Background

The COVID 19 has been a severe pandemic all around the world. Nowadays the patient with co infection of HIV with SARS CoV 2 was rarely reported. Here we report a special case  of HIV and SARS CoV 2 co infection which was accidentally diagnosed and had a very  fast deterioration in her clinical condition. COVID 19 is a novel corona virus disease with over 3,72,32,322 confirmed cases worldwide.¹The knowledge regarding epidemiology and clinical presentation have been evolving gradually in the past months since the initial identification. In the general population, the reported case fatality rate is 3.4 % in different countries.²The concern over the increasing risk of severe COVID-19 disease with patients diagnosed with HIV may be based on the assumption that PLHIV are more likely to be immunosuppressed. HIV infection is associated with abnormal humoral and T-cell–mediated immune responses, resulting in increased susceptibility to numerous opportunistic infections.³Here we are reporting a case of HIV and SARS CoV 2 co infection who presented with a mild dyspnea and fever and later progressed to fast deterioration .Given the urgency of the COVID-19 pandemic and the rapidly changing information about the disease, a high degree of vigilance is needed on the course of infection among PLHIV. As there are 37.9 million PLHIV and 1.7 million new infections each year⁴, patients of COVID-19-HIV co-infection are likely to increase with varied level of clinical presentation and severity.

1. WHO Coronavirus disease situation reports. 2020. https ://www.who.int/.
2. Ciotti MA, Minieri S, Giovannetti M, Benvenuto M, Pascarella DS, Sagnelli C, Bianchi M, Bernardini S, Ciccozzi M. COVID-19 outbreak: an overview. Chemotherapy. 2020;64:1–9
3. Chang CC, Crane M, Zhou J, Mina M, Post JJ, Cameron BA, Lloyd AR, Jaworowski A, French MA, Lewin SR. HIV and co‐infections. Immunological reviews. 2013 Jul;254(1):114-42.
4. Mahy M, Marsh K, Sabin K, Wanyeki I, Daher J, Ghys PD. HIV estimates through 2018: data for decision-making. AIDS (London, England). 2019 Dec 15;33(Suppl 3):S203.
5. Mao ZQ, Wan R, He LY, Hu YC, Chen W. The enlightenment from two cases of asymptomatic infection with SARS-CoV-2: is it safe after 14 days of isolation? Int J Infect Dis. 2020;95:174–5.
6. Cavalcanti AB etal.,2020. Hydroxychloroquinew with or without azithromycin in mild-to-moderate COVID-19. N Engl J Med.
7. Xu K, Chen Y, Yuan J, Yi P, Ding C, Wu W, et al. Factors associated with prolonged viral RNA shedding in patients with COVID-19. Clin Infect Dis. 2020. https ://doi.org/10.1093/cid/ciaa3 51.
8. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin InfectDis.2020. https://doi.org/10.1093/cid/ciaa2 48
9. Mahnke YD, Fletez-Brant K, Sereti I, Roederer M. Reconstitution of peripheral T cells by tissue-derived CCR4 + central memory cells following HIV-1 antiretroviral therapy. Pathog Immun. 2016;1(2):260–90.
10. Harter G et al., 2020. COVID-19 in people living with human immunodeficiency virus: a case series of 33 patients. Infection 1–6.
11. Guo W, Fangzhao M, Dong Y, Zhang Q, Zhang X, Mo P, Feng Y, Liang K, 2020. A survey for COVID-19 among HIV/AIDS patients in two districts of Wuhan, China. SSRN.
12. Vizcarra P, Perez-Elias MJ, Quereda C, Moreno A, Vivancos MJ, Dronda F, Casado JL, Team C-I, 2020. Description of COVID-19 in HIV-infected individuals: a single-centre, prospective cohort. Lancet HIV 7: e554–e564.
13. Xu Z, Zhang C, Wang FS, 2020. COVID-19 in people with HIV. Lancet HIV 7: e524–e526.
14. Gervasoni C, Meraviglia P, Riva A, Giacomelli A, Oreni L, Minisci D, Atzori C, Ridolfo A, Cattaneo D, 2020. Clinical features and outcomes of HIV patients with coronavirus disease 2019. Clin Infect Dis ciaa579.
15. Del Amo J, Polo R, Moreno S, Diaz A, Martinez E, Arribas JR, Jarrin I, Hernan MA, 2020. Incidence and severity of COVID-19 in HIV-positive persons receiving antiretroviral therapy: a cohort study. Ann Intern Med 173: 1–8.
16. Blanco JL, Ambrosioni J, Garcia F et al. COVID-19 in patients with HIV: clinical case series. The Lancet HIV 2020;7: e314–e316.
17. Karmen-Tuohy S, Carlucci PM, Zacharioudakis IM et al. Outcomes among HIV-positive patients hospitalized with COVID-19. Med Rxiv. Available at https://www.medrxiv.org/content/10.1101/2020.05.07.20094797v1 (accessed 18 May 2020).
18. Cill_oniz C, Garc_ıa-Vidal C, Moreno A, Miro JM, Torres A. Community-acquired bacterial pneumonia in adult HIV infected patients. Expert Rev Anti Infect Ther 2018; 16: 579–88.
19. Feikin DR, Feldman C, Schuchat A, Janoff EN. Global strategies to prevent bacterial pneumonia in adults with HIV disease. Lancet Infect Dis 2004; 4: 445–455.
20. Søgaard OS, Reekie J, Ristola M et al. Severe bacterial non aids infections in HIV-positive persons: incidence rates and risk factors. J Infect 2013; 66: 439–446.
21. Kohli R, Lo Y, Homel P et al. Bacterial pneumonia, HIV therapy, and disease progression among HIV-infected women in the HIV epidemiologic research (HER) study. Clin Infect Dis 2006; 43: 90–98.
22. Croxford S, Kitching A, Desai S et al. Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared with the general population: an analysis of a national observational cohort. Lancet Public Health 2017; 2: e35–e46.

Dr Anil Kumar

DNB, IDCCM, IFCCM, MNAMS, Senior Consultant and Head, Department of Critical Care Medicine, Santosh Medical College & Hospitals.GZB UP