Monitoring SARS-CoV-2 Viral Load and CD4+ T-cell Count After ART in a Patient Diagnosed With AIDS Following SARS-CoV-2 Infection: A Case Report

Abstract

We describe the case of a 36-year-old man diagnosed with human immunodeficiency virus (HIV) following prolonged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. The patient had a complication of pneumocystis pneumonia. Upon initiating highly active antiretroviral therapy, we monitored HIV RNA levels, CD4+ T-cell count, SARS-CoV-2 viral load, and IgG antibodies against SARS-CoV-2. At 167 days post SARS-CoV-2 diagnosis, the patient's CD4+ T-cell count increased to 180 cells/μL. IgG antibodies against SARS-CoV-2 were undetectable despite a decreased SARS-CoV-2 viral load. HIV screening is necessary in cases of prolonged SARS-CoV-2 pneumonia or persistent SARS-CoV-2 shedding. When diagnosed with HIV infection, it is advisable to consider the possibility of pneumocystis pneumonia.

Keywords: acquired immune deficiency syndrome (aids); aids; hiv; pneumocystis pneumonia; sars-cov-2.

Figure 1. CT scan of the chest. (a) At eight days after the diagnosis of SARS-CoV-2 infection, diffuse ground-glass opacities are observed. (b) At 24 days after the diagnosis of SARS-CoV-2 infection, diffuse ground-glass opacities and infiltrative shadows in the left lower lobe are observed.

CT: computed tomography; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.

Figure 2. Changes in the cycle threshold value of SARS-CoV-2 viral load, HIV-RNA load, and CD4+ T-cell count.

The graph illustrates the changes in cycle threshold value of SARS-CoV-2, HIV-RNA load, and CD4+ T-cell count. On day 137 after the diagnosis of SARS-CoV2 infection, the HIV-RNA load became undetectable below the sensitivity threshold. On day 165 after the diagnosis of SARS-CoV-2 infection, the patient’s CD4+ T-cell count increased to 180 cells/μL, with a decrease in the SARS-CoV-2 viral load, observed with a cycle threshold value of 36.5. SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; HIV: human immunodeficiency virus.