The main aim of this study was to describe the clinical and immunological outcomes, as well as the inflammatory profile, of patients with advanced HIV in an assisted-living facility in which an outbreak of SARS-CoV-2 occurred. SARS-CoV-2 humoral and specific T-cell response were analyzed in patients with HIV infection and COVID-19; as a secondary objective of the analysis, levels of the inflammatory markers (IL-1β, IL-6, IL-8, and TNFα) were tested in the HIV/COVID-19 group, in HIV-positive patients without COVID-19, and in HIV-negative patients with mild/moderate COVID-19. Antibody kinetics and ability to neutralize SARS-CoV-2 were evaluated by ELISA assay, as well as the inflammatory cytokines; SARS-CoV-2 specific T-cell response was quantified by ELISpot assay. Mann–Whitney or Kruskal–Wallis tests were used for comparisons. Thirty patients were included with the following demographics: age, 57 years old (IQR, 53–62); 76% male; median HIV duration of infection, 18 years (15–29); nadir of CD4, 57/mmc (23–100) current CD4 count, 348/mmc (186–565). Furthermore, 83% had at least one comorbidity. The severity of COVID-19 was mild/moderate, and the overall mortality rate was 10% (3/30). Additionally, 90% of patients showed positive antibody titers and neutralizing activity, with a 100% positive SARS-CoV-2 specific T-cell response over time, suggesting the ability to induce an effective specific immunity. Significantly higher levels of IL-6, IL-8, and TNF-α in COVID-19 without HIV vs. HIV/COVID-19 patients (p < 0.05) were observed. HIV infection did not seem to negatively impact COVID-19-related inflammatory state and immunity. Further data are mandatory to evaluate the persistence of these immunity and its ability to expand after exposure and/or vaccination.

Rhodococcus equi (R.equi) is an acid fast, GRAM + coccobacillus, which is widespread in the soil and causes pulmonary and extrapulmonary infections in immunocompromised people. In the context of HIV infection, R.equi infection (rhodococcosis) is regarded as an opportunistic disease, and its outcome is influenced by highly active antiretroviral therapy (HAART).

Background: Progressive multifocal leukoencephalopathy (PML) is a severe demyelinating disease caused by JC polyomavirus (JCV), affecting immunocompromised individuals. We describe PML demographic, clinical, radiological, and laboratory characteristics and survival over time and according to underlying condition in a large retrospective patient cohort. Methods: This is a retrospective cohort including Italian PML patients observed between 1987 and 2024, with known year of diagnosis and underlying disease. Results: We included 456 cases with either a definite (n = 376, 82.4%) or clinico-radiological (n = 80, 17.6%) PML diagnosis. The relative frequency of human immunodeficiency virus (HIV)-associated cases decreased through four time periods (1987–1996; 1997–2004; 2005–2012; 2013–2024) from 99% to 43%, in parallel with increasing age (P < .0001), proportion of women (P < .001) and CD4+ counts (P < .001) but not cerebrospinal fluid (CSF) or plasma JCV-DNA levels at diagnosis. One-year survival probability increased from 23.8% in 1987–1996 to 59.2% in 2013–2024, with highest values in natalizumab-treated multiple sclerosis (93.8%), followed by combination antiretroviral treatment (cART)-treated HIV infection (55%), hematological malignancies (50.8%), primary immunodeficiencies (41.3%), and cART-untreated HIV infection (11.9%). At multivariate analysis excluding cART-untreated people with HIV, JCV-DNA levels in both CSF and plasma were independently associated with an increased mortality risk of 2.9% and 7.2%, respectively, for each Log increase in JCV-DNA. Conclusions: This observational study showed a changing epidemiological context over 37 years. Although survival improved over time, it remained poor even in the last decade, with a one-year survival probability of 59.2%.

Background: Studies on SARS-CoV-2 conducted in confined settings for prolonged times allow researchers to assess how the coronavirus spreads. San Patrignano (SP), Italy, is the largest European drug rehabilitation facility. Methods: Between 15 October and 31 December 2020, all SP residents were tested for SARS-CoV-2. We analyzed the relationships between individual characteristics and being SARS-CoV-2-positive. Three selected predictive models were used to calculate the number of expected hospitalizations. For each model, we summed the estimated individual risks to obtain the expected number of hospitalizations in our sample, and we tested whether the observed and expected numbers differed. Results: Of 807 residents, 529 (65.6%) were SARS-CoV-2-positive. Of these 323 (61.1%) were symptomatic. A strong relationship was found between being positive and living connections (p-value < 0.001). No statistically significant relationship was found with age, sex, smoking history, or comorbidities. Although 9 to 17 hospitalizations were expected, no hospitalizations were observed (p-value < 0.001). No one died of COVID-19. Conclusions: The peculiar characteristics of SP residents or the SP environment might at least partially explain the null hospitalization rates. Despite the extreme uniqueness of our population and despite the protected environment and all precautions that were taken, the fact that the virus was able to circulate and infect a large portion of the population highlights the fundamental role of social interactions in the spread of the disease.

