Two Serial Case of Coronavirus Disease-19 Patients Coinfected with HIV: Comparison of Pre-anti-Retroviral (art) and on Art Patient

Abstract

BACKGROUND: Today, coronavirus disease (COVID)-19 has become a worldwide pandemic. People living with HIV are one of the special populations who are susceptible to COVID-19 infection and suspected of having a poor prognosis.
 CASE REPORT: We reported two serial cases of COVID-19 with HIV coinfection. First case was a COVID-19 patient coinfected with HIV who had received anti-retroviral therapy (ARV) and had an absolute CD4 cell count of 781 cells/uL. Patient was found with mild symptoms of COVID-19 and had normal laboratory results and chest X-ray. Patient was declared cured after 26 days of treatment in isolation room with complete clinical improvement since day 5 of isolation. Second case was a COVID-19 with HIV coinfection that had not yet received ARV therapy and had absolute CD4 cell count of 155 Cell/uL. Patient came with moderate clinical symptom of COVID-19 and experienced secondary bacterial and tuberculosis infection. Patient was declared cured of COVID-19 on the 8th day of treatment with clinical improvement but still needed further treatment in a non-isolation room.
 CONCLUSION: Clinical characteristics of COVID-19 in HIV and non-HIV patients are the same. A history of ARV therapy and CD4 count did not affect the length of isolation until a negative result on two reverse-transcription-polymerase chain reactions, but could affect prognosis and clinical severity due to the high risk of secondary infection in HIV-positive patients without ARV or HIV/AIDS who had a CD4 count ≤200 cell/uL.

Critical Degree of COVID-19 Pneumonia in A Man with HIV

“…The use of antibiotics in outpatients is as much as 25%, while in patients admitted to the hospital it increases to 90%. For patients admitted to the ICU, antibiotics were administered to all patients (Widiasari et al, 2020). Similar use of antibiotics was also found in another study by Miranda et al, This was associated with severe clinical manifestations in patients as well as laboratory markers indicating ongoing active inflammation (Widiasari et al, 2020).…”

“…The second patient's laboratory examination showed an increased percentage of neutrophils, lymphopenia, and thrombocytopenia accompanied by a reticular pattern on the chest radiograph. The second patient also had chronic symptoms such as weight loss associated with tuberculous lymphadenitis in addition to signs of acute infection caused by bacteria or opportunistic infections (Widiasari et al, 2020). In a study by Huang et al in the COVID-19 population, only four patients (10%) had secondary infections and required intensive care.…”

“…Other immune deficiency conditions such as people with HIV/AIDS (PLWHA) are also considered to have a higher risk of being infected with COVID-19 with a worse prognosis (C. WHO, nd;Widiasari et al, 2020). Research related to COVID-19 infection in HIV/AIDS patients still yields different results in terms of susceptibility to infection, clinical characteristics, severity of symptoms, and prognosis (Widiasari et al, 2020). In this case report, a man with HIV/AIDS suffers from COVID-19.…”

“…Treatment recommendations for COVID-19 patients with HIV co-infection are similar to those for COVID-19 without HIV infection. The high risk of secondary infection in HIV/AIDS patients makes optimization of secondary infection therapy very important (Widiasari et al, 2020). Giving systemic steroids to COVID-19 patients with HIV infection is still recommended, especially in patients with clinically severe COVID-19 or with secondary infection in severe forms of PCP, although systemic steroid administration in a study conducted by and Wang 2020 said it could slow down virus clearance and extend the virus shedding period .…”