T-cell immune response to SARS-CoV-2 in HIV patients.

Objective. To assess the T-cell immune status against SARS-CoV-2 in HIV patients with or without antiretroviral therapy. Patients and methods. The study included 21 HIV patients who had laboratory-confirmed COVID-19 between September and December 2021 without previous immunization against SARS-CoV-2. The characteristics of HIV infection (CD4-lymphocytes count, HIV viral load in blood plasma, the presence of antiretroviral therapy) and COVID-19 (the severity degree and duration of the disease) were analyzed, the T-cell immune response to SARS-CoV-2 was assessed using the ELISPOT method 1 month after COVID-19. Statistical analysis was carried out by non-parametric methods (Mann-Whitney U test, Spearman's rank correlation coefficient) using the IBM SPSS Statistics 22 software package. Results. The study showed a more favorable course of COVID-19 in HIV-infected persons who achieved HIV suppression in the blood: a mild form of the disease was significantly more common, and the virus was eliminated faster. T-cell immune response to SARS-CoV-2 was recorded more frequently in these patients. Significant correlation of T-cell immune status with the CD4-lymphocytes count and HIV suppression in the blood was revealed. Conclusion. Thus, T-cell immune response to SARS-CoV-2 as assessed using the ELISPOT method was registered significantl.Copyright © 2023, Dynasty Publishing House. All rights reserved.

Which Telehealth Features Matter Most? Ranking Results from HIV Care Providers and Patients Living with HIV in South Carolina

Objectives: During the COVID-19 pandemic, telehealth was rapidly implemented to mitigate disruptions in HIV care services. However, participation in and benefits from telehealth were not distributed equally among people living with HIV (PWH). The acceptability of alternative telehealth options in HIV care remains understudied. This study aims to assess the relative importance of telehealth features among HIV care providers and PWH. Method(s): We compiled a comprehensive list of 21 telehealth features from the literature and formative research. Telehealth features were grouped into four domains with 4-6 features each: administrative (5), technology (6), visit-related (6), and other (4) features. 22 purposively selected participants (10 HIV care providers, 12 PWH) from South Carolina were asked to rank these features within domains and the domains themselves according to their perceived relative importance. Ranking data was analyzed through count analysis. Result(s): Domain rankings indicated that visit-related features such as a prior relationship with the provider and multidisciplinary virtual visits were most important. Administrative features such as scheduling modalities (e.g., virtual walk-in options) and the waiting time for an appointment were second most important, followed by technological features such as the type of provider (artificial intelligence vs. human provider) and type of telehealth (video, voice-only, or email). Other features such as the availability of technical support and the location where telehealth visits take place were least important to our participants. Across telehealth features, the relationship to the provider was most often ranked first (14 out of 22 participants) followed by out-of-pocket cost (9 out of 22 participants). Conclusion(s): Our findings highlight the importance of visit-related and administrative features of telehealth. A pre-existing relationship with the telehealth provider was particularly important to many providers and patient participants. Findings may inform telehealth HIV care options to meet the needs of PWH and HIV care providers.Copyright © 2023

What Features of Telehealth Are Important to Patients in HIV Care? A Systematic Literature Review

Objectives: Social distancing requirements and lockdowns due to COVID-19 resulted in a rapid integration of telehealth into HIV care. To maximize patient retention and ensure quality of care, it is vital to understand patient perspectives and preferences for various attributes of telehealth. This study aims to identify preference-relevant features of telehealth. Method(s): A review of PubMed and Embase was conducted in September 2022. Search terms describing telehealth (e.g., telehealth, telemedicine) and its features (e.g., attribute, characteristic) were combined for the search. Duplicate and non-English records, as well as irrelevant records, were removed. Literature was analyzed and synthesized using meta-synthesis and thematic synthesis methodology. Result(s): 10 records were included in the review (5 qualitative studies, 1 mixed-methods study, 4 discrete choice experiments). No HIV-specific studies were identified that described preference-relevant telehealth features. Studies primarily reported telehealth features in primary care, oncology, and rheumatology settings. Data synthesis revealed four domains of preference-relevant telehealth features: administration, technology, visit-related, and other features. Administrative features included waiting time for and during an appointment, scheduling flexibility, and out-of-pocket costs. Technology features included hardware and software used for telehealth visits, extent of privacy, and type of telehealth (e.g., video or voice-only). Visit-related features included relationship to the provider, consultation purpose, and severity of the patient's health concern. Other features included technological support options, convenience, and ease of telehealth use. Continuity of care with a patient's regular provider was the most often reported feature of telehealth within the identified literature. Conclusion(s): While there is no HIV-specific literature, preference-relevant administrative, technology, visit-related, and other features were identified in non-HIV-related literature. Future research needs to assess the importance of identified features to people living with HIV and which tradeoffs they are willing to make. This will inform tailored telehealth options addressing patients' needs and preferences for optimal utilization and care.Copyright © 2023

How did the COVID pandemic impact anxiety and health anxiety in women living with HIV?

