Prolonged SARS-CoV-2 shedding in a person living with advanced HIV and diffuse large B-cell lymphoma: a case report

Abstract

Background

The global spread of SARS-CoV-2 has necessitated case isolation, with recommended isolation times based on mean time to viral clearance.

Case study

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 × 10⁶ 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 × 10⁶. 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.

Conclusions

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.

Keywords:

• HIV
• SARS-CoV-2
• viral shedding
• COVID-19
• lymphoma
• immunocompromised patients

Disclosure statement

No potential conflict of interest was reported by the authors.

Financial interests

KC has received conference and travel support from Roche, Takeda, KITE and Janssen. KC has received consulting fees from Roche, Takeda, Celgene, Atara, Gilead, KITE, Janssen, Incyte. LW has received speaker and advisory fees from ViiV, Gilead, Janssen, Ciple, Mylan and Theratech.

Non-financial interests

KC is in the speaker’s bureau for Roche, Takeda, KITE, Gilead and Incyte. LW is an investigator on ViiV, Gilead and Janssen clinical trials.

The remaining authors (IM, SMP, MS, RM & NA) have no financial or non-financial interests to disclose.

Ethics approval

Research ethics committee approval was not sought for this case report in line with NHS Health Research Authority guidance. The patient reviewed the manuscript prior to submission and provided written informed consent for publication of their clinical details. A copy of the consent form is available for review by the Editor of this journal.