Background: Many people living with HIV (PLWH) have comorbidities which are risk factors for severe coronavirus disease 2019 (COVID-19) or have exposures that may lead to acquisition of severe acute respiratory distress syndrome coronavirus 2. There are few studies, however, on the demographics, comorbidities, clinical presentation, or outcomes of COVID-19 in people with HIV. Objective: To evaluate risk factors, clinical manifestations, and outcomes in a large cohort of PLWH with COVID-19. Methods: We systematically identified all PLWH who were diagnosed with COVID-19 at a large hospital from 3 March to 26 April 2020 during an outbreak in Massachusetts. We analyzed each of the cases to extract information including demographics, medical comorbidities, clinical presentation, and illness course after COVID-19 diagnosis. Results: We describe a cohort of 36 PLWH with confirmed COVID-19 and another 11 patients with probable COVID-19. Almost 85% of PLWH with confirmed COVID-19 had a comorbidity associated with severe disease, including obesity, cardiovascular disease, or hypertension. Approximately 77% of PLWH with COVID-19 were non-Hispanic Black or Latinx whereas only 40% of the PLWH in our clinic were Black or Latinx. Nearly half of PLWH with COVID-19 had exposure to congregate settings. In addition to people with confirmed COVID-19, we identified another 11 individuals with probable COVID-19, almost all of whom had negative PCR testing. Conclusion: In the largest cohort to date of PLWH and confirmed COVID-19, almost all had a comorbidity associated with severe disease, highlighting the importance of non-HIV risk factors in this population. The racial disparities and frequent link to congregate settings in PLWH and COVID-19 need to be explored urgently.

Mucormycosis involves life-threatening rapidly progressive angioinvasion with infiltration across tissue planes, resulting in necrosis and thrombosis, most commonly seen in the setting of immunocompromised states. We describe two cases of isolated cerebral mucormycosis in immunocompetent adults and then describe this syndrome in detail in the context of systemic literature review. Using the criteria: 1) isolated cerebral disease; 2) mucormycosis (by PCR, culture or pathology); and 3) affected an immunocompetent individual, we identified 53 additional cases from 1969 to 2020. Of these 55 cases, approximately 60% occurred in men, >70% were in patients under age 35, 92% were associated with intravenous drug use, and >85% had infection centered in the basal ganglia. Many presented with cranial nerve deficits, headache, focal weakness, or altered mental status. No patient survived without amphotericin and steroid administration was associated with worse outcomes. Given the current opioid crisis, this syndrome may be seen more frequently.

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Objective: Mounting evidence reveals that health care disparities stem from a combined effect of structural bias within our health system and the unconscious bias of well-intentioned health care professionals. The authors designed and evaluated a novel educational intervention to introduce the concept of unconscious bias to front-line providers. Methods: The authors designed and implemented an educational curricula for providers from three different programs at a single large, urban, tertiary-care academic institution. The intervention consisted of participants taking the implicit attitudes test (IAT), which was followed by a facilitated discussion. The discussion was audio recorded, transcribed, and coded for emerging themes. An online survey assessed participant awareness of these topics before and after the intervention and was analyzed using paired t-tests. Results: The authors analyzed the results by focus group. There were 19 participants in Focus Group 1 (FG1), 6 in Focus Group 2 (FG2), and 42 in Focus Group 3 (FG3). The majority of participants were white, between the ages of 26 to 35 and female. When analyzed in aggregate, authors found a statistically significant improvement in selfreported domains on whether the intervention changed participant understanding of healthcare disparities and implicit bias. While the authors' qualitative results indicated varying acceptance of the implicit attitude test, most participants acknowledged that implicit bias exists. Conclusion: Our educational intervention was successful at engaging front-line clinicians on the role of implicit bias on the development of health care disparities. However, prior to scaling our intervention to other institutions, many improvements should be considered including session structure, choice of facilitator and introduction of strategies to mitigate biases in clinical practice.