key: cord-0912934-inndohd4 authors: Cordie, Ahmed; Gaber, Yasmine; AbdAllah, Mohamed; Vergori, Alessandra; Kharono, Brenda; Omran, Salma; Afify, Shimaa; Karkouri, Mehdi; Chakroun, Mohamed; Musa, Sherief; Moorhouse, Michelle; Esmat, Gamal title: Gastrointestinal Manifestations of Human Immunodeficiency Virus and Coronavirus Disease 2019: Understanding the intersecting regions between the two epidemics date: 2021-05-26 journal: Arab J Gastroenterol DOI: 10.1016/j.ajg.2021.05.014 sha: 777026193b17733402ba36f430f4e7936a390fa5 doc_id: 912934 cord_uid: inndohd4 In March 2020, the World Health Organization declared coronavirus disease (COVID-19) a pandemic. As of February 2021, there were 107 million COVID-19 cases worldwide. As a comparison, there are approximately 38 million people living with human immunodeficiency virus (PLHIV) worldwide. The coexistence of both epidemics, and the syndemic effect of both viruses could lead to a delirious impact both at individual and community levels. Many intersecting points were found between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of COVID-19, and HIV; among which, gastrointestinal (GI) manifestations are the most notable. GI manifestations represent a common clinical presentation in both HIV and SARS-CoV-2. The emergence of GI symptoms as a result of SARS-CoV-2 infection provides a new dynamic to COVID-19 diagnosis, management, and infection control measures, and adds an additional diagnostic challenge in case of coinfection with HIV. The presence of GI manifestations in PLHIV during the COVID-19 pandemic could be referred to HIV enteropathy, presence of opportunistic infection, adverse effect of antiretrovirals, or coinfection with COVID-19. Thus, it is important to exclude SARS-CoV-2 in patients who present with new-onset GI manifestations, especially in PLHIV, to avoid the risk of disease transmission during endoscopic interventions. Structural similarities between both viruses adds a valuable intersecting point, which has mutual benefits in the management of both viruses. These similarities led to the hypothesis that antiretrovirals such as lopinavir/Rironavir have a role in the management of COVID-19, which was the target of our search strategy using the available evidence. These similarities may also facilitate the development of an efficient HIV vaccine in the future using the advances in COVID-19 vaccine development. were home isolated,13/28 were hospitalized, and 6/28 had a severe lung deterioration. -Two cases required mechanical ventilation,; one was discharged, and one died. -ARV is thought to be protective to PLHW against the severe outcomes of COVID-19 AWe performed a search of PubMed and Google for all published articles using the search terms "COVID-19",," "SARS-CoV-2",," "gastrointestinal",," and "diarrhea" was performed on PubMed and Google to extract data for this review. We searched for articles in PubMed that discussed the clinical impact of the COVID-19 pandemic on PLHIV and its consequences. Relevant keywords and Medical Subject Headings (Mesh) terms concerning "COVID-19" and "HIV" were included to ensure the maximum output from searching the literature. Search search. The search terms were divided into two categories. They and were written as followfollows: COVID-19 "COVID-19" OR "SARS-COV2" OR "2019-nCOV" and HIV "HIV" OR "AIDS'' OR "acquired immunodeficiency virus" .." All pertinent studies were identified and screened by two authors, and any discrepancy was resolved by involving a third author. AboutApproximately 315 articles were found. After full-text screening and removal of duplicates, only 19 studies were included. Table 1 summarizes the included studies addressing the outcome of COVID-19 in PLHIV. Previous studies showedhave shown structural similarities between HIV and the SARS- response to the SARS-COV-2 virus, as measured by higher than normal levels of Creactive protein, fibrinogen and D-dimer, and cytokines; including interleukin 6 (IL-6), IL-8, and tumor necrosis factor alpha, but not IL-1b. On the other hand, theyHowever, PLHIV remain at risk forof severe COVID-19 due to the possibility of a cytokine storm (30) . COVID-19 is primarily a disease affecting the respiratory system, it has a wide spectrum of severity, ranging from asymptomatic, or mild to a life-threatening disease, the pulmonary symptoms are the main presentations, including cough, and dyspnea together with constitutional symptoms (31),; however, the spread of COVID-19 leads to the evolution of new presenting symptoms. Accumulating