COVID-19 and HIV

“Our health systems and our social bonds are being tested in unprecedented ways by the COVID-19 pandemic. IAPAC thanks HIV and infectious disease clinicians and allied healthcare professionals who are on the front-lines of the COVID-19 response. We also applaud public health officials for the life-saving decisions they are making on a day-by-day basis, including in relation to restrictive measures such as social distancing. We call on government officials to communicate and advance evidence-based messages and public policies. And, we plead with every citizen to do her/his part to bring the COVID-19 pandemic under control.”

– Dr. José M. Zuniga, President/CEO, IAPAC

GENERAL INFORMATION

COVID-19 is a disease that can affect the lungs and airways. It is caused by a novel coronavirus called SARS-CoV-2. People with COVID-19 may have a wide range of symptoms – ranging from mild to severe. Symptoms may appear 2-14 days after exposure to the virus. Symptoms of COVID-19 include, but are not limited to:

- Fever or chills
- Cough
- Shortness of breath or difficulty breathing
- Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea

Many of these symptoms are similar to other illnesses that are much more common, such as cold and flu, thus if you are unsure you should contact your health professional. Do not visit your doctor’s office without an appointment, or present at an emergency room unless you are facing a life-threatening situation.

Although most people with COVID-19 get better within weeks of getting sick, some people experience post-COVID conditions. Post-COVID conditions, also called long COVID, are a wide range of new, returning, or ongoing health problems people can experience more than a month after first being infected with the virus that causes COVID-19.

People at increased risk for SARS-CoV-2 infection include those with underlying medical conditions, including asthma, chronic lung disease, diabetes, and heart disease. However, COVID-19 cases in people without these conditions do occur. Older adults and people with severe underlying medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness.

Update on COVID-19 Vaccines (Source US CDC)

COVID-19 vaccines available in the United States are effective at protecting people from getting seriously ill, being hospitalized, and dying. As with other vaccine-preventable diseases, you are protected best from COVID-19 when you stay up to date with the recommended vaccinations, including recommended boosters.

Four COVID-19 vaccines are approved or authorized in the United States:

Pfizer-BioNTech
Moderna
Novavax
Johnson & Johnson’s Janssen (J&J/Janssen) (CDC recommends that the J&J/Janssen COVID-19 vaccine only be considered in certain situations, due to safety concerns.)

Updated (Bivalent) Boosters

The updated (bivalent) boosters are called “bivalent” because they protect against both the original virus that causes COVID-19 and the Omicron variant BA.4 and BA.5.

Previous boosters are called “monovalent” because they were designed to protect against the original virus that causes COVID-19. They also provide some protection against Omicron, but not as much as the updated (bivalent) boosters.

The virus that causes COVID-19 has changed over time. The different versions of the virus that have developed over time are called variants. Learn more about variants of the COVID-19 virus.

Two COVID-19 vaccine manufacturers, Pfizer and Moderna, have developed updated (bivalent) COVID-19 boosters.

For Healthcare Workers: Learn more about COVID-19 vaccine schedules.

PREVENTION

Simple measures such as washing your hands often with soap and water can help stop viruses like coronavirus from spreading.

Following is a list of public health recommendations to avoid catching or transmitting SARS-CoV-2 infection:

- Get vaccinated!
- Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.
- Always wash your hands when you get home or into work.
- Use an alcohol-based hand sanitizer if soap and water are not available.
- If you are wearing a mask: You can cough or sneeze into your mask. Put on a new, clean mask as soon as possible afterwards and wash your hands.
- If you are not wearing a mask: Always cover your mouth and nose with a tissue when you cough or sneeze, or use the inside of your elbow and do not spit. Throw used tissues in the trash.
- Avoid touching your eyes, nose, or mouth if your hands are not clean.
- Avoid close contact with people who have symptoms of coronavirus.
- Only travel on public transport if you need to.
- Work from home, if you can.
- Avoid social activities, such as going to bars, restaurants, theatres, and cinemas
- Avoid events with large groups of people, observing public health official guidance
- If you are not fully vaccinated and aged 2 or older, you should wear a mask in indoor public places.
- In general, you do not need to wear a mask in outdoor settings. In areas with high numbers of COVID-19 cases, consider wearing a mask in crowded outdoor settings and for activities with close contact with others who are not fully vaccinated.

We urge you to take any other precautions advised by your local public health and government officials. This is particularly true in relation to social distancing, which calls for avoiding large gatherings and maintaining a distance of 6 feet from people. Social distancing aims to reduce the chance of contact with people who knowingly or unknowingly carry the coronavirus infection.

Quarantine if you have been in close contact (within 6 feet of someone for a cumulative total of 15 minutes or more over a 24-hour period) with someone who has COVID-19, unless you have been fully vaccinated. People who are fully vaccinated do NOT need to quarantine after contact with someone who had COVID-19 unless they have symptoms. However, fully vaccinated people should get tested 3-5 days after their exposure, even if they don’t have symptoms and wear a mask indoors in public for 14 days following exposure or until their test result is negative.

