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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (04) : 282 -286. doi: 10.3877/cma.j.issn.1674-1358.2023.04.010

病例报告

两例获得性免疫缺陷综合征合并新型冠状病毒感染者抗病毒治疗并文献复习
吴令杰†(), 陈瑞烈, 陈桂佳, 肖湘明, 林钟滨   
  1. 515041　汕头市，汕头市中心医院感染科
  • 收稿日期:2023-05-06 出版日期:2023-08-15
  • 通信作者: 吴令杰
  • 基金资助:
    广东省医学科研基金(No. B2019247); 汕头市医疗卫生科技计划(No.汕府科[2021]114号28)

Antiviral treatment of two cases with human immunodeficiency virus complicated with severe acute respiratory syndrome coronavirus 2 co-infection and literatures review

Lingjie Wu†(), Ruilie Chen, Guijia Chen, Xiangming Xiao, Zhongbin Lin   

  1. Department of Infectious Diseases, Shantou Central Hospital, Shantou 515041, China
  • Received:2023-05-06 Published:2023-08-15
  • Corresponding author: Lingjie Wu
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吴令杰, 陈瑞烈, 陈桂佳, 肖湘明, 林钟滨. 两例获得性免疫缺陷综合征合并新型冠状病毒感染者抗病毒治疗并文献复习[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(04): 282-286.

Lingjie Wu, Ruilie Chen, Guijia Chen, Xiangming Xiao, Zhongbin Lin. Antiviral treatment of two cases with human immunodeficiency virus complicated with severe acute respiratory syndrome coronavirus 2 co-infection and literatures review[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2023, 17(04): 282-286.

目的

提高获得性免疫缺陷综合征（AIDS）合并新型冠状病毒（SARS-CoV-2）感染抗病毒治疗的认识。

方法

分析2023年2月汕头市中心医院收治的2例AIDS患者合并SARS-CoV-2感染的诊治过程并结合相关文献复习。

结果

2例AIDS患者均因呼吸道感染症状来院就诊，均合并口腔念珠菌感染，胸部CT影像学提示双肺多发磨玻璃样改变，入院后查SARS-CoV-2核酸阳性，使用奈玛特韦利托那韦抗病毒、抗感染等对症支持治疗后，SARS-CoV-2核酸转阴时间分别为抗病毒治疗后第4天、第3天，呼吸道症状改善，均好转出院；出院1个月后随访，2例患者均无发热，仍有咳嗽，但较前改善，伴疲乏症状。

结论

AIDS合并SARS-CoV-2感染者仍以下呼吸道感染为主要临床表现；CD4+ T淋巴细胞水平可能不影响患者转归；积极抗SARS-CoV-2治疗可改善患者预后。

关键词: 获得性免疫缺陷综合征, 新型冠状病毒, 奈玛特韦/利托那韦
Objetctive

To improve the understanding of antiviral treatment for human immunodefeciency virus (HIV) complicated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infection.

Method

The diagnosis and treatment process of 2 patients with HIV/SARS-CoV-2 co-infection admitted to Shantou Central Hospital on February 2023 were analyzed and relevant literature were reviewed.

Results

Two HIV infected patients presented with respiratory symptoms were admitted to our hospital. Both patients had oral candidiasis and chest CT imaging showed multiple ground-glass opacities in lungs. After admission, they were detected positive for SARS-CoV-2 nucleic acid. They received antiviral and anti-infection treatments such as Nirmatrelvir Tablets/Ritonavir Tablets. SARS-CoV-2 nucleic acid turned negative in two patients on the 4th days and 3rd day after using Nirmatrelvir Tablets/Ritonavir Tablets. Their respiratory symptoms improved and they were discharged. One month after discharge, the patients did not have a fever but still had coughing, although both improved compared to before. They also experienced fatigue symptoms during the follow-up visits.

Conclusions

HIV/SARS-CoV-2 co-infected patients still mainly presents lower respiratory tract infections as the primary clinical manifestation. CD4+ T lymphocyte levels may not affect the outcomes of HIV/SARS-CoV-2 co-infection. However, antiviral treatments for SARS-CoV-2 can improve the prognosis of HIV/SARS-CoV-2 co-infection, which should be paid more attention.

Key words: Acquired immunodeficiency syndrome, Severe acute respiratory syndrome coronavirus-2, Nirmatrelvir/Ritonavir
表1 两例AIDS合并SARS-CoV-2感染者临床资料
临床资料 病例1 病例2
性别 女 男
年龄（岁） 59 34
基础疾病 AIDS（经治） AIDS（初治）
CD4+ T（个/μl） 7 8
HIV确诊时间 2018年6月 2023年2月
AIDS分期 Ⅳ期（WHO） Ⅳ期（WHO）
HAART治疗起始时间 2022年12月 2023年2月
HAART治疗方案 3TC + TDF + LPV/r 3TC + TDF + EFV
HAART不良反应 纳差、恶心、呕吐 无
SPO2 96%~100%（未吸氧） 95%~99%（吸氧2 L/min）
胸部CT 双肺可见多发磨玻璃、斑絮片状密度增高模糊影 双肺弥漫性小片状、结节状磨玻璃密度影
WBC（× 109/L） 6.56 8.05
LYM（× 109/L） 0.8 1.1
PLT（× 109/L） 221 310
CRP（mg/L） 9.28 35.0
PCT（ng/ml） 0.297 0.305
LDH（U/L） — 359.00
疾病分型 中型 重型
临床治疗与预后    
抗病毒治疗 奈玛特韦/利托那韦 奈玛特韦/利托那韦
糖皮质激素 未使用 未使用
抗病毒后核酸转阴（d） 4 3
住院天数（d） 19 16
1个月后随访 咳嗽，无气促 疲劳
图1 病例1胸部CT注：A：急诊入院时胸部X片（黑色箭头示肺纹理增粗）；B：出院前胸部X片（黑色箭头示肺纹理增粗较前改善）；C：急诊入院时胸部CT（白色箭头示双肺磨玻璃样）；D：住院治疗2周后胸部CT（白色箭头示双肺磨玻璃样吸收减少）
图2 病例2住院前急诊胸部CT注：黑色箭头所示患者双肺弥漫性炎症渗出性改变
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