Case series of five HIV positive people diagnosed with COVID-19 in Spain

A study reporting on the first 543 consecutive cases of COVID-19 admitted to the Hospital Clínic in Barcelona in the first two weeks of March 2020, included five people who were also HIV positive. Details of their management and outcomes have been published as a case series in Lancet HIV.

Overall, 62 (12%) were admitted to intensive care and 208 were discharged for supervised outpatient care.

The five HIV people (0.92%: 95%CI: 0.39 to 2.14) included three men, two were transgender and four identified as being gay men. Age ranged from 29 to 49. Community exposure risk included health work, sex work, time spent with someone diagnosed with COVID-19 and one reported a chemsex party six days earlier.

The four people on ART had undetectable viral load (two using boosted-darunavir-based and two using dolutegravir-based combinations) and CD4 counts >400 cells/mm³. One was treatment-naive and just diagnosed as a late presenter with a CD4 count of 11 cells/mm³.

Two patients had upper-respiratory tract infections, and three had viral pneumonia, including two requiring admission to the intensive care unit with invasive and non-invasive mechanical ventilation.

Experimental approaches to management of COVID-19 included switching ART for most patients to lopinavir/r plus TDF/FTC; 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.

All three patients who had pneumonia had antibacterials, corticosteroids were given to two patients and tocilizumab in one.

Four patients have since been discharged and one remains in the intensive care unit