evidence demonstratedhas shown that COVID-19 is a multisystem disease with extrapulmonary involvement, including gastrointestinalGI, hepatobiliary, neurological, cardiovascular, dermatologic system, and others (31, 32) . Several reports about gastrointestinalstudies have reported GI manifestations of COVID-19 had been posted,, including patients presentpresenting with either pulmonary symptoms with concurrent gastrointestinalGI symptoms, the onset of gastrointestinalGI symptoms before respiratory symptoms;, or only gastrointestinalGI symptoms withoutin the absence of respiratory symptoms (33) . (53) . These disorders are common either, potentially due to viral effects, opportunistic infections, or drug-induced symptoms (54, 55) . Table 2 shows the prevalence/ incidence of the common symptoms of COVID-19 and HIV among studies. Several mechanisms have been described inproposed to explain COVID-19 -induced diarrhoea, it could be due todiarrhea, including viral cytopathic or non-cytopathic mechanisms (38, 60) , (38, 60) . Moreover, angiotensin-converting enzyme-2 receptors HIV can directly cause structural, functional, and immunological abnormalities of the GI tract causing; this leads to HIV enteropathy, thatwhich is diagnosed by exclusion after a thorough work-up of all other potential causes (4,65)(4,65). viral -Viral gp120 causes enterocyte apoptosis through decreasedecreased tubulin depolymerization, and induction of local cytokines (e.g., interleukin (such as IL)--6, IL-10, tumor necrosis factor)and TNF (4,66) Resulting into (4, 66) . This results in small intestinal villous atrophy and colonic crypt hyperplasia, epithelial hyperproliferation, and CD4+ depletion within the lamina propria,; even after the era of HAART, the reconstitution of CD4 T cells is incomplete and slower in the gut -associated lymphoid tissue than in the peripheral blood (4,67-69)(4,67-69). All of these factors cause diarrhea through gut inflammation, increased permeability, and malabsorption (of bile acids and vitamin B12) (70) . COVID-19 spreadspreads mainly by droplet transmission; however, recent evidence showedhas shown that feco-oral transmission through viral shedding in feces could be a possible way (71) Further-more,, and that those with persistent diarrheal disease were more likely to shed detectable levels of HIV nucleic acids than were those withoutwith no evidence of gastrointestinalGI dysfunction (61, 62) . Endoscopic features: In PLHIV, esophagitisEsophagitis, gastritis, and duodenitis are the most common endoscopic findings. In in PLHIV. With regard to colonoscopy, PLHIV were significantly more likely to have adenomas 6 --9 mm in diameter than hyperplastic polyps (77) . (77) . Despite the high prevalence of GI disorders in COVID-19, data on gastrointestinalGI histologic and endoscopic findings due to COVID-19 are limited, and we can't make a firm confirmationtherefore the association remains unconfirmed (79, 80) . (79, 80 ulcerations, either on top of segmental colitis due to diverticulosis, or colonic ischemia (80) (80) . That raises the suspicion of the possibleThe these findings suggest a role of SARS-CoV-2 in the induction of ischemic injuries to the GI tract that could happen due to, which may occur as a result of a cytokine storm, leading to systemic inflammationsinflammation, endothelial dysfunction, withand subsequent thrombosis (81) . Gastrointestinal endoscopy is widely accepted as an aerosol-generating procedure (AGP) (82) . AerosolizedAlthough aerosolized droplets is are the primary route of Patients with COVID-19 patients are exposed to multiple medications, including antiviralantivirals, antibiotics, proton pump inhibitors (PPIs), anticoagulants, steroids, and anti-interleukininterleukins in severe cases (51) reported with nevirapine, nelfinavir, saquinavir, and didanosine that may lead to, which is also associated with a change in treatment change (103) (104) (105) (106) ,; however, no discontinuation of treatment was reported with atazanavir/ritonavir due to gastrointestinalGI intolerance (107) . Pancreatitis wasMoreover, pancreatitis has been observed with didanosine (108), alsoand nevirapine washas been associated with pancreas-related toxicities (109) . The Among the previously reported similarities between the two virusesSAR-CoV-2 and Table 3 . The pre-exposure prophylaxis combination of TDF/FTC and low-dose hydroxychloroquine havehas been suggested in a large Spanish clinical trial for prophylaxis for COVID-19 in healthcare workers, but no specific recommendations have been