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
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
- Shortness of breath or difficulty breathing
- Muscle or body aches
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
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:
- 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.
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)
- 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.
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)
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
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.
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.
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.
World Health Organization Coronavirus Homepage (World Health Organization)
Coronavirus disease (COVID-19): HIV and antiretrovirals (World Health Organization)
Coronavirus disease (COVID-19) Pandemic Public Advice, Country and Technical Guidance, Situation Reports (World Health Organization)
What People Living with HIV Need to Know about HIV and COVID-19 (UNAIDS)
COVID-19 (Global Fund to Fight AIDS, Tuberculosis, & Malaria)
COVID-19 Prevention and Control among People who use Drugs and People in Prisons (UN Office on Drugs and Crime)
Strategic Considerations for Mitigating the Impact of COVID-19 on Key Population-Focused HIV Programs (PEPFAR, USAID)
PEPFAR Technical Guidance in Context of COVID-19 Pandemic (PEPFAR) (updated 8/18/21)
Rolling Updates on Coronavirus Disease (World Health Organization)
Coronavirus disease (COVID-19) Weekly Epidemiological Update and Weekly Operational Update (World Health Organization)
Maintaining Essential Health Services: Operational Guidance for the COVID-19 Context (World Health Organization)
Community-Based Health Care, including Outreach and Campaigns, in the Context of the COVID-19 Pandemic (World Health Organization)
Information note on HIV and COVID-19 (World Health Organization)
COVID-19 and HIV: What you need to know (International AIDS Society)
WHO Science conversation Episode #48 – HIV & COVID-19 (World Health Organization)
WHO warns that HIV infection increases risk of severe and critical COVID-19 (World Health Organization)
WHO Report: Clinical features and prognostic factors of COVID-19 in people living with HIV hospitalized with suspected or confirmed SARS-CoV-2 infection (World Health Organization)
Clinical Case Series/Systematic Reviews
Barcelona (Spain): COVID-19 in Patients with HIV: Clinical Case Series
Chicago, IL (USA): A Case Series of Five People Living with HIV Hospitalized with COVID-19 in Chicago, Illinois
Chile: Clinical characteristics and outcomes of people living with HIV hospitalized with COVID-19: a nationwide experience
Germany: COVID-19 in People Living With Human Immunodeficiency Virus: A Case Series of 33 Patients
Germany: HIV and SARS-CoV-2 co-infection: cross-sectional findings from a German ‘hotspot’
Istanbul (Turkey): HIV/SARS-CoV-2 Coinfected Patients in Istanbul, Turkey
London (UK): Hospitalized Patients with COVID-19 and HIV: A Case Series
Madrid (Spain): Description of COVID-19 in HIV-Infected Individuals: A Single-Centre, Prospective Cohort
Milan (Italy): Clinical Features and Outcomes of HIV Patients with Coronavirus Disease 2019
Multi Center: COVID‑19 Among People Living with HIV: A Systematic Review
Newark, NJ (USA): COVID-19 Pneumonia in Patients with HIV – A Case Series
New York, NY (USA): Presenting Characteristics, Comorbidities, and Outcomes among 5,700 Patients Hospitalized with COVID-19 in the New York City Area
New York, NY (USA): Outcomes among HIV-Positive Patients Hospitalized with COVID-19
New York, NY (USA): Clinical Features and Outcomes of HIV/SARS‐CoV‐2 Coinfected Patients in the Bronx, New York City
New York, NY (USA): HIV-1 Infection Does Not Change Disease Course or Inflammatory Pattern of SARS-CoV-2-Infected Patients Presenting at a Large Urban Medical Center in New York City
New York, NY (USA): COVID-19 Outcomes Among Persons Living With or Without Diagnosed HIV Infection in New York State
Rome (Italy): COVID‐19 in people living with HIV: Clinical implications of dynamics of the immune response to SARS‐CoV‐2
Uganda: HIV and SARS-CoV-2 Coinfection: A Case Report From Uganda
United Kingdom: Features of 16,749 Hospitalised UK Patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol
United Kingdom: HIV infection and COVID-19 death: a population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform
Wuhan (China): Recovery from COVID-19 in Two Patients With Coexisted HIV Infection
Wuhan (China): A Survey for COVID-19 among HIV/AIDS Patients in Two Districts of Wuhan, China
Cohort Study: HIV and SARS-CoV-2 Co-infection: A Systematic Review of the Literature and Challenges