Background: The Covid pandemic and subsequent lockdown had implications on the population's mental health, particularly amongst society's most vulnerable members. We looked at the impact of the Covid pandemic on both generalised anxiety and health anxiety in women living with HIV (WLHIV). This research aimed to examine any increases in anxiety, what caused these increases, and how WLHIV dealt with them. Method(s): 12 WLHIV, aged 31-62 years old, completed recognised anxiety questionnaires (General Anxiety Disorder (GAD-7) and Health Assessment Questionnaire (HAQ)) to ascertain levels of anxiety and health anxiety respectively. Participants also responded to two open-ended questions: what made you most anxious during Covid lockdown and how did you deal with it? Results: Pre-covid GAD-7 scores averaged 6.3 indicating mild anxiety throughout the sample compared to postcovid scores of 12.9, which indicated moderate anxiety. Average HAQ scores were 21.3 indicating moderate health anxiety throughout the sample. Lack of self-advocacy skills (in relation to health) and isolation were commonly reported as being causes of anxiety;additional reasons included preexisting health issues and inability to access medical appointments and support. Participants reported using exercise, watching TV, sleep and prayer as coping mechanisms. Conclusion(s): The results of this research demonstrated that the Covid pandemic played a major part in raising anxiety, health anxiety and health worries in our sample. This was largely caused by increased isolation and decreased self-advocacy skills. Participants used individualised tools to manage their anxiety. Isolation: Isolation increased women's anxiety and health anxiety as they had no one to talk issues through with and social and organisational support was reduced due to lockdown. Lack of self-advocacy: Many participants reported that during the lockdown they found it difficult to identify and communicate their health concerns, advocate for themselves medically and subsequently negotiate help and support. Recommendations include future programmes to assist WLHIV to improve their self-advocacy skills and increase their attendance at groups/be actively involved with peers to reduce isolation. Supporting and improving advocacy helps women to gain more knowledge about their rights in relation to health care and empowers them to seek answers and negotiate treatment for themselves.

COVID-19 vaccination rates in people living with HIV in north east England

Background: People living with HIV (PLWH) are at increased risk of severe COVID-19. The UK recommends vaccination against COVID-19 for PLWH with two primary doses, a booster dose, then seasonal boosters (i.e. four doses by Autumn 2022). Vaccination uptake in the UK has been lower among non-white minority ethnic groups than in the white British population, despite these groups having a higher risk of severe COVID-19. Method(s): We evaluated vaccine uptake by PLWH attending treatment services at two NHS Trusts in North East England. To ensure representation of minorities, alternating PLWH from white and ethnic minorities (excluding white minorities) were purposively selected for review from the HIV and AIDS Reporting System;vaccination data were obtained from regional integrated care records. Result(s): 200 PLWH were included. 103 (51.5%) were from ethnic minority groups, of whom 78 (75.7%) were of black African ethnicity. Vaccination rates in the total population and among ethnic groups are shown in the table below. Similar proportions of white and minority ethnic background PLWH had received up to two vaccinations. These proportions among white PLWH were similar to those reported in the general English population, while fewer Black African PLWH were unvaccinated than in the general population (14.1% vs. 26%, data not shown). Vaccine uptake among PLWH diverged beyond 3 doses, with white people being almost three times as likely to have received four doses (OR 2.92;95% CI 1.63 to 5.19;pvalue for difference in distribution across all doses=0.005). Conclusion(s): Although ethnic minority PLWH were less likely to be fully vaccinated than white ethnicity PLWH, the proportion of unvaccinated black African PLWH was lower than that reported from the general population. This could infer that regular contact with healthcare professionals coupled with consistent promotion of vaccination by HIV clinicians can improve uptake. (Table Presented).

Comorbidities in people living with HIV in the north east who are unvaccinated against COVID-19: a descriptive study

Background: People living with HIV (PLWH) are at increased risk of severe or critical COVID-19. This is in addition to the increased risk associated with any coexisting conditions such as chronic pulmonary disease (CPD), chronic kidney disease and cardiovascular disease. Vaccination against COVID-19 is therefore strongly recommended for PLWH. Method(s): We conducted a descriptive study to evaluate comorbidities among PLWH attending for HIV care at two NHS Trusts in North East England and who were under- or unvaccinated against COVID-19, defined as having received either zero or 1 doses of any COVID-19 vaccine by 01/10/2022. PLWH under active care were identified using the HIV and AIDS Reporting System (HARS) dataset. Vaccination data were obtained from regional integrated care records (RICR) and cross-referenced with HARS. Information on comorbidities was collated for any patients who were under- or unvaccinated. To quantify risk and clinical vulnerability, we calculated the Charlson Comorbidity Index (CCI) for each of these patients. A CCI score >=1 is associated with mortality/poor outcomes in patients with COVID-19. Result(s): 141 under- or unvaccinated patients were identified out of a total cohort of 1492 patients who attended for HIV care (9.5%);of these, 96 (68.1%) and 45 (31.9%) had received zero and one vaccination respectively. The median age of this under-/unvaccinated cohort was 41 years and 91 (64.5%) were male. 62 patients (44.0%) had a CCI score of 1 or more;13 patients (9.2%) had a diagnosis of AIDS during the time period evaluated;11 (84.6%) of the patients with an AIDS diagnosis were completely unvaccinated. Non-HIV comorbidities included liver disease (10/141, 7.1%), solid organ cancer (5/141, 3.5%), CPD (4/141, 2.8%) and connective tissue disease (3/141, 2.1%). Six patients (4.3%) had >=2 comorbidities. Conclusion(s): Nearly half of the under-/unvaccinated PLWH attending our services were identified as being at an increased risk of having a poor outcome in the event of contracting COVID-19. Proactively identifying these individuals would allow services to offer tailored support in making informed decisions about vaccinations. Useful strategies may include the use of patient information leaflets and targeted discussion with patients explaining their individual risk from COVID-19.

