Prolonged SARS-CoV-2 Infection Successfully Treated with a Consecutive Combined Scheme Therapy in an HIV-Positive Patient with AIDS

Author(s): Alessandra Vergori, Francesco Baldini, Carmela Pinnetti, Susanna Grisetti, Annalisa Mondi, Giulia Matusali, Marta Camici, Fabrizio Maggi, Andrea Antinori

Purpose: Cases of persistent infection have already been widely described with some proposals for combination or extended course therapies in immunocompromised subjects, but nothing has been addressed in AIDS patients. We present a case of prolonged, mild SARS-CoV-2 infection that was successfully treated with a consecutive combined scheme of therapy.

Methods/Results: A prolonged shedding of SARS-CoV-2 was observed up to 92 days and the COVID-19 clinical manifestation was mild without evidence of pneumonia and/or acute respiratory insufficiency. The infection was not cleared after the first treatment with remdesivir IV as early treatment (for 3 days) suggesting a limited effect on SARS-CoV-2 in an immunocompromised individual. Several weeks later, a second therapeutic attempt was made with tixagevimab/cilgavimab 300/300 IM but SARS-CoV-2 RNA was still detected for further 5 weeks. A third attempt with nirmatrelvir/ritonavir determined the definitive viral clearance of SARS-CoV-2 after 92 days since the first detection.

Conclusion: Our data indicate that certain immunocompromised individuals may shed infectious virus longer and need a tailored and valuable therapeutics approach. Additional data from clinical trials are required to support a feasible approach to managing this vulnerable group of patients.