A Case of Prolonged SARS-CoV-2 Shedding and HIV Co-infection: Clinical and Diagnostic Challenges

BACKGROUND: Co-infection of SARS-CoV-2 and HIV presents unique challenges for patients, including potential barriers to accessing care and social support. In the present case report, an unexpected revelation of HIV status was made in an asymptomatic individual who was concurrently infected with SARS-CoV-2. There is insufficient information on asymptomatic but SARS-CoV-2-positive carriers, who have been identified only because of contact tracing and surveillance. Asymptomatic individuals co-infected with SARS-CoV-2 and HIV pose a significant challenge, not only for the patients and their families, but also for the broader community, highlighting the need for enhanced awareness, testing, and contact tracing strategies. CASE PRESENTATION: This study reports a case of a routine surveillance-based asymptomatic patient who was consistently SARS-CoV-2 positive from June to August 2021 by real-time PCR. Clinical investigations revealed that all vital parameters and laboratory tests were within normal limits, except for a notable elevation in D-dimer levels. The patient was vaccinated with two doses of Covishield, with the second dose administered during the quarantine period. The patient was followed up after six months, and we came to know that the patient's condition deteriorated in the month of November 2021, and he was tested HIV positive during his admission to a tertiary care hospital. Later on, he died in March 2022. CONCLUSION: To our knowledge, this is the first study reporting accidental finding of HIV in a SARS-CoV-2 asymptomatic patient who was previously false negative. The persis-tence of SARS-CoV-2 in this case highlights the importance of comprehensive diagnostic workups and careful clinical management in patients with co-infections. This report also highlights the high risk of silent transmission of SARS-CoV-2 by asymptomatic individu-als, emphasizing the need to include such cases in dynamic surveillance strategies to pre-vent further spread. Along with this, the study highlights the need for further investigation into the interplay between HIV co-infection, COVID-19 vaccination outcomes, and the dynamics of SARS-CoV-2 shedding.