key: cord-304816-7gg6pxnt
authors: Li, Wei; Ma, Qiang; Wang, Xiao; Tang, Min; Lin, Jie; Xiao, Bin
title: Letter to the Editor: The characteristics of two patients co‐infected with SARS‐CoV‐2 and HIV in Wuhan, China
date: 2020-06-10
journal: J Med Virol
DOI: 10.1002/jmv.26155
sha: 
doc_id: 304816
cord_uid: 7gg6pxnt

We reported two cases of COVID‐19 patients co‐infected with HIV. The SARS‐CoV‐2 nucleic acid test of patients turned negative while the clinical symptoms persisted, and interstitial pneumonia gradually deteriorated. The cases provided evidences to clinicians for the diagnosis and treatment of COVID‐19 patients co‐infected with HIV. This article is protected by copyright. All rights reserved.

The outbreak of coronavirus disease 2019 in early December 2019 has rapidly spread to all over the world. As announced by World Health Organization (https://www.who.int), there were approximately 4,628,900 people infected with severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), which has killed more than 312,000 people worldwide until May 18, 2020.

However, clinical manifestations vary widely from patient to patient [1] .

The adaptive immune response plays a key role in all viral infections, during which T cells mediated cell immunity and B lymphocytes mediated humoral immunity. As is known to all, the human immunodeficiency virus (HIV) targets the immune system and mainly destroys CD4 + T lymphocytes. Recently, COVID-19 patients co-infected with HIV have attracted the interests of some researchers. A 61-year-old male patient co-infected with COVID-19 and HIV was in stable condition and discharged after 20 days of treatment [2] . Another study concluded that SARS-CoV-2/HIV co-infected patients having a more favorable prognosis when already under antiretroviral therapy [3] . In contrast, a study from New York revealed that the mortality of COVID-19 patients with HIV infection reached up to 78% [4] . Given that, the outcome of SARS-CoV-2/HIV co-infected patients seems controversial, and how to uncover the underlying HIV infected in COVID-19 patients remains to be elucidated.

In the present study, we reported two young male COVID-19 patients co-infected with HIV and analyzed the clinical and laboratory features of them. It will provide clues for the diagnosis and treatment of COVID-19 patients co-infected with HIV. 

(Supplemental Figure 1A) . The laboratory test results showed that the protein synthesis by hepatocytes like TP or ALB were decreased and the hepatocellular enzymes ALT or AST were significantly increased, the absolute count of lymphocytes was lower than the normal reference value. However, the infection had a limited effect on heart function ( Figure 1A ) or renal function (Supplemental Figure 1B) . The detailed characteristics of case 1 were shown in Supplemental Table 1 . Moreover, CT scan images of the lung showed that the high-density area was gradually increased from February 2 to February 20 ( Figure 1B) . The patient had an intermittent fever and chest pain, and the highest body temperature was 39.4℃. Most importantly, the patient presented fluctuating dyspnea symptoms for a long time. The number of lymphocytes also fluctuated from normal to far below the reference value, and the lowest lymphocyte count was 0.56×10 9 /L. The clinicians evaluated the symptoms and examinations comprehensively and speculated that the patients might suffer from immunodeficiency diseases. Then HIV detection results showed that the patient was HIV positive. At last, the patient was transferred to a special hospital for infectious diseases and received further therapy. that the myocardial enzymes such as LDH, HBDH, CK, and CK-MB were gradually increased, the liver function index TP or ALB was decreased and ALT or AST was increased, the absolute count of lymphocytes was lower than the normal reference value ( Figure 1C ). The level of IL-6 was significantly increased (Supplemental Figure 1D) , while the effect of infection on renal function was limited (Supplemental Figure 1E) . The detailed characteristics of case 2 were This article is protected by copyright. All rights reserved.

shown in Supplemental Table 1 . Moreover, the CT scan of the lung showed that the high density area was gradually increased since from March 2 to March 15 ( Figure 1D) . The patient had an intermittent fever and cough, and the highest body temperature was 40.2℃. Most importantly, the symptom of dyspnea had gradually worsened. To validate whether the patient simultaneously suffered from immune deficiency diseases, HIV detection tests were performed. The results showed that the patient was co-infected with HIV. At last, the patient was transferred to a special hospital for infectious diseases and received further therapy.

We reported two cases of COVID-19 patients co-infected with HIV. Although there is a lack of epidemiological investigation on whether HIV patients are susceptible to COVID-19, the above cases presented the following distinctive clinical course and manifestations. Firstly, the symptom of dyspnea persisted, and the exudative inflammation of lung was gradually increased, though the test of SARS-CoV-2 nucleic acid and specific IgM or IgG rapidly turned negative after receiving standard combination therapy. Secondly, previous studies showed that the median hospital time of COVID-19 patients was 12.32 or 14.8 days [5, 6] , however, these two young patients had a longer course of the disease and more severe symptoms. Thirdly, the laboratory test showed that the liver function of Case 1 and heart function of Case 2 was obviously damaged. It has been reported that SARS-CoV-2 not only caused lung dysfunction, but also liver, heart, and This article is protected by copyright. All rights reserved.

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We thank for the work and contribution of all the health providers from Huoshenshan Hospital.

We declare no competing interests.

Accepted Article Accepted Article