LAUSR

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: It is well known now that COVID-19 cause lymphopenia. In the retrospective study the number of total T cells, CD4+ and CD8+ T cells were dramatically reduced in COVID-19 patients, especially in patients requiring Intensive Care Unit (ICU) care. (1) Lymphopenia and drastic reduction of CD4+ T cell counts in COVID-19 patients have been linked with poor clinical outcome too. (2) We present a case of a patient with well controlled HIV infection with stable absolute CD4 count but significant drop during COVID infection CASE PRESENTATION: A 67 year-old-man with history of HIV on ARV therapy with undetectable viral load, panhypopituitarism with central hypothyroidism, adrenal insufficiency and hypogonadism, recurrent DVT/PE on AC therapy, BPH, overactive bladder, stable angina presented with 3 days of fever, chills, diarrhea and malaise to ER. He received first dose of Moderna vaccine 2 weeks before admission. VS -saturation 79% on RA, and 96% on NRB mask, HR 122 beats/min, BP 159/87 mmHg, RR 18/min, T 101. PE unremarkable. Labs: Covid PCR +, WBC 15.3 K/cmm, ferritin 585.8 ng/ml, LDH 489 U/LAST 122 U/l, ALT 100U/L, CRP quant 321 mg/L, D dimer 1287 D-DU ng/ml, HIV RNA quant undetectable, CD4 67 cell/Ul, previous CD4 568 cmm 2 weeks prior admission. CXR:b/l patchy infiltrates. He was treated with dexamethasone, therapeutic Lovenox and received 1 U of convalescent plasma. His oxygen saturation improved, overall course was uneventful and patient was discharged home. CD4 count improved to 523 cmm 2 months later. DISCUSSION: It is shown that HIV infection does not increase the occurrence of COVID-19 and there is no increase in morbidity and mortality (2). The exact influence of COVID-19 on absolute T4 cells subset in HIV and their significance is presently unknown. Our patient had stable absolute CD4 count for years. He was compliant with ART and HIV viral load was undetectable. However, there was a drastic decline in his CD4 count that occurred during an acute COVID infection although he was on the same medications. CD4 recovered to baseline after COVID infection resolved. CONCLUSIONS: This is a unique case with such a dramatic drop of absolute CD4 count in acute COVID infection and further investigation on CD4 cells and it effects on HIV infection will need to be studied. REFERENCE #1: Diao B, Wang C, Tan Y, et al. Reduction and Functional Exhaustion of T Cells in Patients With Coronavirus Disease 2019 (COVID-19). Front Immunol. 2020;11:827. Published 2020 May 1. doi:10.3389/fimmu.2020.00827 REFERENCE #2: Peng Xiaorong, Ouyang Jing, Isnard Stéphane, Lin John, Fombuena Brandon, Zhu Biao, Routy Jean-Pierre, Sharing CD4+ T Cell Loss: When COVID-19 and HIV Collide on Immune System, JOURNAL=Frontiers in Immunology VOLUME=11, YEAR=2020, PAGES=3307, URL=https://www.frontiersin.org/article/10.3389/fimmu.2020.596631 DOI=10.3389/fimmu.2020.596631, ISSN=1664-3224 DISCLOSURES: no disclosure on file for Moses Bachan;no disclosure on file for Zinobia Khan;No relevant relationships by Mirjana Petrovic Elbaz, source=Web Response No relevant relationships by Robert Siegel, source=Web Response