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The Infectious and Tropical Diseases Department of University of Brescia organized free rapid screening tests for HIV and HCV as part of the Fast Track City commitment. A cross-sectional study was conducted, consisting of an anonymous, multiple-choice questionnaire that was administered to individuals who underwent the screening or consultation. The study aimed to compare knowledge and attitudes towards HIV and HCV between age groups (18-40 vs. >40) and sexual orientations (heterosexual vs. LGBTQ+). Overall, 333 questionnaires were completed. Individuals over the age of 40 and those who identified as heterosexual had the lowest level of knowledge about HIV transmission (7.9% and 30% respectively), undetectable=untransmittable (19.7% and 39.4% respectively) and PrEP (9.2% and 18.2% respectively). They were also less willing to cohabit with people with HIV (PLHIV). Only 9.6% of the population demonstrated high levels of knowledge for both HIV and HCV. People over the age of 40 had the largest gaps in knowledge and would benefit the most from educational and prevention interventions.

Background Elderly people living with HIV show a significant prevalence of multimorbidity, polypharmacy and frailty that increase the risk of disability. Telehealth has been suggested as a new tool to monitor people living with HIV in the COVID era, but its effectiveness in elderly is unknown. The aim of this study was two-fold: to explore feasibility of a telephone interview and its capability to collect relevant geriatric outcomes. Methods Assessed health domains included comorbidities, falls, urinary incontinence, antiretroviral drugs exposure and comedications (polypharmacy), and the following patient reported outcomes: quality of life, intrinsic capacity, and resilience. Results 214 (70.6%) answered and completed the interview. During confinement period, 57 (26.7%) of people switched antiretroviral therapy : 119 (55.4%) to dual therapy regimens and 95 (44.6%) to triple regimens. Prevalence of geriatric syndromes were falls in 31 cases (14.7%), urinary incontinence in 48 cases (22.7%) and polypharmacy 122 cases (57.2%). Mean Health-related Quality of Life score was mildly impaired (0,88%) with good concordance of Helath-related Quality of Life self-perception in a visual analogue scale (8/10) (r=+0.348; p Conclusions A structured telephone call was feasible in elderly people living with HIV and allowed to collect clinically meaningful geriatric health domains when face-to-face visits are not needed or discouraged.

Background: We assessed whether the association between the risk of cerebrospinal fluid escape (CVE) and specific antiretroviral (ARV) classes, such as protease inhibitors, is due to suboptimal pharmacological profile generated by archived resistance-associated mutations (RAMs). Methods: A retrospective multicentric study on 300 adult people with HIV on antiretroviral therapy (ART) and available historical plasma genotype resistance testing (HGRT) for reverse transcriptase (RT) and protease genes between 2001 and 2021. The odds ratio for demographic, clinic-, and ART-related variables and CVE was estimated by multivariable modelling. HGRT-adjusted central nervous system effectiveness penetration (CPE) score was computed in modelling the risk. Results: Median age, plasma VL, and CD4 count were 49 years, , p=0.003). CVE risk decreased by 40% per each point increase in HGRT-adjusted CPE score in multivariable models (pConclusions: Viruses harboring mutations appear to favor CVE and the impact of single ARV classes or type of ART regimens may lose significance when adjusted for the presence and effect of specific RAMs.

BacKGrOUnd: Older people hospitalized for cOvid-19 are at highest risk of death. Frailty assessment can detect heterogeneity in risk among people of the same chronological age. We investigated the association between frailty and in-hospital and medium-term mortality in middle-aged and older adults with COVID-19 during the first two pandemic waves. meTHOdS: This study is an observational multicenter study. We recorded sociodemographic factors (age, sex), smoking status, date of symp-tom onset, biological data, need for supplemental oxygen, comorbidities, cognitive and functional status, in-hospital mortality. We calculated a Frailty Index (FI) as the ratio between deficits presented and total deficits considered for each patient (theoretical range 0-1). We also assessed the clinical Frailty Scale (cFS). mortality at follow-up was ascertained from a regional registry. reSULTS: in total, 1344 patients were included; median age 68 years (Q1-Q3, 56-79); 857 (64%) were men. median cFS score was 3 (Q1-Q3 2-5) and was lower in younger vs. older patients. median Fi was 0.06 (Q1-Q3 0.03-0.09) and increased with increasing age. Overall, 244 (18%) patients died in-hospital and 288 (22%) over a median follow-up of 253 days. FI and CFS were significantly associated with risk of death. In two different models using the same covariates, each increment of 0.1 in Fi increased the overall hazard of death by 35% (Hr=1.35, 95%ci 1.23-1.48), similar to the hazard for each increment of cFS (Hr=1.37, 95%ci 1.25-1.50). cOncLUSiOnS: Frailty, assessed with the Fi or cFS, predicts in-hospital and medium-term mortality and may help estimate vulnerability in middle-aged and older cOvid-19 patients.

