{
  "abstract": "Background Chemsex is increasingly reported among gay, bisexual and other men who have sex with men and is associated with higher exposure to sexually transmitted infections (STIs), mental health conditions and risk of disengagement from care. In Italy, collaboration between HIV clinics, addiction services and community-based organizations is not yet standardized. We present a case from a community-based chemsex support programme, highlighting the impact of a structured multidisciplinary intervention.Case presentation A 44-year-old European gay man was diagnosed with acute HIV infection in 2014 (CD4 580 cells/mm 3; HIV-RNA 1,772,994 copies/mL). He promptly started antiretroviral therapy (ART) with EVG/COBI/FTC/TDF, later switched to BIC/FTC/TAF, and has maintained virological suppression since January 2015.He reported an 8-year history of chemsex, mainly involving smoked cocaine (freebase), multiple admissions for addiction treatment and several STI diagnoses (syphilis, gonorrhoea, chlamydia). After moving to Italy, he was referred in January 2025 to our community-based chemsex support programme by his HIV doctor. During our initial assessment, use of methylenedioxypyrovalerone (MDPV) emerged. At first contact, he described himself as ‘a lost cause’.A structured multidisciplinary intervention was activated, involving: (1) individual and group psychotherapy within our programme; (2) referral to a specialized addiction service with expertise on chemsex support, including psychiatric evaluation and follow-up; (3) coordination with the HIV clinic to monitor adherence, viro-immunological parameters and sexual health.In February 2026, with sustained undetectable viral load (<50 copies/mL) and CD4 1070 cells/mm3, ART was switched to long-acting CAB/RPV. At that time, he had discontinued MDPV use for three months.Discussion Despite long-term virological suppression, chemsex represented a significant risk for poor ART adherence. The structured multidisciplinary network ensured retention in care, supported outpatient addiction treatment and allowed therapeutic optimization, including transition to long-acting CAB/RPV. In this context, long acting ART can support adherence and prevent treatment failure. In addiction settings, joint care within a coordinated network also provides psychological containment, reduces isolation and reinforces the experience of being seen and supported.Conclusions This case underscores the pivotal role of community-based chemsex services within integrated care pathways for people living with HIV. Close collaboration between community organizations, addiction services and HIV clinics may support adherence and create an appropriate context for addiction care.",
  "authors": [
    {
      "affiliations": [
        "ASA ODV, Milano, Italy"
      ],
      "name": "A Bianchi"
    },
    {
      "affiliations": [
        "ASA ODV, Milano, Italy"
      ],
      "name": "PL Vinti"
    },
    {
      "affiliations": [
        "San Raffaele Hospital, Milano, Italy"
      ],
      "name": "S Nozza"
    },
    {
      "affiliations": [
        "SerD Canzio, Fatebenefratelli Sacco, Milano, Italy"
      ],
      "name": "ME Traina"
    },
    {
      "affiliations": [
        "SerD Canzio, Fatebenefratelli Sacco, Milano, Italy"
      ],
      "name": "MM Beltrami"
    },
    {
      "affiliations": [
        "ASA ODV, Milano, Italy"
      ],
      "name": "G Fracca"
    },
    {
      "affiliations": [
        "ASA ODV, Milano, Italy",
        "San Raffaele Hospital, Milano, Italy"
      ],
      "name": "M Cernuschi"
    }
  ],
  "title": "CC5 Integrated multidisciplinary management of chemsex and HIV: a case report",
  "uid": "2581a1c1-da98-5c12-9763-6f40b95a3bec"
}