People living with HIV and COVID-19 : a report on 2 clinical cases from South Africa

The impact of HIV in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has not been well established. It is uncertain if outcomes are better or worse in these patients compared with COVID-19 patients with diabetes mellitus, hypertension and other chronic diseases. eTh course and outcome is also unknown in HIV-positive patients who are virally suppressed on antiretroviral treatment (ART) compared with those who are treatment-naive. We present two HIV-positive cases with COVID-19 pneumonia - one virally suppressed and the other newly diagnosed. Both patients had favourable outcomes. A 31-year-old female initially presented with a 1-week history of lfu-like symptoms and had a positive COVID-19 PCR test result on 10 April 2020. She was transferred from the base hospital to the Inkosi Albert Luthuli Central Hospital (IALCH) intensive care unit (ICU) with acute onset respiratory distress. She had a respiratory rate of 30 breaths per minute, blood pressure of 140/75 mmHg and a pulse rate of 107 beats per minute. Her oxygen saturation was 88% on ambient air, increasing to 93% on supplemental oxygen via nasal prongs. Her arterial blood gas (ABG) revealed a pH of 7.51, pCO2 of 4.8kPa, pO2 of 8.3 kPa and sO2 of 90%. Her chest radiograph demonstrated diffuse bilateral reticular nodular infiltrates and computed tomogography (CT) scans showed difuse bilateral ground-glass opacities (Figs 1 and 2). She was treated with 1 g meropenem 8-hourly, 60 mg subcutaneous enoxaparin twice daily, 50 mg hydrocortisone 6-hourly, as well as zinc supplementation. She was counseled and tested positive for HIV, with a CD4+ count of 3 cells/uL and a viral load of 53 781 copies/mL. She did not require intubation and maintained satisfactory oxygenation on nasal prongs. Antiretroviral therapy (ART) was commenced as well as Pneumocystis jirovecii prophylaxis. She was transferred to the general ward aeftr 3 days. Four days later she did not require supplementary oxygen and was subsequently discharged aeftr a negative COVID-19 PCR test result.