proven useful yet. There is also no evidence that switching a patient from their usual ART would be beneficial, and nor is there is no evidence that HIV pre-exposure prophylaxis is effective against COVID-19 (111) (112) (113) (114) . One further matter that deserveswarrants consideration in the similarity between the two viruses is stigma. PLHIV already face significant stigma, and fear of further stigmatization may prevent them from visiting healthcare facilities for testing, treatment, and monitoring, as well as fear of COVID-19, the full impact of which on PLHIV is still unknown and will unfold over the coming months with the surging second wavesubsequent waves. HerdThe herd immunity threshold is defined as the percentpercentage of the population that are required to be immune to decreasehave immunity before virus transmission declines, and for COVID-19, it is approximately 82.5%% (115) . COVID-19 has had a devastating impact across the globe. Recently; however, its impact on PLHIV is still unclear, and will continue to unfold over the coming months. The structural and immunological similarities between the two viruses explored through the window of, particularly their gastrointestinalGI manifestations gave us some, have provided insights about how COVID-19 may impact PLHIV, and the rationale beyondbehind suggesting the use of ARTs for COVID-19 treatment and prevention. Also, it may beIt is also reasonable now to think aboutpay close attention to COVID-19 in patients presenting for endoscopy specially if living withfor HIV and to follow the suggested infection control interventions. StigmaThe stigma against both viruses, as a shared barrier to care, can impact health systems and this is likely to be especially feltparticularly obvious in Lowlow-and middle- Explaining racial disparities in HIV/AIDS incidence among women in the U.S.: A systematic review COVID-19 disparity among racial and ethnic minorities in the US: A cross sectional analysis COVID-19 and Individual Genetic Susceptibility/Receptivity: Role of ACE1/ACE2 Genes, Immunity, Inflammation and Coagulation. Might the Double X-chromosome in Females Be Protective against SARS-CoV-2 Compared to the Single X-Chromosome in Males? Gastrointestinal and hepatic manifestations of COVID-19: A comprehensive review COVID-19 in patients with HIV: clinical case series COVID-19 in people living with human immunodeficiency virus: a case series of 33 patients Among HIV/AIDS Patients in Two Districts of Wuhan Social Science Research Network Recovery from the coronavirus disease-2019 (COVID-19) in two patients with coexisted (HIV) infection Clinical features and outcomes of HIV patients with coronavirus disease 2019 A Case Series of Five People Living with HIV Hospitalized with COVID-19 in Clinical characteristics and outcomes in people living with HIV hospitalized for COVID-19 Description of COVID-19 in HIV-infected individuals: a single-centre, prospective cohort. Lancet HIV [Internet SARS-CoV-2 and HIV Coinfection: Clinical Experience from Rhode Island, United States HIV/SARS-CoV-2 coinfected patients in Istanbul, Turkey COVID-19 Pneumonia in Patients With HIV: A Case Series Coinfection with HIV and SARS-CoV-2 in Wuhan, China: A 12-person case series Outcomes among HIV-positive patients hospitalized with COVID-19. medRxiv Clinical Outcomes and Inflammatory Markers by HIV Serostatus and Viral Suppression in a Large Cohort of Patients Hospitalized With COVID-19 Clinical Outcomes and Immunologic Characteristics of Coronavirus Disease 2019 in People With Human Immunodeficiency Virus Incidence and Severity of COVID-19 in HIV-Positive Persons Receiving Antiretroviral Therapy : A Cohort Study and People Living With Human Immunodeficiency Virus: Outcomes for Hospitalized Patients in New York City. Clin Infect Dis Off Publ Infect Dis Soc Am HIV infection and COVID-19: risk factors for severe disease Hospitalized Patients With COVID-19 and Human Immunodeficiency Virus: A Case Series Structural similarity between HIV-1 gp41 and SARS-CoV S2 proteins suggests an analogous membrane fusion mechanism Architecture of the SARS coronavirus prefusion spike OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients. medRxiv Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease: A Viewpoint on the Potential Influence of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers on Onset and Severity of Severe Acute Respiratory Syndrome Coronavirus 2 Infection Antihypertensive treatment with ACEI/ARB of patients with COVID-19 complicated by hypertension New York