TreatmentUpdate
236

May 2020 

HIV and COVID-19

COVID-19 has the remarkable ability to cause serious disease in some people with underlying conditions. HIV infection weakens the immune system and causes chronic inflammation and immune activation. Even with HIV treatment and subsequent virological suppression, the level of immune activation and inflammation does not return to the levels seen in healthy, HIV-negative people. Furthermore, many HIV-positive people have high rates of co-morbidities—particularly issues such as higher-than-normal blood pressure, cardiovascular disease, type 2 diabetes, kidney injury and so on. In theory, all of these issues might make HIV-positive people more susceptible to SARS-CoV-2 infection and severe COVID-19. Yet to date there have not been reports of large numbers of HIV-positive people developing severe symptoms of COVID-19 in Canada, the U.S., East Asia or European Union.

Doctors at Tongji Hospital in Wuhan, China, reported case details of a man who was diagnosed with both SARS-CoV-2 and HIV infection. He has recovered from COVID-19.

Case details

In late January 2020, a 61-year-old man went to a fever clinic. Such clinics had been established in Wuhan to screen people for SARS-CoV-2 infection. At the clinic the man reported that he had experienced dry cough and fever for the past two days. The man disclosed that he smoked between 20 and 30 cigarettes daily and that he had type 2 diabetes. This latter condition was being managed with the drugs metformin and alogliptin.

At the clinic, doctors performed assessments and found the following:

  • a mild fever
  • CT scans of his lungs suggested pneumonia
  • blood tests revealed modestly decreased levels of lymphocytes

Doctors sent him home with instructions to isolate himself from other family members.

Due to a shortage of tests at the time, it was two weeks before nasal swabs taken at his clinic visit could be tested and revealed that he was infected with SARS-CoV-2.

During this interval, the man developed shortness of breath. Subsequently, another CT scan suggested worsening pneumonia. He was then referred to Tongji Hospital, an institution that treated people with COVID-19.

On admission to the hospital, the man’s body temperature had risen to 39°C and the amount of oxygen in his blood was less than normal. Doctors provided him with supplementary oxygen via a mask. While this intervention raised the amount of oxygen in his blood, it still remained below normal.

The total number of lymphocytes in the man’s blood continued to decrease and the proportion of lymphocytes that were CD4+ cells was extremely low (4.75%). The doctors did not publish CD4+ or CD8+ cell counts.

For reasons that are not clear, the doctors tested the man for HIV infection and the tests confirmed chronic HIV infection.

Since SARS-CoV-2 infection was life threatening, doctors focused on treating that virus. They prescribed Kaletra (lopinavir-ritonavir) for 12 consecutive days in the hope that it would work against the coronavirus. Kaletra is approved in many countries as a treatment for HIV. At the time, Chinese guidelines suggested that doctors could use Kaletra as a potential treatment for coronavirus infection and Kaletra was widely used in China during the initial stages of the COVID-19 pandemic. No additional anti-HIV drugs were prescribed. In addition, the man was given the following:

  • the antibiotic moxifloxacin, 400 mg once daily
  • an intravenous infusion of broad-spectrum antibodies (gamma globulin)
  • an intravenous infusion of the steroid methylprednisolone, 0.8 mg/kg of body weight once daily for three consecutive days

On the 5th day of hospitalization, doctors reported that the man showed “a remarkable clinical improvement.” Another CT scan of his chest showed a decrease in lung inflammation and pneumonia. The level of oxygen in his blood approached normal.

On the 9th day of hospitalization, swabs from the man’s nose and throat tested negative for COVID-19.

On the 11th day of hospitalization, the man was sent home with instructions to stay home for two consecutive weeks as a precaution against infecting others with SARS-CoV-2. He was also referred to a clinic for HIV treatment.

This is only one case, so no firm conclusions can be drawn about co-infection with HIV and SARS-CoV-2 or its treatment.

Resources

Coronavirus disease (COVID-19), HIV and hepatitis C: What you need to know — CATIE News

Kaletra disappointing in people severely ill with COVID-19 — CATIE News

Case series of HIV and COVID-19 in Spain — CATIE News

—Sean R. Hosein

REFERENCE:

Zhu F, Cao Y, Xu S, Zhou M. Co-infection of SARS-CoV-2 and HIV in a patient in Wuhan city, China. Journal of Medical Virology. 2020; in press.