'Don't forget the children' - even in a pandemic

Background: BHIVA's 'Don't Forget the Children' and Standards of Care (SoC) documents highlight the importance of routine HIV testing for children of people living with HIV (PLWH). Our HIV service audited child testing in 2008, 2009 and 2010 with 46%, 78% and 82% respectively of children requiring testing having a documented result. Having evolved a child testing pathway and MDT, with dedicated Health Advisor and Paediatric nurse support, we wanted to re-evaluate our child testing performance during the COVID-19 pandemic. Method(s): Newly diagnosed PLWH, 01/08/2020 - 31/12/2021, were identified via our HARS dataset. All 32 identified individuals case notes were reviewed and the relevant auditable outcomes from BHIVA's SoC document used. Result(s): 32/32 (100%) had documented evidence that child testing had been considered within 4 weeks of diagnosis (BHIVA target 95%). 13/32 had a total of 35 children, 29 of whom did not require testing. 20/29 had documented evidence their mother was not living with HIV post childbirth, 9/29 were >18 years and all but 1, not living in the UK, had either tested in sexual health or antenatal settings. 6/35 (17%) children required testing. 6/6 (100%) had a documented test result within 6 months of their parent's diagnosis, 1 of whom tested negative prior to parental diagnosis (BHIVA target 90%). 5/6 tested aged >18 months. 1 child <18 months, whose parent was diagnosed antenatally, awaits final 4th generation testing at 18 months. Conclusion(s): Our service has a robust mechanism in place for asking all newly diagnosed individuals, and those new to our service, about children during their first consultation. Where children without documented evidence of HIV testing are identified our child testing pathway ensures timely investigation and documentation - all child testing was completed within one month of parental diagnosis in this audit sample. Our service surpassed the BHIVA standards for child testing for all new diagnoses during the COVID-19 pandemic. Future planned work includes a re-audit of child testing for those already known to our HIV service. As neither parental status nor child location is static regular enquiry in relation to children needs embedding into routine HIV care. (Table Presented).

Some clinical and epidemiological aspects of the course of COVID-19 in people living with HIV

Objective. To describe the clinical and epidemical characteristics of a new coronavirus disease 2019 (COVID-19) in people living with HIV, for HIV infection implies the development of an immunosuppressive condition that may exacerbate the course of COVID-19. Material and methods. The research is based on retrospective and current epidemiological situation of HIV and SARS-CoV-2 infections in the Southern Russia regions during 2020 and survey of the patients with the co-infections concerning epidemiological, clinical, and laboratory diagnostic information. We collected all data from 15 regional centers for AIDS prevention and control in the Southern and North Caucasus Federal Districts. The survey sample consists of 121 patients. Statistical computation is done with Microsoft Office Excel 2010. Results and discussion. HIV patients of various age and social characteristics are involved in the COVID-19 epidemic process. Within registered HIV and SARS-CoV-2 co-infections all patients have apparent clinical symptoms. Asymptomatic cases are not presented. Mild cases prevail in the sample (48.8%). The frequency of severe and extremely severe was significantly higher in people living with HIV/AIDS on ART more than 2 months against naive PLHIV or using ART up two one month (p<0.05).Copyright © 2022 by the authors.

Addressing loneliness and dietary needs during the COVID-19 pandemic: experiences of people living with HIV receiving support from a small HIV support organisation

Background: The Voluntary and Community Sector (VCS) is a vital partner in delivering care and support needs: enabling vulnerable people to live fulfilling, independent lives;helping them maintain good health and wellbeing. People living with HIV are disproportionately impacted by poverty, financial instability, stigma and discrimination, all of which were exacerbated during the COVID-19 pandemic. Pre-pandemic, this small HIV support organisation (part of the VCS) provided community, food, friendship and peer-support for people living with or affected by HIV, primarily via a weekly lunch club and monthly supper. This qualitative impact study explored clients' experiences of the change in service provision (eg food collection, doorstep food delivery, and companionship telephone calls) as the organisation adapted to members' needs during lockdowns and as restrictions altered. Method(s): Nineteen clients gave informed consent and participated in a facilitated in-person focus group. Two groups (n=10 and n=9) were held concurrently in June 2021 (after the second lockdown, but before all COVID restrictions were lifted). Focus groups lasted 60-90 minutes, with semi-structured interview question guides to structure discussions;they were recorded and transcribed verbatim. Deductive thematic analysis was conducted using a coding procedure to identify patterns between the groups and emerging themes. Result(s): The following themes relating to clients' experiences of the pandemic and their engagement with the organisation emerged from the focus groups: * Pre-lockdown services * Loneliness * Regular food parcels * Telephone companionship calls * Value of non-judgemental space Pre-lockdown, participants valued peer support and sharing meals together. During the pandemic, some clients experienced food insecurities;some felt disconnected and socially isolated;some lost their jobs or retired. Clients trusted the organisation to keep them safe (eg social distancing), and the volunteers delivering food made them feel valued and connected to their peers. Telephone check-ins helped tackle loneliness and reassured those who were anxious or afraid. Conclusion(s): During the pandemic this organisation helped address stigma, food insecurities and social isolation experienced by people living with HIV. Participants appreciated the organisation's mission and commitment to people living with HIV, and how welcoming and supportive the service is.