Background: COVID-19 pandemic changes the lifestyle and inducted negative emotions. People living with chronic disease (PLWCD) are the frailest social category, both for the risk of severe COVID-19 illness and for the pandemic impact on the continuum of care. Aim of this study was to analyze coping strategies and resilience in people living with HIV (PLWH) compared to people living with oncological diseases (PLWOD) during COVID-19 pandemic. Methods: In this observational study based on the administration of an anonymous questionnaire, we explored the emotional experience, the clinical and demographic factors linked to a COVID-19-related stress syndrome, the patient’s perception about the adequacy of clinical and psychological undertaking from the hospital and the level of resilience through a validated resilience scale. We performed a Kruskal-Wallis and a chi-squared test to compare the characteristics between PLWH and PLWOD and a linear regression to assess the factors associated to higher resilience. Results: We analyzed 324 questionnaires (PLWH n=167, PLWOD n=157). There were no significant differences in prevalence of psychological distress, anxiety, and fear among the whole cohort; however, PLWOD were calmer (p=0.039), less troubled (p=0.014), and more serene (p=0.026) than PLWH. Moreover, PLWH smoked more (pp=0.003) and thus gained more weight (p=0.013) than PLWOD. 62% of patients didn’t have more feelings of solitude than usual (p=0.130) and 71,3% continued to take pleasure from their activities (p=0.511). No differences in resilience were found between the groups, however in the whole cohort lower levels of resilience were found in patients that were unemployed (-3.52; 95% CI = [-6.68 -0.35]; p=0.029), with history of psychological disorders (-2.18; 95% CI = [-3.17 -1.18]; pppConclusions: PLWCD had high level of resilience, preserved in general their psychological well-being, and activated adaptive coping during the pandemic. However, PLWH showed higher distress than PLWOD according to comparable resilience score. Patients with psychological problems, feelings of anger and concern deserve more attention as they show lower levels of resilience.

Background Rapid initiation of antiretroviral therapy (ART) has been largely proven efficacious and safe mostly through clinical trials. Further investigations are needed to better define feasibility and acceptability of rapid ART approach in real-life settings. Methods We conducted a retrospective, observational study on newly HIV-diagnosed patients referred to Infectious and Tropical Diseases department of ASST Spedali Civili Hospital of Brescia from September 1st, 2015, to July 31st, 2019. All patients’ baseline characteristics were anonymously extracted from medical records. According to the timing of ART initiation, we distinguished 3 groups of patients (rapid, intermediate and late group) and represented the trend of virological response during a 400 day-period. The hazard ratios of each predictor on viral suppression (HIV RNA < 50 copies/ml) were estimated through Cox proportional hazard model. Results Median time from HIV diagnosis to first medical referral was 15 days and median time from first HIV care access to therapy start was 24 days. Three groups of patients were differentiated depending on ART initiation: within 7 days (rapid group, 37.6%), between 8 and 30 days (intermediate group, 20.6%) and after 30 days (late group, 41.8%). Longer time to ART start and higher baseline viral load were associated with a reduced probability of viral suppression. After one year, all groups showed high viral suppression rate (99%). Conclusions In high-income setting as Italy, rapid ART approach seems to be useful to accelerate time to viral suppression. The latter tends to be great over time regardless the timing of ART initiation.