It the late 2019, a pneumonia due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, which has immediately spread around the world to become a pandemic problem. The disease has more sequels in more than 60 years old patients and those who has comorbidities, such as pulmonary diseases, chronic kidney diseases, diabetes, hypertension and cardiovascular diseases [1,2]. The disease is spread over all provinces of Iran, leading to the most morbidity and mortality among the Middle East countries (https://www.worldometers.info/coronavirus/?#countries).
A 37-year-old HIV-positive female presented to our institution (on 25 March 2020) with a dry cough, headache, fatigue and a mild fever (37.6 °C). She had infected with HIV through heterosexual transmission and have been received Vonavir (emtricitabine, efavirenz and tenofovir disoproxil fumarate) as anti-HIV medication. Before admission, she went shopping without a mask or protection for the last 2 weeks. Her first symptom was persistence headache that she reports 4 days before admission (21 March 2020) which was followed by a dry cough. She declared that headache was on her forehead. She had no other symptoms such as nasal congestion, runny nose, expectoration and chest tightness, skin symptoms, diarrhea and gastrointestinal problems or smell and taste disorders. She had normal breath with normal respiratory rate, normal pulse and blood pressure at the time of admission. At the chest computed tomography (CT), the typical appearance of the coronavirus disease 2019 (COVID-19) such as peripheral and bilateral ground-glass opacification, consolidation and visible intralobular lines (crazy paving pattern) were observed (Fig. 1). Oropharyngeal and nasopharyngeal swabs sampling were obtained and real-time PCR was positive based on the N and Orf1b genes. Her CD4 cell count was 756 cells/μl and complete blood counts (CBCs) were normal at the time of admission. Her HIV viral load was 0 as well (Supplementary Fig. 1, https://links.lww.com/RMM/A10). Due to her good general condition, she was not hospitalized and just followed-up at home and treated with hydroxychloroquine (200 mg PO Q12 h) and oseltamivir (75 mg PO Q12 h). Three days after treatment, her headache was relieved and her severe cough was improved, but a mild cough was continued until the 16th day of infection. The medication continued until the 14th day. On the 16th day, her chest CT was normal and oropharyngeal and nasopharyngeal swab were negative for SARS-CoV-2 RNA. The patient condition was stable till now.
HIV-positive persons may be at higher risk of SARS-CoV-2 infection due to their immune status. The result of a cohort study among 77 590 HIV-positive persons receiving antiretroviral therapy in Spanish hospitals revealed 236 PCR-positive cases, of them, 64% (151) were hospitalized, 6% (15) admitted to the ICU and 8% (20) died . Another report from Spain (Madrid) revealed that the incidence of HIV and SARS-CoV-2 coinfection was 1.8% (95% confidence interval 1.3–2.3) with mean age of 53.3 years, and male/female ratio of 84 and 16% . In Italy, Gervasoni et al. reported 47 confirmed cases of HIV and SARS-CoV-2 coinfection, which 76% of them were males with a mean age of 51 ± 11 years. As observed, the incidence of COVID-19 was higher in male than female HIV-positive patients. Moreover, it seems that the CD4+ T-cell count and having comorbidities are the major factor that involved in the severity of HIV and SARS-CoV-2 coinfection [6–8]. Our female patient has a normal CD4+ T-cell count and did not have other comorbidity. Due to the increased incidence of COVID-19 in the general population of Iran (https://www.worldometers.info/coronavirus/country/iran/), screening of HIV-positive patients should be greater consideration for early diagnosis and treatment of the patients.
The authors sincerely appreciate doctors, nurses and laboratory personals of Jahrom University of Medical Sciences for their tireless efforts in this crisis.
Authors’ contributions: R.R., A.R.B. and A.B.A. designed the study. A.R.B. and A.B.A. wrote the draft of the article. R.R., A.R.B., A.B.A., H.S. and A.B.B. collected data and performed analyses. A.A. revised the article for submission.
Ethics approval: The study approved by the Ethics Committee of Jahrom University of Medical Sciences, Jahrom, Iran.
The current study was not receiving any founding.
Conflicts of interest
The authors declare no competing interests.
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