Taiwan's national strategies and actions toward HCV elimination before 2025

In 1990, the seroprevalence of antibody against hepatitis C virus (anti- HCV) in Taiwan was first documented to be 0.95% in volunteer blood donors, 90% in hemophiliacs, and 81% in parenteral drug abusers. The risk factors for HCV infection in Taiwan include iatrogenic transmission (medical injection, hemodialysis, acupuncture, and blood transfusion), tattooing, and sexual transmission. The long-term risk of hepatic and non-hepatic diseases has been well-documented by REVEL-HCV study. A national program of antiviral therapy for chronic viral hepatitis was launched in Taiwan in 2003. Mortality rates of end-stage liver diseases decreased continuously from 2000-2003 to 2008-2011 in all age and gender groups. When the World Health Assembly adopted the Global Health Sector Strategy on Viral Hepatitis in 2016, National program to eliminate hepatitis C was very carefully evaluated. It became a consensus to reach the WHO's 2030 goals in 2025. Taiwan Hepatitis C Policy Guideline 2018-2025 was approved and published at the beginning of 2019. There are triple focuses of hepatitis C elimination in Taiwan including (1) therapy spearheads prevention, (2) screening supports therapy, and (3) prevention secures outcome. A total of US$1.7 billion will be allocated from 2017 to 2025 for the elimination of HCV. The coverage of HCV screening and treatment has been increasing significantly since 2017. The HCV screening coverage was almost 100% for dialytic patients, 96% for HIV-infected patients, 65% for patients under opioid substitution treatment, 63% for patients in the pre-end-stage renal disease care program, 57% for patients in the early chronic kidney disease care program, 52% for patients in diabetes care program, 39% for prisoners, and 38% for adults aged 45-79 years old in the general population by April 30, 2020. The budget to cover the cost of DAA increased from US$101 million in 2017 to US$219 million in 2019. The number of chronic hepatitis C patients receiving DAA therapy increased from 9,538 in 2017, 19,549 in 2018, to 45,806 in 2019. However, the number of DAA-treated CHC patients reduced to 36,159 in 2020 and 20,559 in 2021 due to the COVID-19 pandemic. The cure rate based on SVR12 was 96.8% in 2017, 97.4% in 2018, over 98.6% after 2019. It is expected that Taiwan will achieve WHO's HCV elimination goal by 2025.

An audit of uptake of flu, COVID-19 and pneumococcal vaccines in a cohort of people living with HIV

Background: People living with HIV are at greater risk of complications associated with influenza, SARS-CoV-2 and pneumococcus than the general population and BHIVA guidelines recommend vaccinating all patients against these infections. The purpose of this audit was to determine the uptake of these vaccines, and factors associated with uptake, to inform vaccine delivery models. Method(s): All patients who received HIV care in our service at the end of November 2022 were included. Demographic data were collected from the service database, clinical data and pneumococcal vaccine (Prevenar-13) status were obtained from clinical records and COVID-19 and flu vaccine (2021) uptake was obtained from the Vaccine Management Tool (VMT). At the time of audit all patients were recommended to have received at least 3 doses of a SARS-CoV-2 vaccine. Caldicott approval was received for this work. Result(s): There were 364 patients known to the service of which one was excluded as clinical information was not available. Sixty-seven percent had received flu vaccine, 88% >= one dose of COVID-19 vaccination, 76% at least 3 doses of COVID-19 vaccination and 88% had received Prevenar-13. Three percent had received no vaccines and 60% had completed all vaccines. Uptake of both flu and COVID-19 vaccines were lower in the following groups: <50 years old (51% and 62% respectively), urban residence (65%, 71%), higher deprivation scores (51-65%, 64-75%) less time in HIV care (57%, 70%), those not on ART (13%, 25%), CD4 <200 cells/mm3 (40%, 50%), detectable viral load (33%, 42%), those out of care (23%, 23%) and those known to the harm reduction service (33%, 33%). There was higher uptake of Prevenar-13 in all groups. Uptake of all vaccines was high in those with comorbidities. Conclusion(s): The high uptake of Prevenar-13 in higher risk groups suggests that the model of vaccine delivery, opportunistic and pro-active recall for inhouse vaccination, is more effective for protecting those at highest risk for poor outcomes and for those for whom access is challenging compared to the centralised national recall system at designated Vaccine hubs. Vaccination resourcing, planning and delivery should consider the needs of specific risk groups to ensure best outcomes.

