COVID-19 Complications in a Newly Diagnosed HIV Patient: A Case of Multiple Herpesvirus Reactivation and HLH Post-ART Initiation.

BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can trigger profound immune activation and systemic inflammation, leading to severe, often fatal, conditions. Simultaneously, HIV-infected patients, prone to immune dysregulation, face an increased risk of severe complications from SARS-CoV-2. The optimal timeline for initiating antiretroviral therapy (ART) in patients with severe SARS-CoV-2 and HIV co-infection, especially concerning the risk of HLH, remains uncertain. CASE REPORT We detail the case of a 47-year-old male with previously undiagnosed HIV who, following ART initiation, developed HLH amid SARS-CoV-2 co-infection. The patient also had biopsy-proven Kaposi Sarcoma with immunoreactivity to Human Herpesvirus 8 (HHV-8), detectable peripheral blood Epstein Barr virus (EBV) DNA PCR and Cytomegalovirus (CMV) DNA PCR, and suspected Pneumocystis jirovecii pneumonia. We believe these conditions contributed to the development of HLH. This case represents a unique report of multiple herpesviruses reactivation, acquired HLH during COVID-19 in a patient with previously undiagnosed HIV. Despite receiving ART, steroids, and appropriate antimicrobial therapy, the patient's condition did not improve. CONCLUSIONS Further research is required to understand immune dysregulation, including HLH, in patients with HIV and SARS-CoV-2 co-infection. The effects of ART initiation on treatment-naïve patients with potential concurrent opportunistic infections and/or herpesvirus reactivation warrant deeper examination to formulate clinical guidelines.

Mitigating medical student stress and anxiety: Should schools mandate participation in wellness intervention programs?

PURPOSE: Medical students are at increased risk of poor mental health and need to regularly engage in preventive programs to maintain well-being. However, many do not and it remains an open question whether these programs should be mandatory. We implemented a RCT to examine the effectiveness of assigning medical students to a wellness intervention on adherence to engagement in the assigned intervention and on psychological and academic outcomes. METHOD: Medical students participated in a 12-week randomized controlled intervention involving one-hour wellness sessions of either (1) yoga; (2) mindfulness; or (3) walking, held twice-weekly. Students completed standardized psychological assessments at baseline and following the intervention. RESULTS: Students randomized to the wellness intervention group engaged in more minutes of assigned activities than students randomized to the control. There was a significant difference in the change from pre- to post- intervention on measures of state anxiety and perceived stress, with better outcomes for the intervention group. CONCLUSIONS: The assignment of twice-weekly wellness intervention sessions protects medical students from state anxiety and perceived stress with no negative impact on academic performance. Students adhered to the sessions and reported enjoying the sessions once trying them. Actual engagement is more important than wellness activity type.