Review Article: COVID-19 in Immunocompromised Hosts: What We Know So Far
Review Article: Human Immunodeficiency Virus (HIV) and outcomes from coronavirus disease 2019 (COVID-19) pneumonia: A Meta-Analysis and Meta-Regression
Review Article: Immune deficiency is a risk factor for severe COVID-19 in people living with HIV
Review Article: Overview of SARS-CoV-2 infection in adults living with HIV
Cape Town (South Africa): Maternal and neonatal outcomes of COVID-19 in a high-risk pregnant cohort with and without HIV
Review Article: SARS-CoV-2 infection and coronavirus disease 2019 severity in persons with HIV on antiretroviral treatment
European and UK Resources
Coronavirus (European Centre for Disease Control and Prevention)
EACS & BHIVA Statement on Risk of COVID-19 for People Living with HIV (European AIDS Clinician Society and British HIV Association)
Coronavirus (COVID-19) and mental wellbeing (Public Health England)
Coronavirus (COVID-19) (US Centers for Disease Control and Prevention)
HIV and COVID-19 Basics (US Centers for Disease Control and Prevention)
Coronavirus Disease 2019 (COVID-19) Frequently Asked Questions (US Department of Health and Human Services)
COVID-19 Treatment Guidelines: Special Considerations in People With HIV (National Institutes of Health)
COVID-19 (2019 novel coronavirus) resource center for physicians (American Medical Association)
IDSA Guidelines on the Treatment and Management of Patients with COVID-19 (Infectious Diseases Society of America)
COVID-19: Special Considerations for People Living with HIV (Infectious Diseases Society of America)
Guidance for COVID-19 and People with HIV (Guidelines Working Groups of the NIH Office of AIDS Research Advisory Council)
Coronavirus, COVID-19, and Considerations for People Living with HIV and LGBTQIA+ People (Fenway Institute)
Animals and COVID-19 (US Centers for Disease Control and Prevention)
Nursing Home Infection Preventionist Training Course (US Centers for Disease Control and Prevention)
Reducing Stigma (US Centers for Disease Control and Prevention)
Coping with Stress (US Centers for Disease Control and Prevention)
Help for Mental Illnesses (US National Institutes for Health)
Contact Tracing (US Centers for Disease Control and Prevention)
Ready, Set, PrEP (HIV.gov)
APA COVID-19 Information and Resources (American Psychological Association)
How to Protect Yourself and Others (US Centers for Disease Control and Prevention)
CDC Updates and Shortens Recommended Isolation and Quarantine Period for General Population (US Centers for Disease Control and Prevention)
CDC COVID Data Tracker (US Centers for Disease Control and Prevention)
Coronavirus (COVID-19) and People with HIV (U.S. Department of Health & Human Services)
White House National COVID-19 Preparedness Plan 2022
National COVID-19 Preparedness Plan (The White House)
COVID-19: The Biden-Harris plan to beat COVID-19
Test to Treat (Office of the Assistant Secretary for Preparedness and Response)
New ‘Test to Treat Initiative’ Makes COVID Treatments More Accessible to Those Who Need Them Most (Office of the Assistant Secretary for Preparedness and Response)
Fact Sheet: COVID-19 Test to Treat (Office of the Assistant Secretary for Preparedness and Response)
Latin America/Caribbean Resources
PAHO Coronavirus Disease (COVID-19) pandemic (Pan American Health Organization)
COVID-19 Latest Updates on the COVID-19 Crisis from Africa (Africa CDC)
WHO Regional Office for Africa (WHO Regional Office, Africa)
COVID-19 Coronavirus South African Resource Portal (Department of Health, South Africa)
WHO Regional Office for South East Asia (WHO Regional Office, South East Asia)
Southeast Asia COVID-19 Tracker (Center for Strategic and International Studies)
COVID-19 and coronavirus in people living with HIV (NAM, AIDSMAP)
Coronavirus information for people living with HIV (POZ)
HIV and COVID-19: What Do We Know Now? (POZ)
People with HIV can produce an adequate immune response to SARS-CoV-2 (NAM, AIDSMAP)
Legal/Human Rights Resources
Human Rights and Covid-19 Pandemic (JBRA Assisted Reproduction)
Multisystem Inflammatory Syndrome in Children and Adolescents Temporally Related to COVID-19 (World Health Organization)
Paediatric Inflammatory Multisystem Syndrome and SARS-CoV-2 Infection in Children (European CDC)|
Covid-19 vaccine for 5- to 11-year-olds is safe and shows ‘robust’ antibody response, Pfizer says (CNN Health)
Viral Hepatitis Resources
COVID-19 Information for People Affected by Hepatitis B or C (Hepatitis Australia)
COVID-19 Information for People Living with Viral Hepatitis (World Hepatitis Alliance)
Paxlovid for the Treatment of COVID-19: Considerations for People with HIV and Hepatitis C (Infectious Diseases Society of America, HIVMA)