Integrating peer support within NHS clinics: a London Fast-Track Cities Initiative (FTCI) project

Background: BHIVA Standards of Care for people living with HIV (PLWH) include quality statements and auditable outcomes for peer-support pathways to improve selfmanagement and engagement in care. FTCI London convened 3-year 'improvement collaborative' projects between HIV charities and NHS clinics. Chelsea and Westminster Hospital (CWHFT) supported the implementation of this initiative to 4 London HIV clinics with a cohort of >10,000 PLWH. We here illustrate the results of this initiative to date. Method(s): Positively UK, NAZ Project, Plus Health and CWHFT trialled approaches to integrating in-clinic peersupport pathways, with the aim of having >90% of those accessing peer-support retained in care, with a VL<50. 3 peer-supporters (2 FTE posts) received NHS honorary contracts, emails and the ability to log interventions within the Trust's EPR. Data on peer-support attendance and outcomes were collected from the EPR into an encrypted NHS database. Result(s): Although planned as an in-person initiative, the COVID-19 pandemic led to a shift to fully remote support and delayed project initiation to 7/2020, when email referrals commenced for newly diagnosed and those identified as being at risk of lost to follow up (LTFU). Referrals reached 4.4/month within the first 3 months. Initiatives such as MDT, focus group participation, staff teaching, and physical presence in clinics increased referrals to 7/month by 4/2021 and 12/month by 11/2021. Median patient age was 45 years (range 16-74), 13% were female, and 47% from BAME background (vs 34.5% in the CWHFT HIV cohort). Median diagnosis length was 2 years (<1-31). Moving from opt-in to opt-out support for newly diagnosed increased uptake of support from 33% in 4/2021 to 67% by 12/2021. Overall, 287 people (66% of referrals) engaged with peersupport between 7/2020 and 11/2022, with 164 (57%) receiving ongoing support. Virtual appointments moved from 100% to 54% over time. Rates of having a VL<50 increased from 71% at referral to 90% following peer-support, including new diagnoses. Conclusion(s): Implementing in-clinic peer-support pathways significantly increased referrals and uptake of support for new HIV diagnosis and those at risk of LTFU, showing the potential of improving clinical outcomes and quality of life of PLWH.

Ultrasound examination of the lungs in pneumonia in HIV-infected patients

The aim - to study was to assess the condition of the lungs and pleural cavities in HIV-infected patients with community-acquired pneumonia by ultrasound examination. Material and methods. During the period from May 2020 to February 2021, 7 HIV-infected patients with community-acquired pneumonia were observed, who underwent ultrasound of the lungs and pleural cavities. Results and discussion. Ultrasound of the lungs is the most affordable method of diagnosis in outpatient settings, at the pre-hospital stage to solve the issue of patient routing. Ultrasound is mandatory for quick triage of patients with suspected pneumonia in the emergency department. Given that ultrasound is not associated with radiation exposure to the patient, the examination of pregnant women, newborns and children with suspected pneumonia of any etiology should begin with ultrasound of the lungs, pleural cavities and mediastinum. Ultrasound of the lungs can be performed after pneumonia in order to monitor rehabilitation to assess the nature of changes in the chest cavity and determine the prognosis of the disease. The article presents a clinical example of lung ultrasound in an HIV-infected patient with pneumonia of unknown etiology.Copyright © 2021 Infectious Diseases: News, Opinions, Training. All rights reserved.

Features of the diagnosis and course of COVID-19 in HIV-infected patients hospitalized in a hospital

The global pandemic of coronavirus infection (COVID-19) has set complex diagnostic tasks for doctors of polyclinics and hospitals. Considering the simultaneous pandemic spread of two infectious diseases - COVID-19 and HIV infection, the problem of studying the clinical features of combined COVID-19/HIV infection becomes urgent. The aim of the study was to determine the features of the diagnosis and course of COVID-19 against the background of HIV infection in patients undergoing inpatient treatment. Material and methods. The study was conducted on the basis of the temporary Clinical Medical Center COVID-19 of the A.I. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian Federation in Moscow from October 2020 to January 2022. The study included 31 233 patients with COVID-19 complicated by pneumonia. To analyze the features of the course of combined COVID-19/HIV infection, a group of 51 HIV-infected patients was identified. The diagnosis of COVID-19 was determined based on the detection of SARS-CoV-2 RNA by PCR in nasal/oropharyngeal smears and/or according to computed tomography of the lungs (CT). During the study, age, gender, anamnesis, objective examination data were analyzed, taking into account the results of CT scans of the chest organs, data from routine laboratory blood tests, oxygen support regimens, treatment outcomes and duration of detection of SARS-CoV-2 RNA. All patients were treated according to the Temporary Clinical Guidelines for the Diagnosis and Treatment of COVID-19, 14 version dated 12/27/2021. Results. The number of patients with combined HIV infection and SARS-CoV-2 out of the total number of hospitalized COVID-19 patients (n=31 233) was 0.16%. Upon admission, 30 (59%) patients reported having HIV infection and receiving antiretroviral therapy (ART). HIV infection was first diagnosed in 21 patients at 2-3 weeks of inpatient treatment. The average age of patients with SARS-Cov-2/HIV co-infection was 1.5 times less than in patients without HIV (41.1+/-5.3 and 64.4+/-10.1, respectively) (p<=0.05). Concomitant pathology (hypertension, type 2 diabetes mellitus, chronic kidney disease and chronic lung diseases) was less common (51%) in the group of combined infection than in the group without HIV (83%). However, in 41% of patients with coinfection, chronic viral hepatitis B, C was detected, in contrast to 0.3% of cases of COVID-19 patients without HIV. 26 (51%) patients were discharged with improvement, while the average bed-day did not differ from patients without HIV infection (13.4+/-4.5 days and 11.7+/-5.2, respectively) (p>=0.05). 7 (24%) patients at the time of discharge (16.8+/-4.2 days) with clinical and laboratory improvement maintained a positive result of PCR RNA on SARS-Cov-2. In 22 (43%) patients with coinfection, hospitalization was fatal for 3 to 21 days of treatment, with ARDS with respiratory and multiple organ failure, which is 3.6 times higher than in patients without HIV infection. The analysis showed that, regardless of the result of PCR on SARS-CoV-2 RNA, in non-specialized hospitals, HIV testing is indicated for young patients with fever for more than 14 days, with lung damage in the form of bilateral interstitial changes according to CT, a history of chronic hepatitis C, B, with progressive severity of the condition on against the background of COVID-19 therapy. Early consultation of an infectious disease specialist, examination of sputum/lavage by PCR for pathogens of opportunistic infections and the appointment of ART and drugs for the treatment of opportunistic diseases will improve the quality of medical care for patients in a non-core HIV hospital will improve the prognosis of COVID-19.Copyright © Eco-Vector, 2022.

