Two deadly viruses in one body

COVID-19 | HIV

Fifty-six-year-old Mutebi (not real name) was a young secondary school student when he was diagnosed with HIV in 1996. Twentyfour years later, this year in April, he found himself in Entebbe Grade B Hospital, grappling with another pandemic, after testing positive for COVID-19. Elvis Basudde talked to him.

Mutebi had just returned from Nairobi, Kenya on March 18 before he was taken to Entebbe Grade B Hospital on March 24. He came by bus up to Kampala from where he got a taxi to Kyerima in Kayunga district, his home area.

Mutebi, who heads a network of people living with HIV, had gone to Nairobi to facilitate a workshop on the subject, "Living positively with

HIV". He says while still in Nairobi in early March, he started feeling severe stomach issues.

He later got extreme fatigue, a bad cough, chest discomfort, a terrible headache, and a mild fever. At the time, he thought it was food poisoning. Soon, he lost his sense of taste, though it took him a while to notice. He was throwing food out thinking it was bad yet he couldn't taste it.

"But alas, when I thought of the simultaneous symptoms I developed, coupled with serious breathing problems, I started getting apprehensive. COVID-19 was everywhere in the news," he says.

So, on returning, he saw a primary care doctor, an urologist, and a pulmonologist. Everybody was telling him there was nothing wrong with him. All tests revealed nothing amiss. Mutebi's primary care doctor decided that he must be depressed and prescribed antidepressants.

"The drugs didn't help at all. I continued experiencing unbearable pain throughout my body. When the results came out, he had tested positive for COVID-19! 

"Two deadly viruses in my body at the same time! The human immunodeficiency virus (HIV) which causes AIDS and the coronavirus which causes COVID-19! It is horrid to explain," Mutebi says.

He was taken to Entebbe Grade B Hospital, where he was quarantined for 14 days while undergoing vigorous treatment. 

He continued taking his ARVs on a daily basis, though he acknowledged that it was not easy due to the environment. His colleagues in the quarantine were asking why he was taking more medicines regularly.

On April 13, after testing negative twice and recovering from COVID-19, he was discharged.

He suspects he could have contracted the virus in Nairobi, before social distancing was the norm. He says he is grateful to the Infectious Diseases Institute (IDI) and NAFOPHANU that offered him immense support and made sure he did not run out of ARVs during that hard time.

What experts say

Dr Stephen Watiti says people living with HIV and have a compromised immune system should be extra cautious and prevent the coronavirus infection.

"Everyone whose CD4 count is low (less than 200 copies or cell), has a high viral load or a recent opportunistic infection like TB should be extra careful because their immune system may not be prepared to deal with the virus. People living with HIV are more vulnerable to respiratory infections when HIV is not well managed," he cautions.

He advises that it is important to take ARVs as prescribed. This should also apply to older people who are not living with HIV, but have an underlying health condition.

However, other health experts who are accustomed to seeing people living with HIV vulnerable to infections, share the worries of those who may have to fight off a new virus, which seems to target patients who are older and have underlying health conditions.

Yet, surprisingly, they say, there is little evidence to date that HIV puts people at higher risk of COVID-19. For those who are living with HIV but under treatment with ARVs, they say it may be other background conditions such as diabetes, hypertension, obesity, and a history of smoking that leave them vulnerable.

Dr Rachel Bender Ignacio from the University of Washington Medical Centre, says people living with HIV have a higher frequency of those traditional risk factors but adds that to get a better handle on the level of risk for people living with HIV, researchers are looking for clues in the medical records of those who have also been recently infected with COVID-19. 

Ignacio believes that doctors simply do not have answers yet to explain how and why COVID-19 behaves so differently within its human hosts. The disease is so new that doctors are exploring whether immune suppression itself might be a biological advantage against the virus.

He says people with HIV are more likely to acquire COVID-19, but we do not know if HIV puts someone at a lower or higher risk of severe disease. 

With this new pandemic, patients who seem to fare the worst are those whose own immune system revs up so powerfully that their lungs flood with inflammatory hormones and cellular debris. 

Another research shows that people living with HIV often have a more aggressive immune response, because it is constantly being activated by the virus.

"But then they can experience immune exhaustion. It is like running a marathon. It all means that HIV is still a wild card in terms of COVID-19 risk. Until we gather data, we just won't know," he says.

His HIV experience

In 1996, Mutebi started losing weight abnormally and then developed herpes zoster. He suspected that he could be HIV positive and he was terrified. He subsequently became increasingly weak.

This forced him to go for an HIV test at the AIDS Information Centre (AIC). His suspicion was correct; he tested positive. He fell critically sick and was admitted at AIC, where he stayed for six months.

His face was sunken; he looked frail, emaciated, and pale. He started giving up, knowing he was going to die. He was feeding through stomach tubes and became unconscious for weeks. He was subsequently discharged to go and die from his home.

"Naturally, I was scared as hell," he recalled. "I knew that the new drugs were kind of turning things around, but in those days if you met a group of people, one year they were fine, the next year they were sick, the next year, gone."

Mutebi says he managed to cope and live because he accepted his status and infection as part of his life, refusing to interpret his condition as terminal. 

He says the ARVs gave him a new lease of life and he has since been living positively with the virus.