely unknown. We seek to describe the current perceptions of COVID-19 in the EoE population of the United States (US). Methods: For this cross-sectional study, we anonymously surveyed individuals aged 18 years or older who self-identified as having EoE or as being a caregiver for someone with EoE. This survey was sent via an invitation and link to email subscribers of the American Partnership for Eosinophilic Disorders in November 2020. Our primary aim was to describe patients’ and caregivers’ perceptions of COVID-19. We collected patient demographics and asked five multiple-choice questions that assessed the responder’s anxiety related to the pandemic, belief on whether patients with EoE are at higher risk of acquiring COVID-19, willingness to take an approved vaccine, experiences with access to medical care during the pandemic, and use of social media to learn about the impact of COVID-19 on EoE. Our secondary exploratory aim was to identify patient characteristics associated with a positive response to each question. All variables were treated as categorical variables (with age dichotomized into age <48 and >48). Variables were analyzed with proportions and compared using chi-square tests. Results: The majority of responders were female (84.7%) and white (91.9%) (Table 1). The responses to COVID-19 questions are shown in Figure 1. Notably, majority (53%) of responders are anxious about the pandemic, 20% believe that patients with EoE are at higher risk of acquiring COVID-19, 41% are agreeable to taking an approved vaccine, 44% report interruptions in EoE-related care (either missed upper endoscopy or clinic visit) for themself or the person they care for, and only 24% have found social media to be useful to learn about the impact of COVID-19 on the EoE population. Caregivers are more concerned than patients that EoE patients are at higher risk of acquiring COVID-19 (OR 3.65, 95% CI 1.25-12.02). The older age group is less likely to use social media to learn about COVID-19 in the context of EoE (OR 0.35, 95% CI 0.13-0.90). There is a trend toward females being more likely to have interruptions in EoE-related care compared to males (OR 2.95, 95% CI 0.83-12.15). Conclusion: Our pilot data suggests that COVID-19 has led to anxiety and interruptions in care in the EoE population of the US. EoE care providers should take measures to address anxiety and create care plans that decrease pandemic-related delays. Further efforts should be made to study the risk of COVID-19 in EoE patients and to disperse such research on social media for easy accessibility. If and when a safe and efficacious vaccination is approved, providers will be critical in educating the EoE population on risks and benefits of vaccination. (Table presented) Baseline characteristics of all survey responders (Figure presented) Percentage of participants who responded “Yes” to each COVID-19 related question

Cybord-Dara in Newly Diagnosed Transplant-Eligible Multiple Myeloma: Follow up Results from the 16-Bcni-001/Ctrial-IE 16-02 Study Show High Rates of MRD Negativity at End of Treatment

