Resilience and frailty in people living with HIV during the lockdown experience in Italy in March-May 2020: are they two complementary constructs?

Background: The construct of resilience is defined as an individual's "positive adaptation within the context of significant adversity" Therefore, we tried to assess the impact of the lockdown experience in Italy caused by the first COVID-19 epidemic wave in March-May 2020 in PLWH through a validated resilience score in relation to frailty Methods: In May 2020, all PLWH attending Modena HIV Metabolic Clinic at least once from 1 January 2019 were offered to complete an electronic questionnaire including health-related questions and the resilience score questionnaire (CD-RISC-10, short version [1]) A subset of these patients had a frailty evaluation within the previous year, assessed using 1) a 72-item Frailty Index (FI) that evaluated multiple health domains, 2) a 10-item HIV Index (HIVI) scoring the most significant HIV variables and 3) a 10-item Protective Index (PI) including socio-behavioural domains [2] Results: Out of 1100 PLWH reached via mail, 506 (50%) completed the questionnaire Median age was 54 (IQR 49 to 59), HIV duration >20 years was present in 63% According to our cross-sectional survey, only 9% of PLWH worsened the general health status The same proportion reported difficulties in reaching physicians and having access to HIV drugs PLWH resilient to the lockdown event were 329 (73 13%) In a multivariable logistic regression these individuals were more likely to be in the age category > 60 (OR 0 43, 95% CI 0 22 to 0 85) and having a partner (OR 2 25, 95% CI 1 48 to 3 42), after correction for gender, working status and HIV variables In the subset of 235 of PLWH who were assessed for frailty, CD-RISC-10 median score was-0 87 (±3 14) in frail and 0 08 (±2 29) in non-frail individuals (p = 0 02) In logistic regression analysis, resilience was not associated with FI, HIVI and PI Conclusions: Intervention to relieve social isolation and loneliness in PLWH are urgently needed to cope with the challenge of COVID-19 crisis Resilience and frailty constructs may represent two complementary constructs of vulnerability in PLWH and they should be addressed simultaneously