studies look at COVID-19 outcomes and immune function among people with HIV Clinical manifestation and disease progression in COVID-19 infection Extrapulmonary manifestations of COVID-19 Gastrointestinal symptoms, pathophysiology, and treatment in COVID-19 COVID-19 Pandemic: Oral Repercussions and its Possible Impact on Oral Health. Pesqui Bras Em Odontopediatria E ClÃ-Nica Integrada New Insights for the Pathogenesis of COVID-19-Related Dysgeusia Letter to Editor: Oral lesions in a patient with Covid-19. Med Oral Patol Oral Cir Bucal AGA Institute Rapid Review of the Gastrointestinal and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19 COVID-19 extrapulmonary illness -special gastrointestinal and hepatic considerations. Dis--Mon DM COVID-19 presenting as acute pancreatitis Coronavirus Disease-19 (COVID-19) associated with severe acute pancreatitis: Case report on three family members Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes Covid-19 and the digestive system Management of upper GI bleeding in patients with COVID-19 pneumonia Gastrointestinal Bleeding in Patients with Severe SARS-CoV-2 Gastrointestinal Bleeding in Patients With Coronavirus Disease 2019: A Matched Case-Control Study Colitis as a Sole Presentation of SARS-CoV-2 Infection: Case Report. Sn Compr Clin Med SARS-CoV-2 Gastrointestinal Infection Causing Hemorrhagic Colitis: Implications for Detection and Transmission of COVID-19 Disease Prehospitalization Proton Pump Inhibitor (PPI) use and Clinical Outcomes in COVID-19 Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study Gastrointestinal symptoms associated with severity of coronavirus disease 2019 (COVID-19): a pooled analysis Prevalence, Mechanisms, and Implications of Gastrointestinal Symptoms in COVID-19 Idiopathic AIDS enteropathy and treatment of gastrointestinal opportunistic pathogens Acute pancreatitis in HIV/AIDS patients: an issue of concern Human immunodeficiency virusassociated gastrointestinal disease: common endoscopic biopsy diagnoses Gastrointestinal Disorders in HIV Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan Prevalence and Severity of Gastrointestinal Symptoms in HIV/AIDS: 955 Clinical Characteristics of Coronavirus Disease 2019 in China Risk Factors, and Outcomes of Hospitalized Patients With Coronavirus Disease 2019 Presenting as Acute Pancreatitis Putative Mechanisms of Diarrhea in COVID-19 Persistent diarrhea and fecal shedding of retroviral nucleic acids in children infected with human immunodeficiency virus Isolation of human immunodeficiency virus type 1 (HIV-1) RNA from feces by a simple method and difference between HIV-1 subpopulations in feces and serum COVID-19 cytokine storm: the interplay between inflammation and coagulation Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial Enteropathy associated with the acquired immunodeficiency syndrome Supernatants of HIV-infected immune cells affect the barrier function of human HT-29/B6 intestinal epithelial cells Chronic diarrhea and AIDS: insights into studies with non-human primates Viral suppression and immune restoration in the gastrointestinal mucosa of human immunodeficiency virus type 1-infected patients initiating therapy during primary or chronic infection HIV infection and the gastrointestinal immune system COVID-19 and gastrointestinal endoscopies: Current insights and emergent strategies Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis Evidence for Gastrointestinal Infection of SARS-CoV-2 A Case Series of children with 2019 novel coronavirus infection: clinical and epidemiological features Concentration and detection of SARS coronavirus in sewage from Xiao Tang Shan Hospital and the 309th Hospital Unexplained diarrhoea in HIV-1 infected individuals Screening colonoscopy for the detection of neoplastic lesions in asymptomatic HIV-infected subjects Colonoscopy Findings in HIV-Infected Men and Women from an Urban U.S. Cohort Compared with Non-HIV-Infected Men and Women Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission Endoscopic Findings in Patients Infected With COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review Multicentre prospective study of COVID-19 transmission following outpatient GI endoscopy in the UK. Gut The SARS-CoV-2 outbreak: What we know Impact of COVID-19 on endoscopy trainees: an international survey Triaging advanced GI endoscopy procedures during the COVID-19 pandemic: consensus recommendations using the Delphi method Practice of endoscopy during COVID-19 pandemic: position statements of the Asian Pacific