Il consumo di cocaina è in aumento, in particolare tra i giovani adulti. La cocaina è una causa importante di dolore toracico e sindromi coronariche acute ed è il motivo principale di accessi in Pronto Soccorso per motivi cardiovascolari correlati a sostanze da abuso. Il suo consumo, soprattutto per lunghi periodi, è associato anche ad un aumentato rischio di morte per tutte le cause e a diverse importanti malattie cardiovascolari. I meccanismi con cui essa agisce sono solo in parte noti. Queste attuali evidenze hanno importanti implicazioni socio-sanitarie, rinforzano le raccomandazioni sulla valutazione di un’origine voluttuaria delle patologie cardiovascolari nei giovani adulti e sottolineano la necessità di interventi educativi. Per i suoi effetti la cocaina dovrebbe essere considerata un fattore di rischio cardiovascolare, e nei soggetti assuntori dovrebbe essere fatto uno screening per la rilevazione precoce di danno d’organo subclinico.

Introduction Real-world clinical registry data from addiction treatment centers are a valuable source for investigating the association between substance use disorder (SUD) and cardiovascular disease (CVD), but are frequently affected by missing data arising from irregular attendance and heterogeneous data collection. Inadequate handling of missing data may introduce substantial bias in the estimation of epidemiological associations, particularly when missingness varies markedly across variables. Aim To compare the performance of non-parametric missing data imputation methods in a mixed-type real-world clinical registry and evaluate their impact on cardiovascular risk estimates across variables with increasing levels of missingness. Methods A retrospective cohort of 4,895 unique patients admitted to the San Patrignano addiction treatment center (Bologna, Italy) between 2015 and 2024 was analyzed using 40 variables (8 continuous, 32 categorical). The outcome variable was withheld from the imputation model throughout. Three imputation methods were assessed: missForest, kNN, and guided hot-deck, all tuned by grid search. MissForest was evaluated using built-in error estimates: NRMSE for quantitative and PFC for categorical variables, whereas kNN and guided hot-deck were assessed through method-specific proxy indicators. A binary cardiovascular outcome was defined as the presence of cardiovascular disease-related conditions. Odds ratios (ORs) and 95% confidence intervals (95%CI) were estimated using complete-case analysis and after imputation for variables characterized by different levels of missingness: cocaine use (1%), obesity (12%), total cholesterol (39%) and overdose history (73%). To quantify the sensitivity of epidemiological estimates to the imputation strategy, two summary indicators were calculated: ΔOR=(OR_max-OR_min)/OR_cc and ΔIC=(IC_maxwidth-IC_minwidth)/IC_widthcc where and denote the odds ratio and confidence interval width obtained from the complete-case analysis. All statistical analyses were done in R (version 4.5.0). Results kNN showed a more favorable proxy-based profile than guided hot-deck, with lower continuous and categorical proxy values (0.032 and 0.072 vs. 0.091 and 0.226, respectively), while missForest yielded NRMSE=0.604, indicating a relatively high value, and PFC=0.110. The impact of imputation on epidemiological estimates increased with missingness proportion. For low-missingness variables (cocaine 1%, obesity 12%), OR estimates were stable across all methods (OR range: 4.0–4.1; ΔOR=0.26; ΔIC=0.44). For total cholesterol (39% missing), modest differences emerged across imputation strategies (ΔOR=0.62; ΔIC=0.55), although the epidemiological interpretation remained unchanged. The largest variability was observed for overdose history (73% missing), where OR estimates ranged from 1.8 to 3.3 (ΔOR=0.62; ΔIC=0.55). Nevertheless, overdose was consistently identified as a positive risk factor across all methods. Conclusions The practical impact of missing data imputation depended strongly on the amount of information recovered from incomplete variables. For low-to-moderate missingness, complete-case and imputed analyses yielded consistent estimates across algorithms. Differences in point estimates and confidence interval widths emerged only above 70% missingness, without changing the direction or substantive interpretation. Because reconstruction-performance metrics may be structurally heterogeneous across methods, they are best restricted to within-method tuning. In this setting, the operational value of imputation was more appropriately assessed through its impact on downstream epidemiological inference, with ΔOR and ΔIC providing an interpretable framework for comparing imputation strategies in real-world registry studies.