A collaborative approach to research study recruitment in PLWH during the SARS CoV-2 pandemic

Background: Since COVID there are fewer site investigator meetings for non-CTIMP studies to discuss recruitment barriers. Additionally, literature highlights various research trials that have successfully recruited do not report their strategies, consequently impacting ability to learn from success. The pandemic has had considerable impact on enrolment to clinical research, thus services have needed to revaluate their approach. Following the pandemic, patients report more likely to engage in research if offered remote or combined visits. Method(s): We reviewed recruitment strategies at our clinic for two observational studies with large targets (SCAPE-HIV, Positive Voices). SCAPE-HIV, a prospective study exploring immune responses of PLWH to SARS CoV2 infection and vaccination. Positive Voices, a crosssectional questionnaire study. Minimum recruitment targets, 600 and 262 respectively. SCAPE involves open-offer enrolment, Positive Voices from a defined pre-selected cohort. Initial approaches identified people opportunistically at clinic visits, with research staff offering information. However, reaching our targets through COVID became challenging and a move to virtual appointments condensed our opportunities to approach. To increase recruitment, engagement and training of NHS nursing and clinical staff was undertaken alongside remote patient contact. Result(s): After implementing collaborative methods, Positive Voices recruitment increased to 170 in July/ August 2022 (73 in May/June). SCAPE recruitment also improved. Hybrid nurse practitioners dedicating time to approach people during clinic visits and clinic staff involvement attributed to this rise, representing over half of consents (Table A). The clinic team's substantial knowledge of our cohort, combined with their openness to research, leads to greater understanding of how likely individuals are to accept studies. Conclusion(s): Positive Voices and SCAPE-HIV studies have been successful with recruitment due to a collaborative approach, resulting in our site being the highest current recruiting site involved in Positive Voices. This approach has helped motivate the NHS team to become more involved and has become an exemplar for clinical trial delivery within our Trust. (Table Presented).

The impact of the COVID-19 pandemic on cervical screening and outcomes for women living with HIV

Background: Current published Faculty of Sexual and Reproductive Health (FSRH) guidelines recommend annual cervical screening for women living with HIV(WLHIV) but do not reflect current evidence. Aim(s): 1. To assess the impact of the Covid-19 pandemic on frequency and interval of cervical screening in WLHIV 2. To report any changes in outcomes of cervical screening in WLHIV during Covid-19 Method: Data were collected retrospectively over 3 years defined as Pre-Covid (23/3/2019-22/3/2020), during Covid lockdowns (23/3/2020-22/3/2021) and Post-Covid lockdowns (23/3/2021-22/3/2022). Data was collated on demographics, HIV-related data, previous abnormal cervical screens/colposcopy, smoking and high-risk Human Papilloma Virus(hrHPV) vaccination. Result(s): Data was available for 70 women. Mean age was 48 years, 44.3%(n=31) were of African ethnicity. Mean duration of HIV diagnosis was 19 years. 22.9% (n=16) had a previous ADI, median CD4 was 768(range 35-1891), median nadir-CD4 439(range 3-1472), 94.3% (n=66) were taking ARVs and 87.1%(n=61) had HIV-VL <40 copies/ml. 42.9%(n=30) had a previous abnormal cervical screen and 78.6%(n=55) had undergone colposcopy. 4.3%(n=3) were vaccinated against hrHPV. 18.6% (n=13) currently smoked. 60%(n=42) women underwent cervical screening Pre- Covid, 41.4%(n=29) during and 78.6%(n=55) Post-Covid. 19.6-37.2% fewer women were screened during Covid compared to Pre and Post-Covid. 9.5%(n=4) women screened Pre-Covid tested positive for hrHPV compared with 6.9%(n=2) during Covid and 12.7%(n=7) Post-Covid. No cytology changes were seen for the majority however cervical intraepithelial neoplasia(CIN) grade 1 was detected in 2.4%(n=1) Pre- Covid, compared with 3.4%(n=1) during covid and 5.4% (n=3) Post-covid. Post-Covid 1.82%(n=1) had CIN grade 2 detected, no women pre or during covid had CIN grade 2 detected. No women Pre, during or Post-covid had CIN grade 3 or cervical neoplasm detected on cytology. Conclusion(s): Covid increased cervical screening intervals for WLHIV but did not result in delayed cervical cancer diagnosis. FSRH guidelines are currently under review regarding screening intervals. This data, although small in number, may support European AIDS Clinical Society and Department of Health and Human Services guidelines which have extended screening intervals for PWLH especially for those who tested negative for hrHPV.

