{"doi":"10.1016/j.eclinm.2020.100342","title":"SARS-CoV-2 pandemic expanding in sub-Saharan Africa: Considerations for COVID-19 in people living with HIV","abstract":"In December 2019, a novel coronavirus, SARS-CoV-2, started a global pandemic of respiratory illness, termed COVID-19 [[1]Huang C. Wang Y. Li X. Ren L. Zhao J. Hu Y. et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet. 2020; 395: 497-506Summary Full Text Full Text PDF PubMed Scopus (30869) Google Scholar]. The spectrum of COVID-19 has ranged from a mild, self-limiting respiratory tract illness to severe progressive pneumonia, multi-organ failure, and death [[2]Chen N. Zhou M. Dong X. Qu J. Gong F. Han Y. et al.Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study.Lancet. 2020; 395: 507-513Summary Full Text Full Text PDF PubMed Scopus (13556) Google Scholar]. Older patients and those with a weaker immune system appear to have a greater risk of death [[3]Wang D. Hu B. Hu C. Zhu F. Liu X. Zhang J. et al.Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.JAMA. 2020; 323 (Epub ahead of print): 1061-1069Crossref PubMed Scopus (15366) Google Scholar]. Thus far, the vast majority of deaths from COVID-19 have occurred in Italy, China, Iran, and Spain—all Northern hemisphere countries with good health care resources and a low HIV prevalence. After the SARS-CoV-2 pandemic reached sub-Saharan Africa, COVID-19 cases may expand more quickly in high HIV prevalence communities with poor health resources. The first reported cases of COVID-19 in South Africa occurred in early March from travelers who returned from Italy. South Africa has since reported over 400 cases (as of this writing), and the number continues to grow each day. Given the rapid spread of SARS-CoV-2 in South Africa, it now seems likely that COVID-19 cases will occur in all sub-Saharan African countries (Fig. 1). Perhaps what may be less certain is how SARS-CoV-2 will spread in HIV-endemic settings, and whether COVID-19 will have a higher morbidity and mortality rate among people living with HIV (PLHIV). In South Africa, where only 54% of the estimated 7.7 million PLHIV are virally suppressed and tuberculosis remains the leading cause of HIV-related mortality, these questions will need to be addressed. So far, little is known about the pathogenesis and clinical outcomes of COVID-19 in PLHIV. In this EClinicalMedicine issue, Dr. Zhao and colleagues describe a 50-year-old Chinese male living with HIV who had evidence of viral shedding for 39 days after symptom onset, but recovered after receiving human immunoglobulin, methylprednisolone, and inhaled interferon alpha-2b [[4]Li X. Jiang L. Lin F. Wang Y. Liu S. An W. et al.Successful recovery of a severe COVID-19 patient with acquired immunodeficiency syndrome.E Clin Med. 2020; Google Scholar]. Another case report described a 61‐year‐old Chinese male with a history of diabetes, who presented with acute respiratory symptoms, and was newly diagnosed with both HIV and COVID-19 pneumonia [[5]Zhu F. Cao Y. Xu S. Zhou M. Co-infection of SARS-CoV-2 and HIV in a patient in Wuhan city, China.J Med Virol. 2020; (In press)https://doi.org/10.1002/jmv.25732Crossref Scopus (112) Google Scholar]. The patient recovered after receiving steroid therapy, respiratory support, and starting antiretroviral therapy (ART). This author (PKD), however, had a 66-year-old American male with suppressed HIV recently succumb to COVID-19 pneumonia, despite ventilatory support and hydroxychloroquine. Currently, the US Centers for Disease Control and Prevention and the International AIDS Society consider PLHIV with low CD4+ T-cell count or not on ART as potentially vulnerable to more severe COVID-19 disease [[6]US Centers for Disease Control and Prevention. What to Know About HIV and COVID-19. Atlanta, GA, 2020. Accessed on April 16 at: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/hiv.html.Google Scholar]. This concern is based on data from other respiratory diseas","journal":"EClinicalMedicine","year":2020,"id":62566,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":50,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9486,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":331062,"name":"Nigel Garrett","orcid":"0000-0002-4530-234X","position":1,"is_corresponding":false},{"id":331061,"name":"Paul K. Drain","orcid":"0000-0003-3300-3817","position":0,"is_corresponding":true}],"reference_count":8,"raw_metadata":null,"created_at":"2026-07-18T21:10:35.996198Z","pmid":"32322805","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}