COVID-19 and HIV: What you need to know

How COVID-19 affects 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 people can do to protect themselves and others from COVID-19 include:

• Regular hand-washing with soap and water for at least 20 seconds. Download a practical guide on how to support community-level handwashing, particularly in resource-limited settings. Access more resources on handwashing.
• 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, public spaces 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.

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

If you need to access health services, it is recommended to follow national guidance and where possible, call your healthcare provider before arriving at a health facility. In addition, measures should be taken to ensure appropriate infection control and follow guidance on physical distancing.

People living with HIV who are on treatment should ensure that they have at least 30 days of ARVs with them and, where possible, a 3 to 6 month supply of ARVs. Access more information on strategies for extending the duration of ART refills and reducing contact with health facilities.

People living with HIV should stay socially connected with networks and communities using technology where possible and address any stress or anxiety with friends and your healthcare provider.

There is no evidence that PrEP prevents you from getting COVID-19 or that it will help you recover quicker if you use PrEP.

Current clinical data suggest that older people and people with other comorbidities, including cardiovascular disease, diabetes, chronic respiratory disease and hypertension, appear to develop serious COVID-19 illness compared with others.

If you are living with HIV and are older and/or have other comorbidities, such as the ones listed above, then it is particularly important you keep taking any prescribed chronic medication.

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 infection control practices, such as physical 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), to differentiate between those with respiratory illness caused by TB vs COVID-19, which would require different clinical management.

For more information on service delivery to TB clients during the COVID-19 pandemic, read the position statement of Southern Africa HIV Clinicians Society.

People living with HIV who are on treatment should ensure that they have at least 30 days of ARVs with them and, where possible, 3 to 6 months 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 and refills.

Multi-month refills are where clinicians prescribe 3-6 months of HIV medication to reduce the frequency of visits to clinical settings. With longer prescriptions, people living with HIV can access longer ART refills and/or receive ART refills from community-based services. This will limit unnecessary visits to health care facilities thereby reducing the risk of SARS-CoV-2 exposure and reducing the risk of treatment interruption, despite possible lockdowns and disruptions to clinic schedules during the COVID-19 outbreak. Access more information on strategies for extending the duration of ART refills and reducing contact with health facilities.

People who think they may have been exposed to HIV should get tested and seek medical advice as soon as possible. Some countries are increasing HIV self-testing during this time and 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. A Journal of the International AIDS Society (JIAS) article systematically reviewed the clinical outcomes of using antiretroviral drugs for the prevention and treatment of coronaviruses and planned clinical trials.

To date, there is no proven vaccine or antiviral medicine to prevent or treat COVID-19. Possible vaccines and some specific antiviral treatments that target the SARS-CoV-2 virus itself, along with treatments to ameliorate the respiratory complications of severe disease (such as leronlimab), are under investigation as part of clinical trials. The World Health Organization is coordinating efforts to develop new vaccines and medicines and test the efficacy of existing medicines to prevent and treat COVID-19.

For example, the SOLIDARITY trial is a multi-arm, multi-country trial of existing drugs already on the market to treat other diseases to assess if there is any reduced morbidity or mortality from COVID-19. Currently four treatments are included: (1) remdesivir, (2) lopinavir and ritonavir, (3) lopinavir and ritonavir plus interferon beta, and (4) chloroquine. This combined effort will allow comparison of data and speed up the trials overall.

Find out more information and get the latest guidance from the World Health Organization on COVID-19, HIV and antiretrovirals.

While funding, researchers and healthcare workers are being diverted to work on COVID-19, it is important that essential health 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 the impact of COVID-19, where possible, services should be offered via telemedicine, multi-month refills of chronic medications made available and possibly sent via postal services, and other innovative tools implemented more broadly including HIV self-testing and self-sampling using prepared sampling kits and sending preserved specimens safely. The use of telemedicine for initial symptom screening and triage and psychosocial support may by critical to facilitate physical distancing and infection control without impacting the standard of care.

The global response to support the COVID-19 pandemic 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..

The health and safeguarding of our community is our highest priority. In light of the COVID-19 pandemic, the 23rd International AIDS Conference (AIDS 2020), to be held on 6-10 July 2020, will become the first virtual edition of the International AIDS Conference.

Our decision was informed by advice from the World Health Organization, UNAIDS, leading global and local health authorities, and people living with HIV around the globe. In particular, we are acutely aware that there is not yet sufficient data on whether people living with HIV are more susceptible to COVID-19 or more likely to develop severe disease. Therefore, we have a special obligation to reduce any potential risk to the HIV community.

Furthermore, many of those who were planning to attend are now working on the front lines in the response to COVID-19 around the world. We have a responsibility to not put any of these individuals – or their home communities – at risk, nor redirect their efforts at a critical time in the response to the pandemic.

More information can be found at AIDS2020.org. .

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.

Download a guide to preventing and addressing social stigma associated with COVID-19.

The global health community is monitoring the COVID-19 pandemic and is working to ensure healthcare systems, supply chains and communities are prepared. This is especially important in resource-limited settings with high burdens of HIV and other chronic co-infections and co-morbidities, especially sub-Saharan African.

Previous outbreaks have demonstrated that when health systems are overwhelmed, deaths from vaccine-preventable and other treatable conditions can also increase dramatically, including those related to HIV and AIDS, and TB. Countries will need to balance responding directly to the COVID-19 pandemic while maintaining essential health services. WHO has published updated guidance on a set of targeted immediate actions that countries should consider at national, regional, and local level to reorganize and maintain access to high-quality essential health services for all. Read the operational guidance.

In addition to maintaining essential healthcare services, governments must support those most vulnerable, including the homeless and those living in informal settlements, to ensure access to shelter, food and clean water, especially during government-enforced movement restrictions.

To ensure physical distancing, policies need to be in place that limit the number of times people living with HIV visit a health facility. Health facilities must be set up in ways that support appropriate triaging and infection control measures. Where possible, unnecessary visits to health facilities for people living with HIV should be reduced. For example, if someone receives an HIV positive diagnosis they should be supported to immediately initiate ART on the day of diagnosis to reduce unnecessary follow up appointments. People living with HIV who are on treatment should ensure that they have at least 30 days of ARVs with them and, where possible, a 3 to 6 month supply of ARVs. Get more information on strategies for extending the duration of ART refills, out-of-facility HIV treatment support and reducing contact with health facilities.

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