What is the new normal? Frequency of monitoring after COVID-19

Background: Recommended frequency of HIV plasma viral load (VL) monitoring is 6 monthly, but published data suggest a low risk of virological failure with longer monitoring intervals. National COVID-19 'lockdowns' necessitated much reduced VL monitoring. We hypothesised that many people living with HIV (PLWH) may have remained on extended monitoring intervals. Method(s): We interrogated laboratory data for all HIV VL performed in our service for the period 1/1/2018 to 31/12/2022. As COVID-19 lockdowns principally affected face-to-face clinical care during Q2 and Q3 2020, we considered two 27-month periods of 1/1/2018 to 31/3/2020 (P1) and 1/10/2020 to 31/12/2022 (P2). Within each period, PLWH were eligible for inclusion if there were at least two VL results. The last two monitoring visits of the period were used for analyses. An extended monitoring interval was defined as 34 weeks or more. Result(s): 1302 PLWH were monitored during P1 at a mean frequency of 1.97 VL per annum, and 1370 in P2 at 1.76 pa. The proportion of PLWH with VL <200 copies/mL rose from 92.9% in P1 to 96.0% in P2 (p<0.001). The proportion suppressed to <50 copies/mL rose from 76.4% to 86.2% (p<0.001). Of those PLWH with VL <200 copies/mL at initial visit, 9.9% had an extended monitoring interval to the subsequent visit in P1, and 23.0% in P2 (p<0.001). However, within P2, 4.7% of those with an extended monitoring interval had VL >=200 copies/mL at subsequent visit compared with 0.8% of those with standard interval (p<0.001). Conclusion(s): Virological monitoring intervals have become significantly longer in the period since the COVID-19 lockdowns. Viral suppression across all PLWH has improved. However, extended follow-up intervals were associated with increased risk of virological failure, even in the setting of prior suppression. This study was not able to determine the reasons for extended monitoring intervals (e.g. active shared decision vs. suboptimal attendance). Further research is required in order to develop criteria for safe extension of monitoring intervals.

Factors associated with severe SARSCOV- 2 infection in people of Black ethnicities living with HIV in the UK

Background: The COVID-19 pandemic has disproportionally affected people of black ethnicities, who have been at greater risk of SARS-CoV-2 acquisition, morbidity and mortality than those of white ethnicity. We describe factors associated with severe COVID-19 infection in the GEN-AFRICA cohort of people of black ethnicities living with HIV in the U.K. Method(s): First reported episodes of COVID-19 up to October 2022 were ascertained by direct questioning and/or medical records review. Pre-pandemic immune-virological and comorbidity status was based on measurements obtained prior to 01/2020 and used to identify risk factors for severe (requiring hospitalisation or resulting in death) COVID-19, using logistic regression Results: COVID-19 status was available for 1806 (72%) of 2503 GEN-AFRICA participants (mean age 49.2 [SD 10.2] years;56% female;80% sub-Saharan African and 14% Caribbean ancestry, median CD4 count 555 [IQR 400-733] cells/mm3;93% undetectable HIV RNA [<200 copies/ mL]);573 (32%) reported a clinical illness consistent with COVID-19;63 (3.5%) experienced severe COVID-19 (hospitalisation 59;death 4). Those who experienced severe COVID-19 were older, more often male, had lower CD4 counts and fewer had undetectable HIV RNA;they more often had prior AIDS, hypertension, diabetes mellitus and chronic kidney disease. Region of ancestry, nadir CD4 count, and obesity were not associated with severe COVID-19. In multivariable analysis, CD4 count <350 cells/mm3, diabetes mellitus and chronic kidney disease were associated with increased odds of severe COVID-19 (Table). Sex and a pre-pandemic HIV RNA were associated with severe disease although this did not reach statistical significance. By October 2022, 1534 (88%) of this sample had received >=1 dose of SARS-CoV-2 vaccine;those who experienced severe COVID-19 were less likely to report vaccination (77% vs. 89%, p=0.01). Conclusion(s): By the end of October 2022, nearly onethird of people of Black ethnicities with HIV in this sample had experienced COVID-19;3.5% had developed severe COVID-19 disease. Pre-pandemic immunovirological and comorbidity status were associated with severe COVID-19. Black populations with less favourable HIV control than observed for GEN-AFRICA participants may have suffered greater COVID-19 morbidity and mortality. (Table Presented).

