key: cord-0796400-5ufo0ygl
authors: Przydzial, Paulina; Tchomobe, Ghislain; Amin, Krushna; A. Engell, Engell; Okoh, Alexis K.
title: COVID‐19 crossing paths with AIDS in the homeless
date: 2020-07-14
journal: J Med Virol
DOI: 10.1002/jmv.26255
sha: b6c0dd8f24737d5968d0b41a9ab10e77537d5df4
doc_id: 796400
cord_uid: 5ufo0ygl

The coronavirus disease of 2019 (COVID-19) pandemic has created new challenges and magnified existing ones for immunocompromised individuals who may be at risk for worse clinical outcomes. Severe COVID-19 has been associated with a hyperimmune response characterized by a surge in cytokine release defined as a cytokine release syndrome (CRS) (1). Among immunocompromised patients, the inability to mount an immune response may be protective against a poor outcome. This article is protected by copyright. All rights reserved.

To the Editor,

The coronavirus disease of 2019 (COVID-19) pandemic has created new challenges and magnified existing ones for immunocompromised individuals who may be at risk for worse clinical outcomes. Severe COVID-19 has been associated with a hyperimmune response characterized by a surge in cytokine release described as a cytokine release syndrome (CRS). 1 Among immunocompromised patients, the inability to mount an immune response may be protective against a poor outcome.

For individuals living in homeless shelters, the lack of testing and assistance can contribute to a rapid spread of new outbreaks, which may limit a region's ability to control the pandemic. 2 In this report, we describe the clinical course of two homeless patients with a history of acquired immune deficiency syndrome (AIDS) who were admitted for COVID-19. The details of their immunological profile and in-hospital outcomes are described and the pathophysiological consequences of immune dysfunction in the setting of COVID-19 discussed.

Patient 1 is a 51-year-old homeless male with a previous diagnosis of AIDS, not on antiretroviral therapy (ART), polysubstance abuse who had presented to the emergency department due to alcohol intoxication. He had denied any fevers, cough, or dyspnea before his presentation after he was initially stabilized. His vital signs were stable upon presentation except for an oxygen saturation of 86% on ambient air for which he was transitioned to nasal canula for oxygen therapy but escalated to 15 L of non-rebreather to maintain an oxygen saturation >92%. Chest imaging showed bilateral infiltrates on chest xray and ground glass opacities on computed tomography. A naso- In conclusion, we describe our experience with AIDS and COVID-19 in two homeless patients who were expected to be at an increased risk for worse outcomes. Despite their poor immunological profile, their clinical course was uncomplicated, and both were successfully discharged alive with scheduled followup and monitoring. 

In-hospital death, n (%) 0 (0) 0 (0) Readmission 0 (0) 0 (0)

Abbreviations: ALP, alkaline phosphatase; ALT, alanine transaminase; AST, aspartate transaminase; BMI, Body mass index; BUN, blood urea nitrogen; CD4, cluster of differentiation 4; CRP, C reactive protein; HAART, highly active antiretroviral therapy; HIV RNA PCR, human immunodeficiency virus ribonucleic acid polymerase chain reaction; HR, heart rate; ICU, intensive care unit; RR, respiratory rate; SBP, systolic blood pressure; SR, erythrocyte sedimentation rate; WBC, white blood cell count.

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