key: cord-0712486-znpmk0r3
authors: Chen, Jiaxiang; Cheng, Xinge; Wang, Rongpin; Zeng, Xianchun
title: Computed Tomography Imaging of an HIV‐infected Patient with Coronavirus Disease 2019 (COVID‐19)
date: 2020-04-14
journal: J Med Virol
DOI: 10.1002/jmv.25879
sha: 538b163de0e950af9cf22ce33487360b3505d0e0
doc_id: 712486
cord_uid: znpmk0r3

In December 2019, an outbreak of Coronavirus disease 2019 (COVID‐19) occurred in Wuhan, China. Since then, this disease has infected more than 900,000 individuals worldwide. Here we report a case of non‐severe COVID‐19 pneumonia who was living with HIV. Chest computed tomography (CT) showed different abnormalities from those of conventional COVID‐19, and the faster absorption of pulmonary lesions also highlights the importance of antiretroviral therapy in this patient. This report provides reference for the diagnosis and treatment of HIV‐infected patients with COVID‐19. This article is protected by copyright. All rights reserved.

(FCM). Unenhanced CT showed multiple high-density patchy shadows with unclear boundaries in the subpleural regions of the middle and lower lobes of the right lung, with involvement of adjacent interlobar pleura (Fig 1a, 1b) . Finally, he was diagnosed with non-severe COVID-19 pneumonia based on two real-time reverse transcription polymerase chain reaction (RT-PCR) tests on oropharyngeal swabs. The patient was confirmed with HIV infection two years ago, and then received an antiretroviral therapy (ART) (Tenofovir 0.3 g, qd; Lamivudine 0.3 g, qd; Efaviren 0.6 g, qd) for 2 years. He reported to have no history of drug abuse or blood transfusion, and refused to disclose the sexual history. After COVID-19 diagnosis, he was given Lopinavir/Ritonavir (300/75 mg, bid) combined with interferon inhalation (5 μg, bid) for treatment. Meanwhile, the anti-HIV treatment (oral tenofovir, lamivudine and efavirenz) continued. During treatment, the symptoms improved. And follow-up chest CT suggested that the pulmonary lesions decreased on day 7 of hospitalization (Fig 1c, 1d ) and were partially absorbed on day 12 (Fig 1e, 1f ). After 15 days of treatment, the chest CT imaging showed that the pulmonary lesions substantially disappeared, leaving a small amount of residual fibrosis foci (Fig. 1g, 1h ). After three RT-PCR tests on the pharyngeal swab specimens (interval >24 h) all producing negative results, the patient was discharged and transferred to Guizhou Provincial Staff Hospital for This article is protected by copyright. All rights reserved.

The COVID-19 disease has clinical main symptoms of fever, dry cough, and fatigue. 5 Besides, patients with impaired immune functions are more likely to develop severe acute respiratory distress syndrome and even death. 6 However, the HIV-infected case reported here presented moderate clinical symptoms, and laboratory examinations revealed no abnormalities. Furthermore, the symptoms improved after a short period of treatment, and had a good outcome.

The main findings of chest CT in this case were patchy shadows in the peripheral lung, involving the interlobar fissure, which are different from the common COVID-19 CT findings of ground glass opacity followed by consolidation and interlobular septal thickening. 5 This difference suggests that the chest CT findings in this case may be atypical of COVID-19. Commonly, the pulmonary changes in patients with COVID-19 include development into the greatest severity at around 10 days following the initial symptoms and improvement at around day 14. 7 By contrast, the pulmonary lesions of the patient described here improved around 7 days following the initial symptoms, and substantially disappeared around day 15. This article is protected by copyright. All rights reserved.

In conclusion, the chest CT imaging findings of the case of non-severe COVID-19 pneumonia with HIV infection are mainly patchy shadows in the peripheral lung, involving the interlobar fissure, which are different from the common chest CT findings of COVID-19. The quick absorption of pulmonary lesions also highlights the importance of ART in this patient. This report provides reference for the diagnosis and treatment of HIV-infected patients with COVID-19.

World Health Organization. WHO Director-General's remarks at the media briefing on 2019-nCoV on 11

A Novel Coronavirus from Patients with Pneumonia in China

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Co-infection of SARS-CoV-2 and HIV in a patient in Wuhan city

Chest CT Findings in Patients with Corona Virus Disease 2019 and its Relationship with Clinical Features

Clinical Characteristics of Coronavirus Disease 2019 in China

The authors have no conflicts of interest to declare.

This manuscript, or any part of it, has not been published and will not be submitted elsewhere for publication. This report was approved by Jiangjunshan Hospital Institutional Review Board, and the requirement for informed consent was waived.