key: cord-253426-s57wuzyg authors: Benkovic, Scott; Kim, Michelle; Sin, Eric title: 4 Cases: HIV and SARS‐CoV‐2 Co‐infection in patients from Long Island, New York date: 2020-05-19 journal: J Med Virol DOI: 10.1002/jmv.26029 sha: doc_id: 253426 cord_uid: s57wuzyg Originating from Wuhan, China, the novel coronavirus 2019 (SARS‐CoV‐2) has been spreading worldwide since the end of 2019. The most common features of these patients include fever, cough, myalgia or fatigue [1]. As of April 16, 2020 the CDC has reported 605,390 cases and 24,582 deaths in the United States. The illness continues to spread through the world infecting people with various different comorbid conditions. Presented here are four cases which represent some of the first cases of HIV and SARS‐CoV‐2 coinfection in Long Island, New York. These HIV infected patients were compliant with their HIV medication regimen and had robust CD4 T cell counts. The clinical severity ranged from mild to requiring hospitalization. Three of the four patients had fever and two had cough. One patient presented with diarrhea, the incidence rate of diarrhea in SARS‐CoV‐2 infection range from 2% to 50% of cases [4]. One patient had anosmia and aguesia, in a study by Moein et al, the 98% of SARS‐CoV‐2 infected patient experienced some smell dysfunction [5]. One patient required hospitalization however this patient was also infected with influenza A. These cases suggest that uncomplicated cases of SARS‐CoV‐2 in an HIV infected patient can be managed with self‐isolation at home. This article is protected by copyright. All rights reserved. Originating from Wuhan, China, the novel coronavirus 2019 (SARS-CoV-2) has been spreading worldwide since the end of 2019 1 . There has been a reported case of human immunodeficiency virus (HIV) and SARS-CoV-2 coinfection in a man in Wuhan, China 2 , but as of today there have been few reports of coinfection. This letter to the editor seeks to contribute four more cases to the literature. Presented here are four cases of coinfection of HIV and SARS-CoV-2 from Long Island, New York. Their main characteristics are summarized in Table I . A 56-years-old male started to feel fatigued as well as noted a decreased in his sense of taste and smell three days after returning to New York from a trip to Florida. At his local community physician he was given empiric antibiotics for a presumed sinus infection. Although he did not develop fever or respiratory symptoms he became concerned when his symptoms did not resolve after nine days and he went to an urgent care clinic. Due to concerns for chemosensory dysfunction in SARS-CoV-2 infected patients 3 real-time reverse-transcriptase polymerase chain reaction (PT PCR) for the virus was done. SARS-CoV-2 RT PCR resulted positive three days later. Two days after his positive test his symptoms of anosmia and ageusia resolved. This man was diagnosed with HIV in 1995 with a recent CD4 T cell count of 1206 cells/uL and HIV-consisted of emtricitabine, tenofovir alafenamide, dolutegravir and maraviroc. His only other comorbid condition is hyperlipidemia. A 56-years-old male who started to developed subjective fevers and fatigue. 19 days after the initial onset of fatigue he developed a temperature of 102F (38.9C) when he went to urgent care. He had no shortness of breath or cough. His chest x ray was suggestive of pneumonia at which point he was given empiric antibiotics. SARS-CoV-2 RT PCR resulted positive 2 days later. Three days after the positive test result he was asymptomatic. This man was diagnosed with HIV in 1988 with a recent CD4 T cell count of 794 cells/uL and a HIV-1 viral load that was undetectable. His HIV regimen consisted of emtricitabine, tenofovir alafenamide, etravirine and abacavir. His only other comorbid condition consisted of hypertension controlled with Lisinopril 10mg daily. A 62-years-old male who had 2 week of non-productive cough and watery bowel movements. He decided to seek medical attention when he developed a temperature of 100.8F (38.2C). At his local emergency room his temperature was 100, blood pressure was 113/65, heart rate was 75, breathing was non-labored and his oxygen saturation was 97% on room air. White blood cell count was 5200 cell/mL, blood urea nitrogen was 19mL/dL, and creatinine was 1.06 mg/dL. Chest X-ray did not show any consolidation. He was discharged home with instructions to self-isolate. After discharge his SARS-CoV-2 RT PCR resulted positive. One week after discharge he no longer has any symptoms. This man was diagnosed with HIV in 1996 with a recent CD4 T cell count 1412 cells/uL and a HIV-1 viral load that was undetectable. His HIV regimen consisted of emtricitabine, tenofovir alafenamide and dolutegravir. His comorbid condition consist of treated hepatitis C, hyperlipidemia on rosvustatin and hypertension on losartan. A 65-years old man presented to urgent care with cough and subjective fever. He was empirically started on oseltamivir 75mg twice a day for 5 days. Two days later a test done for influenza A returned positive (Influenza A and B RNA, qualitative Real-time PCR, Quest diagnostics). One week after the onset of symptoms, he had completed his course of oseltamivir, however his symptoms did not improve. He went to the emergency room, temperature was 102.9F (39.4C), pulse 83, oxygen saturation 93% on 2 liters nasal cannula, blood pressure was 136/71. He was Table Table I Clinical characteristics and outcome of 4 HIV and COVID-19 coinfection Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China Co-infection of SARS-CoV-2 and HIV in a patient in Wuhan city Association of chemosensory dysfunction and Covid-19 in patients presenting with influenza-like symptoms Diarrhea during COVID-19 infection: pathogenesis, epidemiology, prevention and management Smell dysfunction: a biomarker for COVID-19. Int Forum Allergy Rhinol A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19 CD4 T cell count measured in cells/uL; tenofovir AF, tenofovir alafenamide, HLD, Hyperlipidemia; HTN, Hypertension, T2DM, Type II diabetes mellitus