key: cord-0736701-8bn74f2z
authors: Zhu, Feng; Cao, Yang; Xu, Shuyun; Zhou, Min
title: Reply to Comments on 'Co‐infection of SARS‐CoV‐2 and HIV in a patient in Wuhan city, China’
date: 2020-04-08
journal: J Med Virol
DOI: 10.1002/jmv.25838
sha: 6f2a507b31c76fb14fcdbe335f7ba2145c5fe162
doc_id: 736701
cord_uid: 8bn74f2z

Coronovirus disease 2019 (COVID‐19) caused by severe acute respiratory syndrome coronovirus 2 (SARS‐CoV‐2) infection has been ranging in China throughout the world now. The World Health Organiztion declared the COVID‐19 crisis a global pandemic. The previous our case of co‐infection of SARS‐CoV‐2 and HIV has raised the interests of the HIV research community(1). This article is protected by copyright. All rights reserved.

controlled AIDS according to currently limited information and clinical expertise.

Beuy Joob and Viroj Wiwanitkit has pointed out that none of case of SARS-CoV-2 infection has been reported among HIV infected patients in Thailand within an high prevalence of HIV infection, and standard antiretroviral treatment (lopinavir/ritonavir) against HIV might be a protective factor for people living with HIV (PLWH) in the crisis 3 . In a historical control study, this anti-HIV drug was associated with substantial clinical benefit among SARS-CoV infected patients 4 . And it is being studied in MERS-CoV infection. In the early stage of outbreak in Wuhan, China, the antiretroviral treatment was being used as an off-label medicine for COVID-19, as we reported in our case. Despite a clinical improvement of our case, clinical benefit for COVID-19 with lopinavir/ritonavir was equivocal due to limitation of one case observation. However, treatment outcome among the initial case would be useful for future therapeutic research.

Very recently, a randomized controlled trial of approximately 200 patients was quickly performed in China and that found that combination of lopinavir and ritonavir was not beneficial compared with standard care alone in COVID-19 management 5 . Now, there is no drug that has proven to be effective and safe against SARS-CoV-2. Thus, we would not agree that PLHIV receiving standard antiretroviral treatment might be at low risk in current crisis.

Douglas F. Nixon has given immensely helpful comments to detail our case, especially the information of HIV infection 6 . According to the medical records, there was neither blood transfusion nor sharing of needles due to drug abuse. However, he was highly Accepted Article suspected to be infected with HIV during vaginal sex without a condom. The antigen/antibody combination test of HIV was a routine test for screening HIV infection in our center, despite of there were no clinical clues of AIDS on admission of the patient.

The HIV antigen/antibody test was repeated one week after discharge and remained positive. The patient was asked to do further viral load test to confirm HIV in Chinese CDC and receive the antiretroviral treatment and follow-up in a designated center, in accordance with local epidemic prevention law. However, the process of confirmation test was being delayed because of current strict prevention measures of COVID-19 in local. Thus, we were unable to exclude the false-negative results occurred in our case even a small possibility based on repeated tests. The patient complained no more symptoms and his throat swabs remained negative for SARS-CoV-2 RT-PCR two weeks after discharge.

Our case report has some notable limitations. There was no confirmation test of HIV and additional follow-up was not performed due to an urgent study and limit resource.

Previous studies have found the that HIV-infected people were more susceptible to influenza and at greater risk for severe illnesses than general population in influenza epidemic 7 . In current global pandemic, there will definitely be more cases of concurrence between HIV infection and COVID-19. Thus, future studies with a large sample size and case-control cohort are warranted to further evaluate the outcome and potential effective antiretroviral treatment in PLWH with COVID-19.

This work was supported by Natural Science Foundation of China (No.81700032) and

HUST COVID-19 Rapid Response Call (No. 2020kfyXGYJ0).

The authors declare that there are no conflict of interests.

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