HIV testing during the COVID-19 pandemic

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
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- Kelly S
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- Tavare AN
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- Choy CY
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- Coleman JJ
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- British HIV Association, British Association for Sexual Health and HIV, British Infection Association.
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