key: cord-0822662-gws24ufv
authors: Joumaa, Hassan; Regard, Lucile; Carlier, Nicolas; Chassagnon, Guillaume; Alabadan, Eloïse; Canoui, Etienne; L’honneur, Anne-Sophie; Rozenberg, Flore; Burgel, Pierre-Régis; Roche, Nicolas
title: A severe COVID-19 despite ongoing treatment with Lopinavir-Ritonavir
date: 2020-07-15
journal: Respir Med Res
DOI: 10.1016/j.resmer.2020.100780
sha: 59c9efb112034b670d55a1fb23d0cf683e6dbb6b
doc_id: 822662
cord_uid: gws24ufv

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Lopinavir/Ritonavir (200/50 mg, 2 tablets twice a day). Viral load was undetectable and CD4 + 52 count was 810/mm 3 3 months prior to admission. On admission, oxygen saturation was 84% in 53 room air. Laboratory findings showed high inflammatory markers (C-reactive protein 350 54 mg/L; fibrinogen 9.6 g/L), lymphopenia (lymphocyte count 0.89 x10 9 /L) and moderate hepatic 55 cytolysis and cholestasis. HIV viral load was under the detection threshold and the CD4/CD8 56 lymphocyte ratio was normal (1.31 for normal range 1 -3.6). Unenhanced chest chest CT scan 57 showed bilateral peripheral diffuse ground glass opacities, highly suggestive of COVID-19 58 pneumonia (Figure 1 .A). The reverse transcription polymerase chain reaction on 59 nasopharyngeal swab was positive for SARS-CoV-2. The patient was treated with intravenous 60 cefotaxime and spiramycin and lopinavir/ritonavir was continued. Low-dose enoxaparin (4000 61 IU per day) was administered for thromboprophylaxis. Therapeutic dose monitoring for blood 62 lopinavir and ritonavir concentrations measured 2 days after admission showed that both drugs 63

were overdosed respectively at 25,982 ng/mL (normal range 1,000-8,000 ng/mL) and 1,194 respiratory status required to initiate high-flow nasal oxygen therapy (HFNOT) with a FiO2 up 70 to 75%. Fibrinogen level had increased to 10.9 g/L and D-dimer level was over 10 000 ng/ml. 

Ritonavir in Adults Hospitalized with Severe Covid-19

Darunavir 121 does not prevent SARS-CoV-2 infection in HIV patients

COVID-19 in patients 124 with HIV. Lancet HIV, 2020

Clinical characteristics and 126 therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving 127 combined Chinese and Western medicine treatment

Letter to the Editor: Case of the Index Patient Who Caused Tertiary 130 Transmission of Coronavirus Disease

Lopinavir/Ritonavir for the Treatment of COVID-19 Pneumonia Monitored by

Factors 135 associated with prolonged viral shedding and impact of Lopinavir/Ritonavir treatment 136 in hospitalised non-critically ill patients with SARS-CoV-2 infection

SARS-CoV-2 and HIV

COVID-19 in patients with HIV: clinical case series

Incidence of thrombotic complications in critically ill ICU patients with COVID-147 19