The patient was a 23-year-old woman who had been diagnosed with HIV 17 years prior and had since received standard antiretroviral therapy (ART). Notably, she had switched from first line to simplified dual regimen (abacavir-lamivudine-efavirenz to lamivudine-dolutegravir) due to adverse events. She was diagnosed with TB five months prior, when her sputum smear was positive for acid-fast bacilli and the sputum culture subsequently grew TB. She was treated with rifampin, isoniazid, ethambutol, and pyrazinamide. According to "Chinese Guidelines for HIV/AIDS Diagnosis and Treatment", when she was diagnosed with SARS-CoV-2 infection, she was in the AIDS stage due to poor adherence to antiretroviral medications with an HIV load of <100 viral copies/mL and a CD4+ T-cell count of 7 cells/microL.
On hospital day 1, the patient had a positive PCR test for SARS-CoV-2 in a hospital screening. She was referred to a local hospital with constitutional symptoms, including intermittent fever with chills. She had no cough or expectoration but was diagnosed with anemia and TB 5 months prior. There were no retrievable previous trends to compare.
On hospital day 6, the patient was transferred to the Southern Hospital of Zhengzhou First People's Hospital. She had fever and chills, her temperature was 39.0 C at admission, and her SPO2 was 100% (without oxygen inhalation). She had density shadows in both lungs but had no respiratory distress and had normal oxygen saturation. The patient was found to have normochromic anemia with a hemoglobin level of 85 g/L. Additional blood test results are presented in Table 1. TB and COVID-19 were managed with azithromycin, moxifloxacin, isoniazid, rifabutin, and ethambutol, and ART was continued with lamivudine and dolutegravir. Anemia was treated by transfusion with suspended red blood cells. On hospital day 8, chest computed tomography (CT) scanning revealed substantial pulmonary lesions (Figure 1). 
On hospital day 13, the patient reported fever (temperature of up to 38.8 C), but no cough, sputum cough, chest tightness, or shortness of breath. Laboratory tests results are presented in Table 1. A diagnosis of disseminated MAC infection was made by two sputum cultures positive for MAC. Co-infection is a high-risk factor for the progression of COVID-19 to severe and the patient was treated with BRII-196+BRII198 monoclonal antibody therapy. MAC was managed with moxifloxacin, azithromycin, rifabutin and ethambutol, sulfamethoxazole given orally this compound also helps to prevent pneumocystis pneumonia (PCP). Thymalfasin was given to improve immunity, low molecular weight heparin calcium was given as an anticoagulant therapy, and the other treatments described above were continued. On hospital day 16, the chest CT scan showed a thin ground-glass density shadow in both lungs, but it was slightly smaller than in previous scans (Figure 2). Laboratory tests showed C-reactive protein (CRP) of 87.6 mg/L. Azithromycin and moxifloxacin were added to the treatment protocol for anti-infection treatment, and amikacin was used as an anti-MAC treatment. 
On hospital day 27, the patient had intermittent fever and pain in the left abdomen and the blood test results are presented in Table 1. Chest CT scanning was performed, which showed significant improvement of the pulmonary lesions (Figure 3). On hospital day 31, the patient received convalescent plasma therapy. 
During days 35-48 of hospitalization, the patient had stable signs and did not have cough, fever, chest tightness, or shortness of breath. The treatments described above were continued.
During days 49-54 of hospitalization, the patient had scattered leukoplakia on the oral mucosa and received fluconazole injection as an antifungal treatment and a sodium bicarbonate gargle. She received a nebulized inhalation of 2 mL of sterilized water and was administered a twice-daily injection of recombinant human interferon alpha. On hospital day 54, a throat swab was submitted for fungal culture and returned a positive result for Candida albicans infection. The above treatments were continued.
On days 65-67 of hospitalization, two sequential PCR tests for SARS-CoV-2 returned negative results. Three consecutive days of examination showed negative results. The patient was discharged in accordance with the "Diagnosis and Treatment Plan for New Coronavirus Infected Pneumonia (Trial Seventh Edition)".