The past several months have seen monumental changes throughout the world due to the
coronavirus disease-2019 (COVID-19) pandemic. These changes range from economic hardships,
atrophied social lives, and, in the worst case, the dangerous health risks of becoming
infected. At this moment there are 20.1 million confirmed cases of COVID-19 and almost
737,000 deaths.[1],[2],[3],[4] While many studies are focusing on advising healthy people on the dangers of COVID
infection, Shareef et al.[1],[2],[3],[4] have decided to base their study on at-risk patients, specifically those with human
immunodeficiency virus (HIV) who have been coinfected with COVID-19. Although the
most reliable testing method is the polymerase chain reaction (PCR)-based test, numerous
additional testing methods have been developed, including antibody/serological technique.[5]
The current issue of Avicenna Journal of Medicine is a systematic review of SARS-CoV-2 and HIV coinfection, where the authors shed
light on a neglected topic while offering advice on the actions that should be taken
if an HIV infected individual becomes affected and acquired SARS-CoV-2 (COVID-19)
coinfection.[6] By utilizing the meta-analysis methodology, they reviewed existing literature pertaining
to COVID-19/HIV coinfection systematically, narrowing their search to seven reports,
in which a total of 16 cases were reported. The methodology of each report was then
assessed using a data quality gage developed by Murad et al.[6] which gives a score out of 4 to a study (1–2 being a poor-quality study, 4 being
a good-quality study). Of the cases that qualified for this report, three were given
a score of 4, 10 were given a score of 3, and 3 were given scores of 1 or 2.
The main variables extracted from each case included age and gender of the patient,
duration of HIV infection, name of antiretroviral therapy (ART), presence of comorbidities,
clinical presentation, duration of illness prior to presentation, presence of hypoxia
on initial presentation, patient’s most recent HIV RNA viral load and CD4- count,
initial laboratory workup and imaging findings, different treatment modalities that
were provided, last follow-up day, patient’s status, and disposition plan. Statistical
analysis was then performed, calculating the mean and standard deviation of continuous
variables, while categorical variables were depicted as percentages and numbers.[6] These statistics were processed using IBM Statistical Package for the Social Sciences
(SPSS).
The mean age of patients in this study was 42.7 ± 12.8 years and all were male except
for one. The average length of infection with HIV for the patients was 10.2 ± 5.2
years. 13 out of 16 patients were taking ART at home with documented compliance and
suppressed viral load. One patient was poorly compliant with ART due to bipolar disorder,
and two others were not taking ART before presenting with COVID-19. Regarding comorbidities,
four patients were hypertensive, two patients were diabetic, one was obese, one had
syphilis, and one had a reported history of hepatitis C virus.[6]
The authors recorded 94% of patients presented with a fever, 88% had a dry cough,
and 81% presented with dyspnea and the mean duration of illness after presentation
was 10.17 ± 5.19 days. Five patients also suffered from hypoxia and required oxygen
via nasal cannula, two patients required manual ventilation; one improving and the
other being placed on extracorporeal membrane oxygenation. The screening and laboratory
findings of the patients infected with HIV and COVID-19 were found to be similar to
those without HIV coinfection. Although the presence of HIV infection indicates a
certain element of immunosuppression, there was a tremendous improvement in the effectiveness
of drugs used to treat HIV-infected patients. Therefore, and rightfully so, the recommended
approach to patients who have both HIV and COVID-19 coinfection should not stray from
the current recommended guidelines for COVID-19 infection.[6]
Although the study sample is small, in our opinion, the authors gave healthcare stakeholders
an adequate preliminary overview of this topic and its related clinical implications.
They concluded by acknowledging the fact that the findings of their review are preliminary,
and require further evidence. The implications of the paper are summarized by providing
recommendations for the management of HIV/COVID-19 coinfection and are summarized
as follows; follow guidelines of social distancing, self-isolation, personal hygiene,
strict compliance with ART, and practicing healthy behaviors to control nonrelated
chronic conditions. Furthermore, they pointed out at the end of their review that
future research and analysis would be highly recommended and they went further by
specifying some of these goals to strive for. Although there was a tremendous effort
by all scientists all over the world to improve our understanding of this pandemic,
there are obviously still many gaps in our knowledge. These include, but are not limited
to, the role of lymphopenia in pathogenesis, testing patterns and results’ consistency,
clinical outcome, and effectiveness of HIV treatment in the event of HIV/COVID-19
coinfection.
The authors of this insightful paper should be commended for attempting to tackle
such a new and poorly understood issue; however, some issues have to be reviewed to
give readers better data and more up-to-date statistics. There are most probably more
eligible studies to include in this paper, as the sample of size of just 16 patients
is small and may lead to skewed statistics if an attempt to reference the paper is
made in the future.
At the end of 2019, many people were looking forward to a fresh start and smooth transition
into 2020. Unfortunately, the world was blindsided by the COVID-19 pandemic, and its
consequences are still being felt at this moment, with no sign of stopping. Many questions
arise whether the pandemic will finally slow or come to a stop with the approach of
2021 just around the corner, and all of us are hoping for a happy conclusion to 2020.[7],[8] These wishes include the successful development of an effective vaccine.[9]
