Unusual association of COVID-19, pulmonary tuberculosis and human immunodeficiency virus, having progressed favorably under treatment with chloroquine and rifampin

Abstract

Infection with the new coronavirus has been declared an international health emergency. Its curative treatment is unknown and is the subject of several clinical trials. In addition, the concomitant association of COVID-19 with tuberculosis and the human immunodeficiency virus, hitherto never described, is potentially fatal. We report the illustrative case of a 32-year-old patient who presented this trifecta of infections and who did well under treatment with chloroquine and anti-mycobacterial drugs. This patient arrived at the ER with respiratory discomfort that had been evolving over a month with symptoms of flu and deterioration of her general condition. A chest CT scan revealed an aspect of lung miliary tuberculosis with isolation of Koch’s bacilli in the sputum. A polymerization chain reaction (PCR) was positive for COVID-19 on a nasopharyngeal swab. HIV serology was positive. The course was marked by a spectacular clinical improvement and two negative COVID-19 PCR controls at the end of treatment (at days 9 and 10). Anti-tubercular drugs (especially, rifampin) are powerful enzyme inducers that can reduce the effectiveness of chloroquine in our patient. This therapeutic success may be linked to the effect of anti-tubercular drugs against SARS ncov-2, especially rifampin, inhibiting the formation of messenger RNAs of SARS ncov-2 or to the synergistic effect of chloroquine and rifampin. Researchers should explore the effect of these drugs on SARS ncov-2.

Overview of SARS-CoV-2 infection in adults living with HIV

“…Although, reports of high frequency of pneumonia caused by P jirovecii resulting from COVID-19-induced lymphopenia are scarce. Finally, concomitant diagnoses should be considered, such as COVID-19 and tuberculosis, 70 pneumonia caused by P jirovecii , 69 , 71 or cryptococcosis.…”

A Pandemic within Other Pandemics. When a Multiple Infection of a Host Occurs: SARS-CoV-2, HIV and Mycobacterium tuberculosis

“…Thus, 84 studies finally met our inclusion criteria ( Supplementary File S3 ), three of them reporting a detailed description of cases with the three concomitant infections: HIV, TB, and SARS-CoV-2 ( Supplementary File S4 ) [ 37 , 38 , 39 ].…”

“…In addition, HCQ and CQ were proposed as treatment for COVID-19 also in the dawn of this pandemic, but recent clinical studies on COVID-19 patients treated with CQ/HCQ and AZM led to controversial results because of their inefficacy and adverse side effects [ 45 , 46 , 47 ]. All the patients in the cases series reviewed were completely recovered though ( Supplementary File S4 ) [ 37 , 38 , 39 ].…”

“…HIV and TB co-infection was known but uncontrolled in only one case [ 38 ]. In addition, both infections were previously unidentified and simultaneously diagnosed in two out of all cases [ 37 , 39 ].…”

Covid-19, Hiv E Tuberculose: Riscos E Ameaças Da Coinfecção Tripla

“…À luz do acima exposto, acredita-se que os pacientes com COVID-19 com doenças coexistentes como TB e HIV podem ter consequências deletérias em todas as fases da infecção com COVID-19 [7]. Pacientes que vivem com HIV podem ter maior risco de desenvolver fases mais graves da COVID-19 e desfechos clínicos complicados devido a várias razões: como sistema imunológico fraco, presença de várias co-infecções e efeito colateral do medicamento de anti-retrovirais (TARV) [8,12]. Além disso, o diagnóstico e o manejo da co-infecção TB e COVID-19 são desafiadores devido à semelhança das características clínicas, o que pode levar a diagnósticos errados das doenças.…”