AMA Telehealth quick guide (American Medical Association)
General Provider Telehealth and Telemedicine Tool Kit (American Academy Family Physicians)
Information Note: Tuberculosis and COVID-19 (World Health Organization)
Ensuring Continuity of TB Services During the COVID-19 Pandemic (World Health Organization)
Tuberculosis and COVID-19: What to Do? (Stop TB Partnership)
Vaccines for COVID-19 (US Centers for Disease Control and Prevention)
COVID-19 Vaccine Booster Shots (US Centers for Disease Control and Prevention)
Stay Up to Date with COVID-19 Vaccines Including Boosters (US Centers for Disease Control and Prevention)
Allergic Reactions after COVID-19 Vaccination (US Centers for Disease Control and Prevention)
COVID-19 Vaccines for People who are Moderately or Severely Immunocompromised (US Centers for Disease Control and Prevention)
COVID-19 vaccines in people with HIV (AIDSMAP)
Pfizer-BioNTech COVID-19 Vaccines (US Food & Drug Administration)
Moderna COVID-19 Vaccines (US Food & Drug Administration)
Janssen COVID-19 Vaccine (US Food & Drug Administration)
COVID-19 Vaccines and People with HIV – Frequently Asked Questions (HIVMA)
COVID-19 Vaccination Recommendations for People with HIV (HIVMA)
Recomendaciones de vacunación para la COVID-19 en personas con VIH (Español) (HIVMA)
COVID-19 Vaccines and HIV (UNAIDS)
BNT162b2 vaccine breakthrough: clinical characteristics of 152 fully vaccinated hospitalized COVID-19 patients in Israel
Effectiveness of SARS-CoV-2 mRNA Vaccines for Preventing Covid-19 Hospitalizations in the United States
Household Transmission of SARS-CoV-2 in the United States
Altered Immunocompetence: General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP) (US Centers for Disease Control and Prevention)
Media Statement from CDC Director Rochelle P. Walensky, MD, MPH, on Signing the Advisory Committee on Immunization Practices’ Recommendation for an Additional Dose of an mRNA COVID-19 Vaccine in Moderately to Severely Immunocompromised People (US Centers for Disease Control and Prevention)
The Advisory Committee on Immunization Practices’ Updated Interim Recommendation for Allocation of COVID-19 Vaccine (US Centers for Disease Control and Prevention)
COVID-19 Vaccine Boosters (US Centers for Disease Control and Prevention)
Safety and efficacy of the mRNA BNT162b2 vaccine against SARS-CoV-2 in five groups of immunocompromised patients and healthy controls in a prospective open-label clinical trial
Safety and antibody response to the first dose of severe acute respiratory syndrome coronavirus 2 messenger RNA vaccine in persons with HIV
The BNT162b2 mRNA Vaccine Elicits Robust Humoral and Cellular Immune Responses in People Living With Human Immunodeficiency Virus (HIV)
Association Between Immune Dysfunction and COVID-19 Breakthrough Infection After SARS-CoV-2 Vaccination in the US
COVID-19 infections post-vaccination by HIV status in the United States
Similar risk of SARS-CoV-2 infection and similar nucleocapsid antibody levels in people with well-controlled HIV and a comparable cohort of people without HIV
Anti-spike antibodies and neutralising antibody activity in people living with HIV vaccinated with COVID-19 mRNA-1273 vaccine: a prospective single-centre cohort study
Variants of Concern
Variants of the Virus (US Centers for Disease Control and Prevention)
Understanding Variants (US Centers for Disease Control and Prevention)
SARS-CoV-2 Variant Classifications and Definitions (US Centers for Disease Control and Prevention)
Tracking SARS-CoV-2 variants (World Health Organization)
SARS-CoV-2 variants of concern as of 25 August 2022 (European Centre for Disease Prevention and Control)
What are Oral Antivirals? (U.S. Department of Health & Human Services)
Fact Sheet For Patients, Parents, And Caregivers: Emergency Use Authorization (EUA) Of Paxlovid For Coronavirus Disease 2019 (COVID-19) (US Food & Drug Administration)
PAXLOVID™ (nirmatrelvir and ritonavir) (Pfizer)
Paxlovid (Office of the Assistant Secretary for Preparedness and Response)
Fact Sheet For Healthcare Providers: Emergency Use Authorization For Paxlovid (US Food & Drug Administration)
13 Things To Know About Paxlovid, the Latest COVID-19 Pill (Yale Medicine)
Ritonavir-Boosted Nirmatrelvir (Paxlovid) (US National Institutes for Health)
COVID-19 Rebound After Paxlovid Treatment (US Centers for Disease Control and Prevention)
Fact Sheet for Patients And Caregivers: Emergency Use Authorization (EUA) Of LAGEVRIO (molnupiravir) capsules For Coronavirus Disease 2019 (COVID-19) (US Food & Drug Administration)
Lagevrio (molnupiravir) (Office of the Assistant Secretary for Preparedness and Response)