Neutralizing Activity and T Cell Response after Bivalent Third Booster Dose in Plwh

Background: Aim of the study was to analyze neutralizing activity against BA.5,BQ.1.1 and T cell response after 3rd booster dose [3BD (5th shot)] with BA.4/5 bivalent vaccine by hybrid immunity (HI) and CD4 count in advanced PLWH. Method(s): In PLWH with previous AIDS and/or CD4< 200/mm3 receiving 3BD (original strain/BA.4/5),immunogenicity was assessed at time of 3BD (T0) and at day 15 (T1) by microneutralization assay [MNA90] against Omicron BA.5, BQ.1.1 and by IFNgamma-ELISA. PLWH were stratified by HI vs. nHI and by CD4 count at T0 ( >or< 500/3). For crude mean comparisons, neutralizing antibodies (nAbs) were expressed in natural scale and fold changes, IFNgamma and all values for regression analyses in log2 scale, paired t-test used to test changes over T0-T1. Two 2-arms parallel trials were emulated: HI and CD4 count as exposure, log2 nAbs and IFNgamma as outcome. Average treatment effect (ATE) of the two exposures were estimated by marginal models weighted for potential confounders (age, CD4 nadir, years from AIDS;when HI was the exposure also CD4 count). Result(s): N=48 PLWH on ART, 15% female, median age 56 yrs, 45% >1 comorbidity, 87% with previous AIDS, median CD4 nadir 44 cell/mm3 (16-102), 98% with HIV-RNA < 50 cps/mL. A significant increase of nAbs against BA.5 (fold-increase 8.8,p< 0.0001) and BQ.1.1 (6.4, p< 0.0001) was observed from T0 to T1. At T1, in nHI (n=29), mean nAb was 176 and 53 against BA.5 and BQ.1.1, respectively, with a fold change reduction (FCR) vs BA.5 of 3.3;in HI (n=19), 496 and 128, respectively, with a FCR of 3.8 (Fig.1A). After controlling for confounders, HI was associated with a higher level of neutralizing response against BA.5 [ATE=1.17 log2 (95%CI 0.34;2.00), P=0.006] but not against BQ.1.1 [0.65 log2 (-0.18;1.48), p=0.124]. At T1, among PLWH with CD4 count< 500 (n=29), mean nAb was 290.8 and 83.9 against BA.5 and BQ.1.1, respectively, with a FCR of 3.4;in those with CD4 count >500 (n=19), 230.4 and 64.3, respectively, with a FCR of 3.6 (Fig. 1C).There was no impact of CD4 count on neutralization after controlling for potential confounding factors. No evidence for a difference between T0 and T1 was detected for IFNg (Fig.1B,D). Conclusion(s): In PLWH with advanced diseases, bivalent BA.5 3BD elicited strong neutralization against BA.5, and retained cross-neutralization against BQ.1.1, even if 3 times lower. HI but not CD4 count >500 appeared to enhance neutralization against BA.5. Importantly, bivalent vaccine appeared to have no effect on T-cell mediated response. (Figure Presented).

12-MONTH CONSEQUENCES IN PEOPLE WITH HIV/SARS-CoV-2 COINFECTION: NATIONAL EHR COHORT

Background: Long-term consequences of COVID-19 are well characterized in general populations. Yet it remains unclear how existing HIV infection attributes to the risks of long-term consequences in people with coinfection of HIV/SARSCoV- 2. This study aims to examine the long-term consequences of people living with HIV (PLWH) at 12 months after the first SARS-CoV-2 infection. Method(s): Using the National COVID Cohort Collaborative (N3C), Electronic Health Records (EHR) sampled from 50 states and over 75 healthcare systems in the US, we constructed a cohort of PLWH with COVID-19 between March 1, 2020 and January 15, 2021, a historical control group (HIV individuals without COVID-19 between March 1, 2018 and January 15, 2019, two years predating the pandemic), and a contemporary control group (PLWH without COVID-19 between March 1, 2020 and January 15, 2021) to mitigate time/selection biases. The time of HIV infection was before March 1, 2020 for the cases and contemporary controls and, before March 1, 2018 for historical controls. The date of the first COVID-19 infection marked the start of a 12-month follow-up in the COVID-19 group. The start of follow-up in the contemporary controls was assigned by matching the same distribution of start dates of COVID-19 cases. We used logistic regression to examine odds ratios of health consequences at 12 months post COVID-19 comparing against contemporary and historical controls, respectively. Result(s): We identified 5,619, 41,791, and 24,240 patients for COVID-19 cases, contemporary controls, and historical controls, respectively. The COVID-19 group had significantly higher odds in acute respiratory distress syndrome [OR: 3.45, 95% CI (2.98, 3.99)], hypertension [OR: 1.41, 95% CI (1.29, 1.54)], congestive heart failure [OR: 1.36, 95% CI (1.14, 1.63)], myocardial infarction [OR: 1.51, 95% CI (1.22, 1.86)], and diabetes [OR: 1.62, 95% CI (1.42, 1.84)], compared to contemporary controls. Odds in these outcomes were significantly higher when compared to historical controls (Figure 1). Conclusion(s): This sentinel study for the first time reported elevated risks of multi-system dysfunction (i.e., respiratory, cardiovascular, and metabolic) among PLWH at 12 months post COVID-19. To our knowledge, it is the largest EHR cohort study assessing long-term consequences in PLWH. Our findings call for immediate attention to the post-COVID care among PLWH, including followup guidelines, care planning, and health policy tailored for PLWH.