Title: COVID-19 Infection in Pregnancy with Human Immunodeficiency Virus: A Case Series

Objective: The effects of COVID-19 on patients with HIV have not been well studied extensively. Knowing the effects of COVID-19 disease in vulnerable populations, like pregnant patients with HIV, can help us in obtaining good clinical outcomes and prevent possible maternal morbidity and mortality.

Case Presentation: This paper presents four cases of HIV pregnant patients with COVID-19 co-infection. Three were asymptomatic while the remaining one had mild symptoms (cough, colds, and ageusia). All of them were on anti-retroviral therapy (ART): A tenofovir-based regimen. Their CD4 count levels were within acceptable levels (316-950 cell/mm³) and a majority of them were virally suppressed. All of them had good clinical outcomes.

Discussion: Contradicting theories were observed in studies on COVID-19 and PLWH. Some suggested that HIV infection can increase the risk of having a poorer course of COVID-19 because of the abnormal immune response but some, due to the mild immunosuppression and the possible protection from ART, believed that HIV patients may show a milder presentation. Based on the clinical course of our index cases, which was also supported by several studies, it showed that the clinical presentation, levels of inflammatory markers, and course of COVID-19 disease were similar for the general population and in PLWH. Current evidence also showed that the risk of disease severity is dependent on the chronic medical conditions commonly present in PLWH like cardiovascular diseases, chronic lung disease, and diabetes. Our index cases can somehow possibly benefit from the lymphopenia caused by HIV infection and the immunomodulatory effects of Tenofovir, but these assumptions need to be supported by more research and more randomized clinical trials.

Conclusion: Several studies about HIV and COVID-19 have been published but there is still no consensus on how HIV infection affects the risk of having COVID-19 infection and how HIV influences its clinical course. It was shown in the four index cases that there is no difference in COVID-19 severity and clinical course between persons living with HIV (PLWH) and HIV-negative patients, which was also supported by several clinical studies. There is also not enough evidence to conclude that there is a higher prevalence of COVID-19 among PLWH. Further investigation into the relationship between COVID-19 outcomes and CD4+ T cell count, HIV viral load, ART, and the use of Tenofovir is warranted.