COVID-19 and HIV: What you need to know

The impact of COVID-19 on people living with HIV is not fully known yet. At present there is no evidence to suggest that there is an increased risk of infection and increased severity of illness for people living with HIV (with the understanding that they are not immunosuppressed and/or have no other co-infections or co-morbidities).

However, people living with HIV who are not on treatment or who are not virally suppressed may have a compromised immune system (measured by a low CD4 count) that makes them vulnerable to opportunistic infections and more severe illnesses.

It is thought that people living with HIV who have achieved viral suppression through antiretroviral treatment and do not have a low CD4 count will be affected by COVID-19 in a similar way to what a person not living with HIV would be, based on other coronavirus-caused disease outbreaks such as SARS (caused by SARS-CoV-1) and MERS (caused by MERS-CoV), where only a few cases of mild disease among people living with HIV were reported.

People living with HIV are advised to take the same precautions as the general population and adhere to their specific government recommendations. Things you can do to protect yourself and others from COVID-19 include:

• Regular hand-washing with soap and water for at least 20 seconds.
• Cover your mouth and nose with a tissue, your sleeve or your elbow (not your hands) when you cough or sneeze.
• Put any used tissues into the bin immediately.
• Avoid touching eyes, nose or mouth with unwashed hands.
• Stay away from work, school and other people if you become sick.
• Continue to take your HIV treatment regularly, as prescribed, to keep your immune system as strong as possible.

Additionally, people living with HIV should ensure vaccinations are up to date (influenza and pneumococcal vaccines).

People living with HIV who know their status and are not yet on antiretroviral treatment should start treatment without delay and follow guidance on social distancing.

People living with HIV who are on treatment should ensure that they have at least 30 days of ARVs and, where possible, a 3 to 6-month supply of ARVs. This also applies to other medication, where possible. Routine viral load testing should continue to be made available to ensure that the viral load is undetectable.

People who do not know their HIV status who were or continue to be vulnerable to HIV acquisition should get tested without delay.

There is no evidence that PrEP prevents you from getting COVID-19 or that it will help you recover quicker if you use PrEP. If you are having unprotected sex and you think you are vulnerable to acquiring HIV, continue to take PrEP.

Current clinical data suggest that older people and people with other co-morbidities, including cardiovascular disease, diabetes, chronic respiratory disease and hypertension, appear to develop serious illness more often than others.

If you are living with HIV and are older and/or have other co-morbidities, such as the ones listed above, then it is particularly important you keep taking any prescribed chronic medication and follow guidance on social distancing.

While there is no available data yet on how COVID-19 impacts people co-infected with HIV and TB, people living with HIV who are also living with TB or who are TB survivors often have lung damage. They therefore may be more susceptible to COVID-19 and may develop serious illness. People living with HIV and TB co-infection or are pulmonary TB survivors who are likely to have damaged lungs should pay particular attention to guidance on social distancing.

Given that both pulmonary TB and COVID-19 affect the lungs, high TB burden countries will need to protect people living with TB and TB survivors from SARS-CoV-2 exposure (SARS-CoV-2 is the virus that causes the coronavirus disease COVID-19), while maintaining effective TB testing strategies during this time to differentiate between those with respiratory illness caused by TB vs COVID-19, which would require different clinical management.

People living with HIV who are on treatment should ensure that they have at least 30 days of ARVs and, where possible, a 3 to 6-month supply of ARVs.

Before the COVID-19 outbreak, the World Health Organization already recommended that clinically stable adults, children, adolescents and pregnant and breastfeeding women, as well as members of key populations (men who have sex with men, people who inject drugs, sex workers and transgender people), could benefit from multi-month prescriptions.

This is when doctors prescribe 3-6 month supplies of HIV medication to reduce the frequency of visits to clinical settings and will help to ensure you have regular access to treatment despite possible lockdowns and disruptions to clinic schedules during the COVID-19 outbreak.

People who think they may have been exposed to HIV should get tested and seek medical advice as soon as possible. Many clinics are now asking clients to call in advance so please follow the guidance of your local health services.

Currently, there is insufficient data to assess the effectiveness of any type of antiretroviral for treating COVID-19. A recent study published in the New England Journal of Medicine showed that a combination of lopinavir and ritonavir – both antiretrovirals used to treat and prevent HIV – was not associated with clinical improvement or mortality in seriously ill patients with COVID-19 compared to standard of care alone. The question of whether earlier treatment or different combinations of antiretrovirals and other drugs could have clinical benefit is an important one that requires further study.

While funding, researchers and healthcare workers are being diverted to work on COVID-19, it is important that quality HIV and general healthcare services remain available to people living with and affected by HIV to protect against HIV disease progression and complications from any other co-infections or co-morbidities, such as some prevalent chronic conditions like hypertension and diabetes.

To mitigate this, interventions such as task-shifting must be adopted and, where possible, services could be offered via telemedicine, multi-month prescriptions made available and possibly sent via postal services, and other innovative tools implemented more broadly such as self-testing or self-sampling using prepared sampling kits and sending preserved specimens safely via post. The use of telemedicine for initial symptom screening and triage and psychosocial support may facilitate social distancing without impacting the standard of care.

The global response to control COVID-19 may also influence health product supply chains, including logistics and shipping. The Global Fund is working closely with suppliers and partners to assess the impact on core health product supplies and provide recommendations for implementing partners on how to manage that impact. You can find the most recent assessment and recommendations from the Global Fund here.

Ensuring the health and safety of our community and that of our host cities is our top priority. We are closely monitoring developments related to COVID-19 and actively exploring alternative options, should they be needed, to ensure that attendees have access to and can engage with the insights, knowledge and science presented at the conference.

Our decisions will be informed by guidance from local, state and federal health officials in the US, WHO and experts in the HIV community.

We are acutely aware that there is not yet sufficient research on the impact of COVID-19 on people living with HIV. We are also conscious of the fact many delegates working in health and research are currently stretched and are providing essential support to their communities. We feel a special obligation to reducing any potential risk to both of these groups.

More information can be found here.

As countries implement measures to respond to COVID-19 outbreaks, national governments should ensure that any measures to protect health do not repeat human rights violations which have inadvertent negative public health implications as evidenced by the HIV response. Criminalization of non‐disclosure, exposure or transmission of HIV is one such strategy which has negative public health impacts, including stigmatizing people living with HIV and discouraging people from learning their HIV status, and should not be applied to COVID-19.

In countries where there are COVID-19 related restrictions to people’s travel, it is important to ensure that people living with and affected by HIV have access to HIV and other services without disruption. This includes being able to access HIV treatment anonymously. Where possible, doctors should prescribe 3-6 month supplies of HIV medication to reduce the frequency of visits to clinical settings.

Healthcare workers should be applauded for their dedication and commitment to providing much-needed health services during this time. If people living with or affected by HIV do experience stigma or discrimination in relation to HIV or other services, challenges to incidents of injustice experienced or observed should be made while being mindful of the extreme pressures being placed on healthcare workers during the COVID-19 outbreak.

The IAS will continue to work on addressing barriers in access to healthcare services for people living with and affected by HIV. During the COVID-19 outbreak it is important to ensure that key populations, including men who have sex with men, people who inject drugs, sex workers and transgender people, have access to HIV prevention and other services, including condoms, PrEP, sterile needles and syringes and/or opioid substitution therapy, and gender-affirming hormone therapy.

A guide to preventing and addressing social stigma associated with COVID-19 can be found here.

Do you have a question about COVID-19 and HIV? Submit your question here.