一名感染艾滋病毒的青少年感染 COVID-19 的临床病例

T. A. Kaplina, D. Ivanov, V. N. Timchenko, S. L. Bannova, G. V. Kondratyev, V. Sukhovetskaya, M. Subbotina, E. B. Pavlova, A. Nazarova, A. V. Fedorova, O. V. Bulina
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The stage of HIV infection, indicators of the immune status, viremia, and taking antiretroviral therapy correlate with the severity of the course of COVID-19/HIV and have prognostic value. A clinical observation of the course of a new coronavirus infection in a 15-year-old teenager born to an HIV infected mother (who hid her HIV status at the time of hospitalization of a child) who was not at a dispensary observation at the AIDS Center was presented. The child was hospitalized with a new coronavirus infection (COVID-19), complicated: acute community-acquired (interstitial) bilateral pneumonia. The low index body mass of the child, the presence of concomitant pathology, the non-smooth course of the disease made it possible to suspect the patient of an immunodeficiency condition and identify concomitant HIV infection in the secondary disease stage (4B), the progression phase with the absence of antiretroviral therapy. 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摘要

COVID-19 在有严重并发症的人群中的不平稳病程是一个热点问题。在患有肥胖症、慢性支气管肺病、心血管疾病、艾滋病毒感染、糖尿病、肿瘤等疾病的人群中,死于新型冠状病毒感染的人数最多。由于医疗系统将重点放在 COVID-19 大流行病上,对免疫缺陷病毒的防治关注较少,尽管俄罗 斯联邦艾滋病毒感染的流行病学形势依然紧张。艾滋病毒感染者可能会增加 COVID-19 并发症和死亡的风险。艾滋病病毒感染的阶段、免疫状态指标、病毒血症和接受抗逆转录病毒治疗的情况与 COVID-19/HIV 病程的严重程度相关,并具有预后价值。本文介绍了对一名 15 岁少年新冠状病毒感染病程的临床观察,该少年的母亲是一名艾滋病病毒感染者(在孩子住院时隐瞒了自己的艾滋病病毒感染状况),但她并未在艾滋病中心接受诊疗观察。患儿因新型冠状病毒感染(COVID-19)住院,并发急性社区获得性(间质性)双侧肺炎。由于患儿体重指数较低、存在并发症、病程不平稳,因此怀疑患者患有免疫缺陷病,并在继发疾病阶段(4B),即缺乏抗逆转录病毒治疗的进展阶段发现了并发的艾滋病病毒感染。结论:病程不平稳和病情严重主要是由于继发感染病理所致。在一名感染艾滋病毒的儿童身上发现的严重免疫抑制导致了 SARS-CoV-2 病毒的长期存在。在这个病例中,并不能确定患者的艾滋病毒感染是导致 COVID-19 严重病程和预后不利的因素。包括抗逆转录病毒疗法在内的复合疗法阻止了免疫抑制的进一步发展,使患者从新的冠状病毒感染中恢复过来,并控制了合并症。处于感染晚期的艾滋病毒感染者人数增加,他们往往在住院期间才被偶然发现,由于诊断较晚、合并继发性病变以及在免疫状态参数较低的背景下病程的严重性,给治疗带来了困难。
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Clinical case of COVID-19 in an HIV-infected teenager
The problem of non-smooth course of COVID-19 in people with severe comorbidities is topical. The greatest number of deaths from a new coronavirus infection was noted in the presence of such diseases as: obesity, chronic bronchopulmonary, cardiovascular diseases, HIV infection, diabetes mellitus, oncohematology, etc. Due to the focus of the healthcare system on the COVID-19 pandemic, less attention is paid to the fight against the immunodeficiency virus, despite the fact that the epidemiological situation with HIV infection in the Russian Federation continues to be tense. Individuals with HIV infection may be at increased risk of complications and death associated with COVID-19. The stage of HIV infection, indicators of the immune status, viremia, and taking antiretroviral therapy correlate with the severity of the course of COVID-19/HIV and have prognostic value. A clinical observation of the course of a new coronavirus infection in a 15-year-old teenager born to an HIV infected mother (who hid her HIV status at the time of hospitalization of a child) who was not at a dispensary observation at the AIDS Center was presented. The child was hospitalized with a new coronavirus infection (COVID-19), complicated: acute community-acquired (interstitial) bilateral pneumonia. The low index body mass of the child, the presence of concomitant pathology, the non-smooth course of the disease made it possible to suspect the patient of an immunodeficiency condition and identify concomitant HIV infection in the secondary disease stage (4B), the progression phase with the absence of antiretroviral therapy. Conclusion: the non-smooth course and severity of the disease were mainly due to secondary infections pathology. Severe immunosuppression detected in a child due to HIV infection contributed to the long-term persistence of the SARS-CoV-2 virus. In this case, it was not established that HIV infection in the patient was a factor predisposing to the severe course of COVID-19 and contributing to a prognostically unfavorable outcome. Complex therapy including antiretroviral therapy prevented further progression of immunosuppression and led to recovery from new coronavirus infection and management of comorbidity. The increase in the number of HIV-infected persons in the late stages of infection, often detected by chance, only during hospitalization, presents difficulties for therapy due to late diagnosis, the presence of a combined secondary pathology and the severity of its course against the background of low immune status parameters.
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