HIV and COVID-19 co-infection : mild infection or prolonged transmission

Abstract

BACKGROUND. Comorbid conditions may be associated with severe COVID-19. However, there is no evidence to suggest that people living with HIV have a higher risk of contracting SARS-CoV-2 or, if infected, have more severe disease. OBJECTIVE. To describe three patients with HIV and COVID-19 co-infection. METHOD. The study was conducted in a private hospital in Gauteng Province, South Africa. All three patients were known to have HIV disease and were treated with chronic antiretroviral medication. All patients admitted to the unit were screened for chronic conditions such as HIV, tuberculosis, diabetes and hypertension. They were admitted to the hospital after being diagnosed with COVID-19, this being confirmed by positive reverse transcription polymerase chain reaction (RT-PCR) tests. RESULTS. The combination of HIV and SARS-CoV-2 (HIVCO) with comorbidities in case 1 (dialysis-dependent end-stage renal failure and hypertension) resulted in severe illness, a long hospital stay and protracted viral shedding. The protracted shedding pattern (>60 days) was confirmed by multiple positive RT-PCR tests and positive viral cultures obtained after 60 days. Despite comorbidities, case 2 (Takayasu’s disease in remission, dyslipidaemia and previous deep vein thrombosis) and case 3 (hypertension and diabetes) presented with mild illness. The mild clinical course and negative RT-PCR tests in cases 2 and 3 indicated resolution of infection. CONCLUSION. Patients with HIVCO and comorbidities may present with mild or severe illness. Unusually long SARS-CoV-2 shedding is a risk for disease transmission, and its association with HIV, other immunocompromised conditions and comorbidities is unclear. We describe a shedding classification that may assist in identifying and managing infectious subsets of patients. Multiple SARS-CoV-2 tests and viral cultures may be necessary to confirm protracted shedding.