key: cord-0710275-ifb3qiz7
authors: Zhang, Rong; Chen, Xiaohua; Huang, Yuqing; Zhang, Qi; Cheng, Yan; Zhang, Nan; Zhang, Haibo; Yang, Bo; Liu, Fang; Liu, Yingle; Lan, Ke
title: A Study of Two Cases Co-Infected with SARS-CoV-2 and Human Immunodeficiency Virus
date: 2020-09-07
journal: Virol Sin
DOI: 10.1007/s12250-020-00280-9
sha: d95e53d432d40554335756febb4fb1ea36174715
doc_id: 710275
cord_uid: ifb3qiz7

nan

Patient 2, male, 37 years old, unmarried, lived in Wuchang District, Wuhan City before onset of the disease, developed fever without any cause in early January, when chest pain was intermittent. CT scan results in early February indicated lesions in bilateral lungs (Supplementary Table S1 ), but the result of the SARS-CoV-2 nucleic acid test was negative. Patient 2 was severely ill and admitted on February 11, with significant wheezing symptoms. Low-dose hormonal anti-inflammatory therapy began on February 14 and continued until patient 2 became relieved on February 18. Patient 2 was also treated with antiviral, anti-infective, and other symptomatic treatments. However, the patient's condition deteriorated again on February 20, and the nucleic acid test results were single positive for COVID-19 SARS-CoV-2. After that, three more SARS-CoV-2 nucleic acid test results were negative. The patient was treated with tocilizumab injection on March 5 due to his critical condition. However, two SARS-CoV-2 antibody tests of patient 2 obtained negative results on March 5 and 6. The patient was tested for HIV antibodies on March 7 and 8, respectively, and the results were both positive (Table 3 ). After that, the test results were reported to the Wuhan Center for Disease Control and Prevention for review, the final reexamination result is still positive. On March 8, the patient was transferred to a specialized hospital for further treatment.

We report the early clinical treatment of two COVID-19 patients diagnosed with AIDS. Both patients showed typical symptoms of SARS-CoV-2 infection throughout the disease, such as fever, chest tightness, and shortness of breath. CT scans of both patients can be used as imaging evidence for COVID-19 infection. Meanwhile, CT scans of both patients during treatment showed disease deterioration.

The laboratory test of SARS-CoV-2 mainly consists of SARS-CoV-2 virus nucleic acid test and serological test. Specific antibodies are generally produced 3-5 days after the onset of COVID-19. An increased IgM antibody indicates recent acute infection, while an increased IgG antibody indicates a previous infection. In this study, we found unnormal changes of viral nucleic acid and antibodies in two 

Notes: ND, no data; ?, positive; -, negative We assumed that HIV infection had damaged their immune systems; this could also explain why the patient tested negative for SARS-CoV-2 antibodies in the late stages of treatment when the disease became worse. The destruction of the immune system by HIV may have affected the normal humoral immune process. Meanwhile, considering the latent period of HIV is usually quite long, 8-9 years, on average, we suspect that co-infection with SARS-CoV-2 may increase the pathogenicity of both and lead to the destruction of the immune system. The patient's symptoms seemed to ease in the early stages of treatment, but as AIDS progressed, the immune system was destroyed, making COVID-19 condition worse and the treatment less effective. It is also worth noting that the patient was admitted to a designated hospital for COVID-19 treatment, where an IL-6 inhibitor (tocilizumab injection) was used to relieve severe inflammation. SARS-CoV-2 infected patients may develop an uncontrolled immune response known as a cytokine storm, which leads to the massive production of proinflammatory cytokines and other inflammatory proteins, such as IL-6, TNF-a, and GM-CSF, causing severe lung tissue damage, respiratory failure, and even death (Vaninov 2020; Mehta et al. 2020). Interleukin 6 (IL-6) is a type of cytokine produced by activated T cells and fibroblasts. It turns the precursor of B cells into antibody-producing cells. Synergizing with colony-stimulating factor, it can promote the growth and differentiation of original bone marrow-derived cells and enhance the lysis function of natural killer cells (Smits et al. 2011; Tanaka et al. 2014) . IL-6 appears to be a significant contributor to coronavirus-mediated respiratory failure (Herold et al. 2020; Liu et al. 2020) . In this study, both severely ill patients presented with abnormally high levels of IL-6. The patient 1 began treatment with tocilizumab on March 4. The data indicated that the patient's symptoms were relieved, and there was no fever after 3 days of treatment with tocilizumab. The clinical manifestations of patient 1 after the administration of IL-6 inhibitors indicated that IL-6 could be a key target for inhibiting COVID-19 inflammation. Although the patient's condition deteriorated again later, we suspect that this was related to the destruction of the immune system in patient 1 with AIDS. Patient 2 was also treated with tocilizumab on March 5. Because 1 day after the start of the medication, the patient was transferred to a specialized hospital for further treatment, the treatment effect still needs to be evaluated by the following study. In general, the blocking of the IL-6 receptor with tocilizumab has a particular effect on the treatment of COVID-19 patients with severe disease, but it may have little effect on patients with Fig. 1 The clinical courses of two cases co-infected with SARS-CoV-2 and HIV.

R. Zhang et al.: Two Cases Co-Infected with SARS-CoV-2 and HIV autoimmune diseases, which should be considered comprehensively in clinical practice. COVID-19 patients with immunodeficiency disease may cause more severe illness and poor treatment response due to the destruction of the immune system. However, the current screening work for patients with immunological diseases is still not very adequate; the therapeutic effect for an immunocompromised patient without the corresponding targeted treatment may not be evident (Castro and Gourley 2010) . Therefore, we suggest that patients with COVID-19 should be tested for immune diseases to achieve targeted treatment. 

Diagnostic testing and interpretation of tests for autoimmunity

Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19

The role of interleukin-6 in monitoring severe case of coronavirus disease 2019

COVID-19: consider cytokine storm syndromes and immunosuppression

Distinct severe acute respiratory syndrome coronavirusinduced acute lung injury pathways in two different nonhuman primate species

IL-6 in inflammation, immunity, and disease

Vaninov N (2020) In the eye of the COVID-19 cytokine storm

Acknowledgement This study was supported by the Special Fund for