The anti-CD38 monoclonal antibody Daratumumab has shown impressive activity in combination with other agents for the treatment of multiple myeloma (MM), improving progression free survival and overall survival in several phase 3 studies. We conducted a phase 1b study of intravenous Daratumumab (16 mg/kg) with weekly subcutaneous bortezomib (1.3-1.5 mg/m 2 ), cyclophosphamide (150-300 mg/m 2), and dexamethasone (40 mg) (CyBorD-DARA) as induction before autologous stem cell transplantation (ASCT), followed by CyBorD-DARA consolidation (2 cycles) and monthly DARA +/- bortezomib (in high-risk disease) maintenance for 24 months. We hypothesized that the addition of cyclophosphamide could lead to enhanced antibody dependent cellular phagocytosis (ADCP). This trial was registered at www.clinicaltrials.gov as NCT02955810. We previously reported the initial results of this study. 1. In addition to a favourable safety profile we observed promising anti-MM activity with 10 of 13 patients (77%) in whom assessment was possible achieving measurable residual disease (MRD) negativity at a sensitivity of 10 -5 by next generation sequencing (NGS) after ASCT. We now report the results at EOT, with a focus on MRD. Eligible patients were ≤70 years of age with untreated transplant-eligible MM. 18 patients were enrolled. Median age was 56.5 years (range, 32-66 years), 61% were male and 94% of patients had Eastern Cooperative Oncology Group performance status ≤1. The International Staging System stages were I, II, and III in 78%, 17%, and 6% of patients, respectively. 29% of patients had high-risk genetic features by fluorescent in situ hybridisation (FISH) or gene expression profiling, including 17p deletion in 12% and t(4;14) and t(14;16) in 6% each. On an ITT basis, the rates of very good partial remission or better (≥VGPR) after ASCT, consolidation and at end of treatment (EOT) (after completion of 24 months of DARA) were 94%, 94% and 81% respectively, and rates of complete response or better (≥CR) were 50%, 63% and 63% respectively. Measurable residual disease (MRD) assessment was possible in 13 patients after induction, ASCT and consolidation, and 10 at EOT. Sustained MRD negativity (ie. MRD negativity after ASCT, consolidation and at EOT) to a level of 10 -5 by NGS was achieved in 33% (ITT). Of 13 patients who remained on study at EOT in VGPR or better, 54% were MRD negative (MRD was unavailable in 23%). 7 patients were MRD negative after both ASCT and consolidation. Of these patients, all evaluable at EOT(6/7) remained MRD negative, with 1 patient unable to undergo MRD assessment due to the COVID-19 pandemic, but remaining in CR. Nausea and diarrhoea occurred in 89% of patients, but were mostly grade 1-2 (Grade ≥3 nausea 17%;diarrhoea 6%). Neutropenia occurred in 44% (Grade ≥3 17%), anaemia in 39% (Grade ≥3 22%), and thrombocytopenia in 33% (Grade ≥3 22%). The rate of neutropenic sepsis was 11%. Infusion-related reactions occurred in 50% (Grade ≥3 6%) and peripheral neuropathy occurred in 33% (Grade ≥3 0%) The most commonly reported serious adverse event (SAE) was sepsis in 22%. One patient developed abnormal liver function tests leading to discontinuation from the trial. CyBorD-DARA induction, consolidation and DARA-maintenance is an effective and well-tolerated IMiD free regimen in transplant-eligible patients with MM. MRD negativity at a level of > 10 -5 after ASCT and consolidation may be predictive of sustained MRD negativity at EOT. References: 1. Naicker SD, et al. Cyclophosphamide alters the tumor cell secretome to potentiate the anti-myeloma activity of daratumumab through augmentation of macrophage-mediated antibody dependent cellular phagocytosis. Oncoimmunology. 2021 Jan 25;10(1):1859263. doi: 10.1080/2162402X.2020.1859263. PMID: 33552684;PMCID: PMC7849715. 2. O'Dwyer M, et al. CyBorD-DARA is potent initial induction for MM and enhances ADCP: initial results of the 16-BCNI-001/CTRIAL-IE 16-02 study. Blood Adv. 2019 Jun 25;3(12):1815-1825. doi: 10.1182/bloodadvances.2019000010. PMID: 31201169;PMCI : PMC6595251. Disclosures: O'Dwyer: ONK Therapeutics: Current Employment, Current equity holder in publicly-traded company, Membership on an entity's Board of Directors or advisory committees;Janssen: Consultancy;Bristol Myers Squibb: Research Funding. Quinn: Takeda: Honoraria. Szegezdi: ONK Therapeutics: Research Funding.

Implementing virtual mind-body programming to support cancer patients during COVID-19

Background: Despite growing evidence of mindbody therapies for physical and psychological health among patients with cancer, their access remains limited. The COVID-19 pandemic has further disrupted the delivery of necessary cancer and supportive care;thus, the need to support patients with cancer is unprecedented. To expand the reach and access of mind-body therapies, we developed, implemented, and evaluated a novel virtual mind-body program for patients with cancer. Methods: We rapidly developed a 7-day a week virtual mind-body program, Integrative Medicine at Home (IM@Home), for patients with cancer (ages ≥18 years) and deployed it on April 1 , 2020. IM@Home included mind-body group therapy classes in fitness, meditation, yoga, dance, tai chi, and music delivered using Zoom video conferencing. Classes ranged from 30-45 minutes and were led by an integrative medicine clinician. Patients had the option to register for a 1-month, 3-month, or 6-month membership to gain unlimited access to all virtual mind-body classes. Multi-method evaluation was conducted using the RE-AIM conceptual framework to guide surveys and qualitative interviews. Surveys were analyzed using descriptive statistics and interviews were analyzed using grounded theory. Results: Between April 2020 and January 2021, IM@Home registered over 32,000 class participants, with a weekly average attendance of 700-800 participants. In a 4-month postdeployment survey (n = 131), nearly all participants were satisfied with IM@Home (93.9%) and would recommend the program to friends and family (95.4%). A majority of participants also found IM@Home to be simple to use (87.0%) and said the program had a variety of classes that interested them (93.1%). Three-quarters of participants (74.8%) were taking 3 to 7 classes a week (range: 1 to 15 classes), among which the most popular classes were fitness (88.7%), chair yoga (37.1%), and tai chi (33.1%). Most participants preferred a 3- month membership (51.6%), followed by a 6- month membership (19.5%). In qualitative interviews (n = 30), participants reported IM@Home helped them to: 1) maintain structured routines and stay motivated to exercise;2) cope with COVID-19-related and cancer-related stressors;and 3) connect with their fellow cancer patient community and foster social relationships during a time of isolation. Conclusions: Virtual mind-body programming, through IM@Home, reached many patients with cancer to address their physical and psychological challenges during COVID-19. As patients with cancer experience high physical and psychological symptom burden following diagnosis, future clinical trials are needed to evaluate the specific effects of IM@Home when integrated into active treatment and survivorship care.

