key: cord-312513-mad9xkz8
authors: Iordanou, Stelios; Koukios, Dimitris; Matsentidou, Chrystalla‐Timiliotou; Markoulaki, Despina; Raftopoulos, Vasilios
title: Severe SARS‐CoV‐2 pneumonia in a 58‐year‐old patient with HIV: a clinical case report from the Republic of Cyprus
date: 2020-05-25
journal: J Med Virol
DOI: 10.1002/jmv.26053
sha: 
doc_id: 312513
cord_uid: mad9xkz8

HIV and severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) co‐infection is a major challenge for the clinicians as it urged the importance of developing an optimal pharmaceutical scheme and patient's management. The reports that have been recently published regarding the course of SARS‐CoV‐2 in patients with HIV are sparse. In this brief report we describe, our first single‐centre experience from a 58‐year‐old Caucasian male patient with HIV who developed a severe SARS‐CoV‐2 infection, including clinical characteristics, treatment, and outcomes. This article is protected by copyright. All rights reserved.

minute. The patient was awake, alert, and fully oriented.

The patient's medical history is notable for HIV infection since 1995, followed in an outpatient HIV clinic. His most recent (August 2019) CD4 cell count was 1,640 per μL, and viral load was undetectable under Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide Fumarate. He had no comorbidities.

The results of laboratory tests upon admission were unremarkable except for a mildly elevated CRP (52mg per litter). Specimens were collected in accordance with ECDC guidance 5 and included nasopharyngeal and oropharyngeal swab specimens for influenza A and B and SARS-CoV-2 (Table 1 ). Chest radiography was performed, which showed bilateral air space pacifications ( Figure 1 ).

The patient was started on levofloxacin (750mg once daily) and oseltamivir (standard dose, 75mg twice a day), pending results from PCR analyses. The first (hospital day 1) and a repeat (hospital day 3) upper respiratory specimen tested with reverse transcriptase real-time PCR (RT-PCR) for SARS-CoV-2 returned a negative result. COVID-19 was finally confirmed from a third nasopharyngeal/oropharyngeal sample on hospital day 6. Azithromycin (500 mg once daily) and Chloroquine (500mg twice a day) was administered (Table 1 ). Influenza came out negative, and

Oseltamivir was subsequently stopped.

The patient progressively developed severe acute respiratory distress syndrome (ARDS) (Figure 1 ) with a PO2/FiO2 ratio of 55mmHg on hospital day 7; he was electively intubated and admitted to the ICU (Table 1) . Given the changing clinical presentation and concern about hospital-acquired pneumonia, piperacillin-tazobactam (4.5gr four times a day), and vancomycin (1750mg loading dose followed by 1000mg three times a day) were initiated. Nasal PCR testing for methicillin-resistant Staphylococcus aureus was negative, as were all other obtained cultures. Serial procalcitonin was tested negative. Due to persistent fever, the antimicrobial treatment Accepted Article sedation and mechanical ventilation, the patient regained consciousness relatively quickly and remained oriented and cooperative during the entire stay. He was weaned off the ventilator on hospital day 29, and decannulation was performed on hospital day 31. The patient was discharged from the ICU the following day and transferred to a clinic for rehabilitation. So far, he makes a quick and uneventful recovery.

Standard antimicrobial treatment was used in combination with Chloroquine and azithromycin, based on studies that showed promising results. 10 The patient remained on his previous ART (on tenofovir-containing regimen), 3, 4 given his excellent virologic and immunologic condition. Remdesivir, Lopinavir/Ritonavir, Tocilizumab, and corticosteroids were not used due to inconclusive data about their efficacy and safety. 11 COVID-19 characteristics such as serial false-negative upper respiratory specimens, deterioration between days 7 and 10, near-normal lung compliance, hyperventilation, prolonged need for mechanical ventilation, and increased risk for thrombotic complications, were observed in our patient, in line with findings from other case studies. The absence of comorbidities, the virologic and immunologic condition, as well as the use of standard antimicrobial treatment in combination with chloroquine and azithromycin and the maintenance of previous ART instead of adaptation ART seem to have an impact on patient's recovery despite his age. The early initiation of antimicrobial treatment may be translated into a lower risk for opportunistic infections.

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