Maan Irfaan, Paraskevopoulou Stavroula Maria, Cwynarski Kate, Shrestha Meena, Waters Laura, Miller Robert, Ahmed Nadia
Institute for Global Health, University College London, London, UK.
Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK.
Infect Dis (Lond). 2022 Jul;54(7):529-533. doi: 10.1080/23744235.2022.2055136. Epub 2022 Mar 29.
The global spread of SARS-CoV-2 has necessitated case isolation, with recommended isolation times based on mean time to viral clearance.
We present a 28-year-old female living with vertically acquired HIV, undergoing chemotherapy for lymphoma who tested SARS-CoV-2-PCR positive for 164 days. The patient had a history of difficulty taking ARVs, with detectable HIV-RNA and CD4 count below 200 × 10 for the 8 years prior to presentation with symptoms. She stopped ARVs 10 months prior to experiencing fevers, night sweats and loose stool, with a viral load of 354,000 copies/ml and CD4 count of 30 × 10. Following no yield on basic investigations, positron emission tomography scan showed diffuse colonic and oesophageal avidity and a caecal biopsy showed diffuse large B-cell lymphoma. She re-started ARVs and underwent five cycles of R-CHOP chemotherapy. Her first positive SARS-CoV-2 PCR test was detected through routine asymptomatic screening. She self-isolated due to repeated positive tests on a further 8 swabs for a total of 164 days until a negative PCR test. She reported feeling low in mood and frustrated by repeated positive tests and the associated lack of social contact or ability to work. Her positive tests prevented in-person review by her HIV team, which impacted her ARV adherence leading to an unplanned break in therapy.
Our case highlights the challenges to physical and mental health faced by patients with prolonged SARS-CoV-2 shedding and the need to develop surrogate markers for infectivity to enable prompt medical and psychological support and accurate advice about the need for isolation.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）在全球的传播使得病例隔离成为必要，推荐的隔离时间基于病毒清除的平均时间。
我们报告一名28岁的女性，她患有垂直传播的艾滋病病毒（HIV），正在接受淋巴瘤化疗，其SARS-CoV-2聚合酶链反应（PCR）检测呈阳性达164天。该患者有服用抗逆转录病毒药物（ARVs）困难的病史，在出现症状前的8年里，其HIV核糖核酸（RNA）可检测到，且CD4细胞计数低于200×10⁶。在出现发热、盗汗和腹泻前10个月，她停止服用ARVs，病毒载量为354,000拷贝/毫升，CD4细胞计数为30×10⁶。基础检查未发现异常，正电子发射断层扫描显示结肠和食管弥漫性摄取增高，盲肠活检显示弥漫性大B细胞淋巴瘤。她重新开始服用ARVs并接受了5个周期的利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）化疗。她的第一次SARS-CoV-2 PCR检测阳性是通过常规无症状筛查发现的。由于另外8次拭子检测反复呈阳性，她自我隔离了总共164天，直到PCR检测呈阴性。她报告情绪低落，对反复的阳性检测以及随之而来的缺乏社交接触或工作能力感到沮丧。她的阳性检测结果妨碍了艾滋病团队对她进行面对面的复查，这影响了她对ARVs的依从性，导致治疗出现意外中断。
我们的病例突出了SARS-CoV-2长期排毒患者所面临的身心健康挑战，以及开发传染性替代标志物的必要性，以便能够及时提供医疗和心理支持，并就隔离需求提供准确建议。