Sars-cov-2 seroprevalence and igg levels are lower among people living with hiv

Background: Although data are mixed, most cohorts show a similar or lower COVID-19 incidence among people living with HIV (PLWH) compared to the general population. However, incidence may be impacted by lower testing rates among vulnerable populations. We compared SARS-CoV-2 seroprevalence and IgG levels, and disease severity, among patients with and without HIV receiving care within a county hospital system over a three-month period. Methods: From August through October 2020, remnant serum samples were collected from all PLWH who underwent routine outpatient laboratory testing at San Francisco General Hospital which houses a large HIV clinic (Ward 86). Patients with HIV were matched on time of collection (same day) and age (+/- 5 years) to 1-2 adults without HIV. SARS-CoV-2 levels of IgG levels was quantified in serum using the Pylon IgG assay (100% specificity on internal validation). Seroprevalence was compared by HIV status via conditional logit models, adjusting for sex. For those with reactive results, IgG levels were compared by HIV status using log-transformed generalized estimating equations. Severe disease, assessed via chart review, was defined as requiring oxygen. Results: Among 1,411 individuals (46% PLWH), the median age was 58 (IQR: 49-65), 64% were men. COVID-19 seroprevalence was 3.1% among PLWH compared to 6.8% among people without HIV (adjusted odds ratio 0.41;95% confidence interval (CI): 0.25-0.68, p<0.001). Among those with reactive COVID-19 IgG results (n=72, 20 in PLWH);antibody levels were 47% lower among PLWH (95% CI: 19-65% lower;p=0.003;Figure);however, there was a trend towards higher disease severity among PLWH [15% (n=3) vs. 4% (n=2);p=0.13]. Conclusion: Both seroprevalence, and absolute SARS-CoV-2 IgG levels in those with reactive results, were lower among PLWH, within a time and agematched population of outpatients receiving routine laboratory testing in an urban hospital. PLWH may have had higher adherence to non-pharmaceutical interventions (NPIs) than those without HIV, leading to lower COVID-19 seroprevalence and, possibly, lower COVID-19 IgG levels if infected with a lower viral inoculum due to NPIs. Alternatively, PLWH may mount lower antibody responses to SARS-CoV-2, as has been demonstrated with hepatitis B and yellow fever vaccines. Further studies of COVID-19 susceptibility and immunity are needed among PLWH. Moreover, PLWH should be enrolled in SARS-CoV-2 vaccine studies or followed after vaccination to ensure they mount sufficient humoral responses.

Higher SARS-CoV-2 RT-PCR cycle threshold (CT) values associated with longer symptom duration among patients hospitalized with COVID-19

Background: Most diagnostic tests for SARS-CoV-2, the causative agent of COVID-19, are RT-PCR based. This method is sensitive but cannot distinguish replicating from non-replicating virus. RT-PCR cycle threshold (Ct) values are inversely correlated with viral load, and higher Ct values have been correlated with lower in vitro viral infectivity. However, relatively few data exist on the association between Ct values and patients' duration of symptoms remains unclear. We thus evaluated Ct values and symptom duration in a cohort of patients hospitalized with COVID-19. Methods: We assessed all patients admitted to San Francisco General Hospital between April 1 and May 18, 2020 with confirmed COVID-19 infection based on RT-PCR testing (Abbott m2000 platform). We included patients having diagnostic testing for suspected COVID-19 and patients having asymptomatic testing per hospital policy. For symptomatic patients, date of symptom onset was abstracted from hospital records, and time from symptom onset to test date was calculated. RT-PCR Ct values were manually extracted. Median Ct and IQR were calculated for patients with < 10 days of symptoms, ≥10 days of symptoms, and asymptomatic disease. Betweengroup comparisons were performed using the Kruskal-Wallis test. Results: Among 61 patients with positive RT-PCR tests, 40 patients reported < 10 days of symptoms at the time of testing, 15 reported ≥10 days of symptoms, and 6 were asymptomatic. The median Ct value was 14.2 cycles (IQR, 10.2, 18.3) among patients reporting < 10 days of symptoms, 19.7 cycles (IQR, 15.3, 23.9) among patients reporting ≥10 days of symptoms, and 26.3 (IQR, 25.0, 29.1) among asymptomatic patients. Ct values were significantly lower among patients with < 10 days of symptoms compared to patients with >=10 days of symptoms (p=0.01) and when compared to asymptomatic patients (p=0.0002) [Figure]. Conclusion: SARS-CoV-2 RT-PCR cycle threshold values were higher (indicating lower viral load) in patients with longer symptom duration and were highest in asymptomatic patients. These results add to emerging data suggesting that strategies for optimal isolation of patients in both community and hospital settings could be informed by a combination of symptom duration and RT-PCR Ct values. (Table Presented).