Society for Digestive Endoscopy (APSDE-COVID statements) Restarting gastrointestinal endoscopy in the deceleration and early recovery phases of COVID-19 pandemic: Guidance from the British Society of Gastroenterology Safely restarting GI endoscopy in the era of COVID-19 Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy ASGE guideline for infection control during GI endoscopy Elimination of high titre HIV from fibreoptic endoscopes Recommendations for Prevention of HIV Transmission in Health-Care Settings Effectiveness of Lactobacillus helveticus and Lactobacillus rhamnosus for the management of antibioticassociated diarrhoea in healthy adults: a randomised, double-blind, placebo-controlled trial Chloroquine for the 2019 novel coronavirus SARS-CoV-2 A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19 Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial Increased Risk of COVID-19 Among Users of Proton Pump Inhibitors Proton pump inhibitor use and the risk of small intestinal bacterial overgrowth: a meta-analysis Gastric acid suppression by proton pump inhibitors as a risk factor for clostridium difficile-associated diarrhea in hospitalized patients Quadruple nucleos(t)ide reverse transcriptase inhibitors-only regimen of tenofovir plus zidovudine/lamivudine/abacavir in heavily pre-treated HIV-1 infected patients: salvage therapy or backbone only? Treatment Modification in Human Immunodeficiency Virus-Infected Individuals Starting Combination Antiretroviral Therapy Between Observational study to evaluate clinical outcomes after first-line efavirenz-or lopinavir-ritonavir-based HAART in treatment-naive patients Longterm follow-up of nevirapine-treated patients in a single-centre cohort A randomized trial comparing the efficacy and tolerability of two HAART strategies at two years in antiretroviral naive patients Three-Year Outcome Data of Second-Line Antiretroviral Therapy in Ugandan Adults: Good Virological Response but High Rate of Toxicity Pharmacokinetics and Safety of Saquinavir/Ritonavir and Omeprazole in HIV-infected Subjects Once-daily atazanavir/ritonavir versus twice-daily lopinavir/ritonavir, each in combination with tenofovir and emtricitabine, for management of antiretroviral-naive HIV-1-infected patients: 48 week efficacy and safety results of the CASTLE study Toxicities Associated with Dual Nucleoside Reverse-Transcriptase Inhibitor Regimens in HIV-Infected Children Risk factors for treatment-limiting toxicities in patients starting nevirapine-containing antiretroviral therapy Systematic review of the efficacy and safety of antiretroviral drugs against SARS, MERS or COVID-19: initial assessment Triphosphates of the Two Components in DESCOVY and TRUVADA are Inhibitors of the SARS Analysis of therapeutic targets for SARS-CoV-2 and discovery of potential drugs by computational methods Nucleotide Analogues as Inhibitors of SARS-CoV Polymerase. bioRxiv Remdesivir, lopinavir, emetine, and homoharringtonine inhibit SARS-CoV-2 replication in vitro Is Herd Immunity Against SARS-CoV-2 a Silver Lining? Rapid COVID-19 vaccine development View of COVID-19 vaccination: an attempt to control the pandemic | The Southwest Respiratory and Critical Care Chronicles COVID-19 disparity among racial and ethnic minorities in the US: A cross sectional analysis COVID-19 and Individual Genetic Susceptibility/Receptivity: Role of ACE1/ACE2 Genes, Immunity, Inflammation and Coagulation. Might the Double X-chromosome in Females Be Protective against SARS-CoV-2 Compared to the Single X-Chromosome in Males? Gastrointestinal and hepatic manifestations of COVID-19: A comprehensive review COVID-19 in patients with HIV: clinical case series COVID-19 in people living with human immunodeficiency virus: a case series of 33 patients Among HIV/AIDS Patients in Two Districts of Wuhan Social Science Research Network Recovery from the coronavirus disease-2019 (COVID-19) in two patients with coexisted (HIV) infection Clinical features and outcomes of HIV patients with coronavirus disease 2019 A Case Series of Five People Living with HIV Hospitalized with COVID-19 in Clinical characteristics and outcomes in people living with HIV hospitalized for COVID-19 Description of COVID-19 in HIV-infected individuals: a single-centre, prospective cohort. Lancet HIV [Internet SARS-CoV-2 and HIV Coinfection: Clinical Experience from Rhode Island, United States HIV/SARS-CoV-2 coinfected patients in Istanbul, Turkey COVID-19 Pneumonia in Patients With HIV: A Case Series Coinfection with HIV and SARS-CoV-2 in Wuhan, China: A 12-person case series Outcomes among HIV-positive patients hospitalized with COVID-19. medRxiv Clinical Outcomes and Inflammatory Markers by HIV Serostatus and Viral Suppression in a Large Cohort of Patients Hospitalized With COVID-19 Clinical Outcomes and Immunologic Characteristics of Coronavirus Disease 2019 in People With Human Immunodeficiency Virus Incidence and Severity of COVID-19 in HIV-Positive Persons Receiving Antiretroviral Therapy : A Cohort Study and People Living With Human Immunodeficiency Virus: Outcomes for Hospitalized Patients in New York City. Clin Infect Dis Off Publ Infect Dis Soc Am HIV infection and COVID-19: risk factors for severe disease Hospitalized Patients With COVID-19 and Human Immunodeficiency Virus: A Case Series Structural similarity between HIV-1 gp41 and SARS-CoV S2 proteins suggests an analogous membrane fusion mechanism Architecture of the SARS coronavirus prefusion spike OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients. medRxiv Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease: A Viewpoint on the Potential Influence of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers on Onset and Severity of Severe Acute Respiratory Syndrome Coronavirus 2 Infection Antihypertensive treatment with ACEI/ARB of patients with COVID-19 complicated by hypertension New York studies look at COVID-19 outcomes and immune function among people with HIV Clinical manifestation and disease progression in COVID-19 infection Extrapulmonary manifestations of COVID-19 Gastrointestinal symptoms, pathophysiology, and treatment in COVID-19 COVID-19 Pandemic: Oral Repercussions and its Possible Impact on Oral Health. Pesqui Bras Em Odontopediatria E ClÃ-Nica Integrada New Insights for the Pathogenesis of COVID-19-Related Dysgeusia Letter to Editor: Oral lesions in a patient with Covid-19. Med Oral Patol Oral Cir Bucal AGA Institute Rapid Review of the Gastrointestinal and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19 COVID-19 extrapulmonary illness -special gastrointestinal and hepatic considerations. Dis--Mon DM COVID-19 presenting as acute pancreatitis Coronavirus Disease-19 (COVID-19) associated with severe acute pancreatitis: Case report on three family members Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes Covid-19 and the digestive system Management of upper GI bleeding in patients with COVID-19 pneumonia Gastrointestinal Bleeding in Patients with Severe SARS-CoV-2 Gastrointestinal Bleeding in Patients With Coronavirus Disease 2019: A Matched Case-Control Study Colitis as a Sole Presentation of SARS-CoV-2 Infection: Case Report. Sn Compr Clin Med SARS-CoV-2 Gastrointestinal Infection Causing Hemorrhagic Colitis: Implications for Detection and Transmission of COVID-19 Disease Prehospitalization Proton Pump Inhibitor (PPI) use and Clinical Outcomes in COVID-19 Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study Gastrointestinal symptoms associated with severity of coronavirus disease 2019 (COVID-19): a pooled analysis Prevalence, Mechanisms, and Implications of Gastrointestinal Symptoms in COVID-19 Idiopathic AIDS enteropathy and treatment of gastrointestinal opportunistic pathogens Acute pancreatitis in HIV/AIDS patients: an issue of concern Human immunodeficiency virusassociated gastrointestinal disease: common endoscopic biopsy diagnoses Gastrointestinal Disorders in HIV Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan Prevalence and Severity of Gastrointestinal Symptoms in HIV/AIDS: 955 Clinical Characteristics of Coronavirus Disease 2019 in China Risk Factors, and Outcomes of Hospitalized Patients With Coronavirus Disease 2019 Presenting as Acute Pancreatitis Putative Mechanisms of Diarrhea in COVID-19 Persistent diarrhea and fecal shedding of retroviral nucleic acids in children infected with human immunodeficiency virus Isolation of human immunodeficiency virus type 1 (HIV-1) RNA from feces by a simple method and difference between HIV-1 subpopulations in feces and serum COVID-19 cytokine storm: the interplay between inflammation and coagulation Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial Enteropathy associated with the acquired immunodeficiency syndrome Supernatants of HIV-infected immune cells affect the barrier function of human HT-29/B6 intestinal epithelial cells Chronic diarrhea and AIDS: insights into studies with non-human primates Viral suppression and immune restoration in the gastrointestinal mucosa of human immunodeficiency virus type 1-infected patients initiating therapy during primary