COVID-19 Treatments and Medications (Source CDC)

What You Need to Know

If you test positive for COVID-19 and are more likely to get very sick, treatments are available that can reduce your chances of hospitalization and death.
Don’t delay: Treatment must be started within days after you first develop symptoms to be effective.
Other medications can help reduce symptoms and help you manage your illness.
The Treatment Locator (hhs.gov) can help you find a location that offers testing and treatment or a pharmacy where you can fill your prescription.

People who are more likely to get very sick include older adults (ages 50 years or more, with risk increasing with age), people who are unvaccinated, and people with certain medical conditions, such as chronic lung disease, heart disease, or a weakened immune system. Being vaccinated makes you much less likely to get very sick. Still, some vaccinated people, especially those ages 65 years or older or who have other risk factors for severe disease, may benefit from treatment if they get COVID-19. A healthcare provider will help decide which treatment, if any, is right for you. Check with your healthcare provider or pharmacist if you are taking other medications to make sure the COVID-19 treatments can be safely taken at the same time.

The FDA has authorized antiviral medications to treat mild to moderate COVID-19 in people who are more likely to get very sick.

Antiviral treatments target specific parts of the virus to stop it from multiplying in the body, helping to prevent severe illness and death.

The National Institutes of Health (NIH) provides COVID-19 Treatment Guidelines for healthcare providers to help them work with their patients and determine the best treatment options for them. Several options are available for treating COVID-19.

Treatment

Nirmatrelvir with Ritonavir (Paxlovid)
Antiviral

Adults; children ages 12 years and older

Start as soon as possible; must begin within 5 days of when symptoms start

Taken at home by mouth (orally)

Remdesivir (Veklury)
Antiviral

Adults and children

Start as soon as possible; must begin within 7 days of when symptoms start

Intravenous (IV) infusions at a healthcare facility for 3 consecutive days

Molnupiravir (Lagevrio)
Antiviral

Adults

Start as soon as possible; must begin within 5 days of when symptoms start

Taken at home by mouth (orally)

Some treatments might have side effects or interact with other medications you are taking. Ask a healthcare provider if medications to treat COVID-19 are right for you. If you don’t have a healthcare provider, visit a Test to Treat location or contact your local community health center or health department.

If you are hospitalized, your healthcare provider might use other types of treatments, depending on how sick you are. These could include medications to treat the virus, reduce an overactive immune response, or treat COVID-19 complications.

Convalescent Plasma

Some people with COVID-19 who are immunocompromised or are receiving immunosuppressive treatment may benefit from a treatment called convalescent plasma. Your healthcare provider can help decide whether this treatment is right for you.

VARIANTS

Viruses constantly change through mutation, and new variants of a virus are expected to occur.

The XBB.1.5 was first identified in the United States in New York in October 2022. The World Health Organization (WHO) has called XBB.1.5 the most transmissible Omicron strain so far. AS of January 2023, XBB.1.5 was projected to make up 49.1% of new cases of COVID-19

COVID-19 AND HIV

Whether people with HIV are at greater risk of acquiring SARS-CoV-2 infection is currently unknown. Data on the clinical course of COVID-19 in people with HIV are emerging. In the initial case series from Europe and the United States, no significant differences in clinical outcomes were found between people with HIV who developed COVID-19 and individuals without HIV.

Following is a summary of World Health Organization (WHO) guidance regarding COVID-19 and HIV:

- People living with HIV who have not achieved viral suppression through antiretroviral therapy (ART) may have a compromised immune system that leaves them vulnerable to opportunistic infections and further disease progression.
- 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. We know that during the SARS and MERS outbreaks there were only a few case reports of mild disease among people living with HIV.
- Current clinical data suggest the main mortality risk factors are linked to older age and other comorbidities including cardiovascular disease, diabetes, chronic respiratory disease, and hypertension. Some very healthy and younger people have also developed severe disease from coronavirus infection.
- People living with HIV who know their HIV status are advised to take the same precautions as the general population (e.g., wash hands often, cough hygiene, avoid touching your face, social distancing, seek medical care if symptomatic, self-isolation if in contact with someone with COVID-19, and other actions per local and national government responses). People living with HIV who are taking antiretroviral drugs should ensure that they have at least a 30-day supply of these drugs, if not a 3- to 6-month supply and ensure that their vaccinations are up to date (influenza and pneumococcal vaccines). Polypharmacy considerations should also be taken into account, including related to adequate supplies of medications for comorbidities (e.g., hypertension, diabetes), as well as contraception and gender-affirming hormone therapy.
- It is also an important opportunity to ensure that all people living with HIV who are not yet on ART get initiated on ART to achieve viral suppression. People who feel they may have been at HIV risk are advised to seek testing to protect against HIV disease progression and complications from any other comorbidities.

There is no evidence that HIV pre-exposure prophylaxis (PrEP) prevents the acquisition of coronavirus, or that its use will help patients recover quicker. If you are having unprotected sex and you think you are vulnerable to acquiring HIV, continue to take PrEP. Regarding HIV antiretrovirals, there is no evidence these medications are effective to treat COVID-19.

COVID-19 RESOURCES

Global Resources