What happened in Wuhan:
HIV services in the coronavirus outbreak
The novel coronavirus (COVID-19) outbreak is causing much uncertainty around the world, including for people living with and affected by HIV. Dr Ke Liang shares his account of being on the frontline of the outbreak in Wuhan, China, and what happened to HIV services...
My name is Ke Liang and I was born in Suizhou City in Hubei province. Currently, I am an Associate Chief Physician in the Infectious Diseases Department of Zhongnan Hospital of Wuhan University in China. I take care of both inpatients or outpatients with infectious diseases, such as HIV, viral hepatitis and fever of unknown origin, etc. In November and December 2019, I worked in a fever clinic, and from 11 January 2020, I have been on the frontline of the outbreak of the COVID-19 epidemic.
At the beginning of the outbreak, we faced a difficult situation. On the one hand, we could not cope with the high numbers of patients with fever who came into our clinic; we were very busy and tired. On the other hand, we could not provide enough inpatient wards for them. But I was not scared – I knew that I was an experienced infectious diseases physician. After completing my Bachelor’s degree in 2002, I worked on the frontline against SARS. Before I graduated with my Master’s in 2005, I faced HIV and AIDS. When I got my Doctor’s degree in 2009, I fought H5N1 and then bird flu (H7N9) in 2017. For me, the novel coronavirus was just the same thing with a different name.
People living with HIV faced more difficulties than general patients during the COVID-19 outbreak. It was difficult for people living with HIV to find a hospital if they started to show signs of other diseases because nearly all hospitals in Wuhan were now dealing with only COVID-19. This was the situation not only for people living with HIV, but also for other people living with chronic diseases. Lastly, people living with HIV faced double pressures. They were more scared than the general population because they felt more vulnerable and those not on treatment or not virally suppressed may have a compromised immune system.
The lockdown made it even more difficult for people living with HIV to get ARVs, especially in rural areas. The government and Centers for Disease Control and Prevention (CDC) responded with special measures: people could refill ARVs at the nearest CDC or by post, which kept them enrolled on ART and sustained good adherence.
The national guidelines for diagnosis and treatment of COVID-19 also suggested treating COVID-19 patients with LPV/r. This drug might be useful for treatment in the early stage of COVID-19, but I do not think that it has an impact on people living with HIV accessing their usual treatment. The hospitals get LPV/r from elsewhere.
From my experience and preliminary investigations, I do not think that there are higher rates of COVID-19 infection among people living with HIV than the general population. I am conducting a survey of COVID-19 among people living with HIV in Wuhan and hopefully, we will publish the results soon.
During the outbreak, three of the people living with HIV who I was treating acquired COVID-19. But, unfortunately, I also saw some people living with HIV with COVID-19 in other hospitals developing acute respiratory distress syndrome and dying.
On 25 January, one of my patients living with HIV came to my department with his parents because he had a severe headache. I had been treating him for cryptococcus meningitis for three months. We managed to get the meningitis under control, but then he stopped using the prophylactic medicine (fluconazole). I knew that the cryptococcus meningitis had come back when he started having headaches again. Without treatment, he would likely die. But my hospital was focusing only on COVID-19 patients and I did not have a bed for him.
I reached out to other hospitals outside Wuhan, but due to the lockdown, my patient was not allowed to leave Wuhan. His father was anxious and felt helpless. This was the most difficult moment in my life. I thought: “I could save him, and if I refuse him, he will likely die.” I spoke with the management in my hospital and they agreed to admit him. He was put into the safe area. I was happy that thanks to the treatment, he recovered.
The most important lesson to learn from the COVID-19 outbreak linked to people living with HIV is that we should have a plan so that we are prepared to respond in exceptional situations that can affect people living with HIV worldwide, such as natural disaster and plague.
The message I would like to send to people living with HIV is that they do not need to panic. No winter lasts forever; no spring skips its turn. If you follow the preventative measures (such as wearing a mask and washing hands), the chances of getting infected by COVID-19 are much lower.