or chronic infection HIV infection and the gastrointestinal immune system COVID-19 and gastrointestinal endoscopies: Current insights and emergent strategies Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis Evidence for Gastrointestinal Infection of SARS-CoV-2 A Case Series of children with 2019 novel coronavirus infection: clinical and epidemiological features Concentration and detection of SARS coronavirus in sewage from Xiao Tang Shan Hospital and the 309th Hospital Unexplained diarrhoea in HIV-1 infected individuals Screening colonoscopy for the detection of neoplastic lesions in asymptomatic HIV-infected subjects Colonoscopy Findings in HIV-Infected Men and Women from an Urban U.S. Cohort Compared with Non-HIV-Infected Men and Women Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission Endoscopic Findings in Patients Infected With COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review Multicentre prospective study of COVID-19 transmission following outpatient GI endoscopy in the UK. Gut The SARS-CoV-2 outbreak: What we know Impact of COVID-19 on endoscopy trainees: an international survey Triaging advanced GI endoscopy procedures during the COVID-19 pandemic: consensus recommendations using the Delphi method Practice of endoscopy during COVID-19 pandemic: position statements of the Asian Pacific Society for Digestive Endoscopy (APSDE-COVID statements) Restarting gastrointestinal endoscopy in the deceleration and early recovery phases of COVID-19 pandemic: Guidance from the British Society of Gastroenterology Safely restarting GI endoscopy in the era of COVID-19 Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy ASGE guideline for infection control during GI endoscopy Elimination of high titre HIV from fibreoptic endoscopes Recommendations for Prevention of HIV Transmission in Health-Care Settings Effectiveness of Lactobacillus helveticus and Lactobacillus rhamnosus for the management of antibioticassociated diarrhoea in healthy adults: a randomised, double-blind, placebo-controlled trial Chloroquine for the 2019 novel coronavirus SARS-CoV-2 A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19 Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial Increased Risk of COVID-19 Among Users of Proton Pump Inhibitors Proton pump inhibitor use and the risk of small intestinal bacterial overgrowth: a meta-analysis Gastric acid suppression by proton pump inhibitors as a risk factor for clostridium difficile-associated diarrhea in hospitalized patients Quadruple nucleos(t)ide reverse transcriptase inhibitors-only regimen of tenofovir plus zidovudine/lamivudine/abacavir in heavily pre-treated HIV-1 infected patients: salvage therapy or backbone only? Treatment Modification in Human Immunodeficiency Virus-Infected Individuals Starting Combination Antiretroviral Therapy Between Observational study to evaluate clinical outcomes after first-line efavirenz-or lopinavir-ritonavir-based HAART in treatment-naive patients Longterm follow-up of nevirapine-treated patients in a single-centre cohort A randomized trial comparing the efficacy and tolerability of two HAART strategies at two years in antiretroviral naive patients Three-Year Outcome Data of Second-Line Antiretroviral Therapy in Ugandan Adults: Good Virological Response but High Rate of Toxicity Pharmacokinetics and Safety of Saquinavir/Ritonavir and Omeprazole in HIV-infected Subjects Once-daily atazanavir/ritonavir versus twice-daily lopinavir/ritonavir, each in combination with tenofovir and emtricitabine, for management of antiretroviral-naive HIV-1-infected patients: 48 week efficacy and safety results of the CASTLE study Toxicities Associated with Dual Nucleoside Reverse-Transcriptase Inhibitor Regimens in HIV-Infected Children Risk factors for treatment-limiting toxicities in patients starting nevirapine-containing antiretroviral therapy Systematic review of the efficacy and safety of antiretroviral drugs against SARS, MERS or COVID-19: initial assessment Triphosphates of the Two Components in DESCOVY and TRUVADA are Inhibitors of the SARS Analysis of therapeutic targets for SARS-CoV-2 and discovery of potential drugs by computational methods Nucleotide Analogues as Inhibitors of SARS-CoV Polymerase. bioRxiv Remdesivir, lopinavir, emetine, and homoharringtonine inhibit SARS-CoV-2 replication in vitro Is Herd Immunity Against SARS-CoV-2 a Silver Lining? Rapid COVID-19 vaccine development View of COVID-19 vaccination: an attempt to control the pandemic | The Southwest Respiratory and Critical Care Chronicles