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HIV testing during the COVID-19 pandemic

Sarah Ann Filson, Anika Rahim, Victoria Parris, Alastair McGregor and Padmasayee Papineni
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DOI: https://doi.org/10.7861/clinmed.Let.21.1.6
Clin Med January 2021
Sarah Ann Filson
London North West University Healthcare NHS Trust, London, UK
Roles: Infectious diseases and microbiology registrar
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Anika Rahim
Royal Free London NHS Foundation Trust, London, UK
Roles: Internal medical trainee
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Victoria Parris
London North West University Healthcare NHS Trust, London, UK
Roles: Consultant in infectious diseases and acute medicine
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Alastair McGregor
London North West University Healthcare NHS Trust, London, UK
Roles: Consultant in infectious diseases and microbiology
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Padmasayee Papineni
London North West University Healthcare NHS Trust, London, UK
Roles: Consultant in infectious diseases and acute medicine
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Editor – We support the recommendations made in the recent report by Kelly et al for increased awareness of importance of HIV testing during the COVID-19 pandemic.1

During the UK's first wave, our hospital trust in north west London experienced a high burden of COVID-19 patients, with clinical staff quickly becoming familiar with the clinical and radiological features of COVID-19. Studies that have compared pooled nasopharyngeal aspirate results with cross-sectional imaging indicate that the sensitivity of reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2 may be very poor.2 As a result, a significant proportion of COVID-19 patients are diagnosed on the basis of typical clinical and radiological features, despite negative tests.3

Between March and June 2020, three patients were admitted with signs and symptoms consistent with COVID-19 (respiratory failure and bilateral infiltrates on chest imaging) but were COVID-19 RT-PCR negative. These patients were subsequently diagnosed with advanced HIV (mean CD4 count 62 × 106/L (range 12–108 × 106/L)) and Pneumocystis jirovecii pneumonia (PCP). Due to the initial presumed clinical diagnosis of COVID-19 there was a delay in testing for HIV and diagnosing and treating PCP.

PCP and COVID-19 are difficult to distinguish on clinical grounds, with shared symptoms including fever, dyspnoea, dry cough and fatigue; although, in COVID-19 the onset is more acute.4,5 The similar radiological findings include bilateral infiltrates with COVID-19 typically involving the lung peripheries whereas PCP is often peripherally sparing.5

Our experience highlights the importance of maintaining diagnostic vigilance when pursuing a diagnosis of COVID-19.1 We strongly advocate HIV testing all individuals presenting with acute respiratory illness, including those with ‘typical’ features of COVID-19 as per UK national guidelines.6

  • © Royal College of Physicians 2021. All rights reserved.

References

  1. ↵
    1. Kelly S
    , Waters L, Cevik M, et al. Pneumocystis pneumonia, a COVID-19 mimic, reminds us of the importance of HIV testing in COVID-19. Clin Med 2020;20:590–2.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Ai T
    , Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing for coronavirus disease 2019 (COVID-19) in China: A report of 1014 cases. Radiology 2020;296:E32–40.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Tavare AN
    , Braddy A, Brill S, et al. Managing high clinical suspicion COVID-19 inpatients with negative RT-PCR: a pragmatic and limited role for thoracic CT. Thorax 2020;75:537–8.
    OpenUrlFREE Full Text
  4. ↵
    1. Choy CY
    , Wong CS. It's not all about COVID-19: pneumocystis pneumonia in the era of a respiratory outbreak. J Int AIDS Soc 2020;23:e25533.
    OpenUrl
  5. ↵
    1. Coleman JJ
    , Manavi K, Marson EJ, et al. COVID-19: to be or not to be; that is the diagnostic question. Postgrad Med J 2020;96:392–8.
    OpenUrlAbstract/FREE Full Text
  6. ↵
    1. British HIV Association, British Association for Sexual Health and HIV, British Infection Association.
    British HIV Association / British Association for Sexual Health and HIV / British Infection Association adult HIV testing guidelines 2020. BHIVA, 2020. www.bhiva.org/file/5f68c0dd7aefb/HIV-testing-guidelines-2020.pdf [Accessed 23 November 2020].
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HIV testing during the COVID-19 pandemic
Sarah Ann Filson, Anika Rahim, Victoria Parris, Alastair McGregor, Padmasayee Papineni
Clinical Medicine Jan 2021, 21 (1) e118-e119; DOI: 10.7861/clinmed.Let.21.1.6

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HIV testing during the COVID-19 pandemic
Sarah Ann Filson, Anika Rahim, Victoria Parris, Alastair McGregor, Padmasayee Papineni
Clinical Medicine Jan 2021, 21 (1) e118-e119; DOI: 10.7861/clinmed.Let.21.1.6
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