Table.
Demographics, clinical characteristics at admission, treatment, and outcomes of five patients with HIV and COVID-19
| Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 | ||
|---|---|---|---|---|---|---|
| Demographics and baseline HIV status | ||||||
| Age (years) | 40 | 49 | 29 | 40 | 31 | |
| Gender | Transgender | Male | Male | Male | Transgender | |
| HIV-risk factor and exposure | MSM, gym worker | Bisexual man, health-care worker | MSM, sexual worker participant in ChemSex session 6 days before | MSM, dinner 5 days before with another person who was COVID-19 positive | MSM, sexual worker | |
| Comorbidities* | None | Hypothyroidism | None | Asthma | None | |
| HIV status | ||||||
| Year of HIV diagnosis | 2007 | 2003 | 2013 | 2003 | 2020 | |
| Last CD4 cell count (cells per μL) | 616 | 445 | 604 | 1140 | 13 | |
| Last CD4:CD8 ratio | 0·8 | 0·46 | 1·1 | 1·2 | 0·1 | |
| HIV viral load at or before admission (copies per mL) | <50 | <50 | <50 | <50 | 45 500 | |
| ART-regimen before admission | Tenofovir alafenamide, emtricitabine, and darunavir-boosted cobicistat | Abacavir, lamivudine, and dolutegravir | Tenofovir alafenamide, emtricitabine, and darunavir-boosted cobicistat | Abacavir, lamivudine; and dolutegravir | No ART: current diagnosis is late presenter | |
| Clinical findings on admission | ||||||
| Duration of symptoms, days | 2 | 5 | 2 | 3 | 7 | |
| Diagnosis | Upper respiratory tract infection | Lower respiratory tract infection | Upper respiratory tract infection | Lower respiratory tract infection | Lower respiratory tract infection | |
| Symptoms and vital signs | ||||||
| Temperature | Fever (38·7°C) | Fever (39°C) | Fever (39·5°C) | Fever (39·5°C) | Fever (38·5°C) | |
| Symptoms | Cough, malaise, headache | Cough | Cough, malaise, headache, dyspnoea | Cough, malaise, headache, dyspnoea | Cough, dyspnoea | |
| Blood pressure (mm Hg) | 140/90 | 110/70 | 129/69 | 115/76 | 127/56 | |
| Respiratory rate (breaths per min) | 14 | 28 | 16 | 24 | 20 | |
| Heart rate (beats per min) | 90 | 94 | 78 | 103 | 121 | |
| Chest x-ray findings | Normal | Bilateral ground-glass opacities | Normal | Right basal interstitial infiltrate | Right basal pneumonia with pleural effusion | |
| O2 saturation in ambient air | SpO2 100% | SpO2 <90% | SpO2 97% | SpO2 94% | SpO2 <90% | |
| PaO2/FiO2ratio | ND | 182 | ND | ND | 230 | |
| Laboratory results | ||||||
| White blood cell count (cells per 106/L) | 7840 | 29 160 | 6730 | 6140 | 14 670 | |
| Lymphocyte (cells per 106/L) | 2700 | 1170 (4%) | 1500 | 1600 | 900 | |
| Platelets (cells per 106/L) | 345 000 | 135 000 | 124 000 | 186 000 | 309 000 | |
| LDH (U/L) | ND | 316 | 256 | 465 | 1149 | |
| C-reactive protein (mg/dL) | ND | 30 | 0·72 | 0·43 | 40 | |
| D-dimer (ng/mL) | ND | >10 000 | 400 | 300 | ND | |
| Ferritin (ng/mL) | ND | 1020 | ND | 1044 | 866 | |
| Procalcitonin (ng/mL) | ND | ND | <0·03 | ND | ND | |
| Severity of the infection at admission | Mild | Severe | Mild | Moderate | Severe | |
| Treatment and outcomes | ||||||
| ART† | ART at admission maintained | Tenofovir disoproxil fumarate, and emtricitabine plus lopinavir-boosted ritonavir (on going) | Tenofovir disoproxil fumarate, and emtricitabine plus lopinavir-boosted ritonavir (for 3 days) | Tenofovir disoproxil fumarate, and emtricitabine plus lopinavir-boosted ritonavir (for 14 days) | Tenofovir alafenamide, emtricitabine, and darunavir-boosted cobicistat (on going) | |
| Other antiviral treatments | No | Interferon beta-1b (for 7 days), hydroxychloroquine (for 7 days) | Hydroxychloroquine (for 5 days) | Hydroxychloroquine (for 5 days) | Interferon beta-1b (for 4 days), hydroxychloroquine (for 5 days) | |
| Other antibiotics | No | Meropenem (for 16 days), linezolid (for 14 days) | Azithromycin (for 5 days) | Azithromycin (for 5 days), cefixime (for 5 days) | Azithromycin (for 5 days), ceftaroline fosamil (for 7 days), co-trimoxazole (for 21 days, followed by secondary prophylaxis) | |
| Admitted to an intensive care unit | No | Yes | No | No | Yes | |
| Invasive or non-invasive mechanical ventilation | No | Invasive | No | No | Non-invasive | |
| Corticosteroids or tocilizumab | No | Tocilizumab, 400 mg one single dose (on day 10) | No | Inhaled corticosteroids | Corticosteroids | |
| Length of hospital stay (days) | 1 | 21 | 3 | 4 | 12 | |
| Length of home hospitalisation (days)‡ | 13 | .. | .. | 10 | .. | |
| Outcomes | Cured | Still at hospital | Cured | Cured | Cured | |
| Additional comments | .. | Extracorporeal membrane oxygenation since day 13 (on going) | .. | .. | Concomitant Pneumocystis jiroveci and bacterial pneumonia treatment | |
Lopinavir-boosted ritonavir was given as 400 mg of ritonavir boosted with 100 mg of lopinavir twice a day for 14 days; azithromycin was given as 500 mg once a day, with a loading dose on the first day, and then 250 mg once a day for 4 days; hydroxychloroquine was given as 400 mg twice a day with a loading dose on the first day and then 200 mg twice a day for 4 days, and interferon beta-1b was given as 250 μg (8 million units) every 48 h. MSM=men who have sex with men. ND=Not done.
Hepatitis C virus, hepatitis B virus, chronic obstructive pulmonary disease, asthma, chronic kidney failure, hypertension, cardiovascular disease, diabetes, solid organ transplantation, use of biologics, other types of immunosuppression.
Tenofovir alafenamide, emtricitabine, and darunavir-boosted cobicistat was indicated before the information provided by Janssen on March 18, 2020.
Discharged with a supervised home-care programme.