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 new illness that can affect the lungs and airways. It is caused by a novel coronavirus named SARS-CoV-2. There is no vaccine against COVID-19.

Symptoms of COVID-19 include a cough, a high temperature, and shortness of breath. 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.

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 are being documented. Moreover, while initial indications seemed to suggest higher risk for people aged >60 years, COVID-19 cases have been confirmed in people under age 60.

There is currently no specific treatment for COVID-19. Antibiotics do not help, as they do not work against viruses. Current clinical management protocols aim to relieve COVID-19 symptoms until a patient’s recovery. Thus, patients with symptoms are encouraged to self-quarantine for 14 days and seek COVID-19 testing by means made available through local public health officials.

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 coronavirus:

  • Wash your hands with soap and water often (for 40-60 seconds)
  • Always wash your hands when you get home or into work
  • Use an alcohol-based hand sanitizer (for 20-30 seconds) if soap and water are not available
  • Cover your mouth/nose with a tissue or your sleeve (not your hands) when you cough/sneeze
  • Put used tissues in the bin/trash immediately and wash your hands afterwards
  • 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 and 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
  • Do not have visitors to your home, including friends and family

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.

COVID-19 AND 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

World Health Organization Coronavirus Homepage (World Health Organization)
Q&A on 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)
Unite to Fight (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)
Rolling Updates on Coronavirus Disease (World Health Organization)
Coronavirus Disease (COVID-2019) Situation Reports (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)

Clinical Case Series/Systematic Review

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
Germany: COVID-19 in People Living With Human Immunodeficiency Virus: A Case Series of 33 Patients
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
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
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

European and UK Resources

European Centre for Disease Prevention and Control Coronavirus Home Page (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 and Mental Wellbeing (Public Health England)

US Resources

Coronavirus (COVID-19) (US Centers for Disease Control and Prevention)
Coronavirus Disease 2019 (COVID-19) Frequently Asked Questions (US Department of Health and Human Services)
COVID-19 Resource Center for Physicians (American Medical Association)
Infectious Diseases Society of America 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)
Interim Guidance for COVID-19 and Persons with HIV (US Department of Health and Human Services)
Coronavirus, COVID-19, and Considerations for People Living with HIV and LGBTQIA+ People (Fenway Institute)
COVID-19 Resource Center (HIV Medicine Association)
What to Know about HIV and COVID-19 (US Centers for Disease Control and Prevention)
COVID-19 and Pets (US Centers for Disease Control and Prevention)
Nursing Home Training (US Centers for Disease Control and Prevention)
Stigma (US Centers for Disease Control and Prevention)
Contact Tracing (US Centers for Disease Control and Prevention)
Stress and Coping (US Centers for Disease Control and Prevention)
Mental Disorders (US National Institutes for Health)
Contact Tracing Training (US Centers for Disease Control and Prevention)
Ready, Set, PrEP (HIV.gov)
COVID-19 Information and Resources (American Psychological Association)
Daily Activities and Going Out (US Centers for Disease Control and Prevention)
Duration of Isolation and Precautions for Adults with COVID-19 (US Centers for Disease Control and Prevention)

Latin America/Caribbean Resources

Pan American Health Organization Coronavirus (COVID-19) Home Page (Pan American Health Organization)

African Resources

COVID-19 Latest Updates on the COVID-19 Crisis from Africa (Africa CDC)
World Health Organisation Regional Office for Africa (WHO Regional Office, Africa)
COVID-19 Coronavirus South African Resource Portal (Department of Health, South Africa)

Asia-Pacific Resources

WHO Regional Office for South East Asia (WHO Regional Office, South East Asia)
Southeast Asia COVID-19 Tracker (Center for Strategic and International Studies)

Community Resources

Personal and Community Guidance – COVID 19 (International Treatment Preparedness Coalition)
Coronavirus (COVID-19) and HIV (NAM, AIDSMAP)
What People with HIV Need to Know About the New Coronavirus (POZ)

Legal/Human Rights Resources

Human Rights and Covid-19 Pandemic (JBRA Assisted Reproduction)

Pediatric Resources

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)

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)

Telemedicine Resources

AMA Quick Guide to Telemedicine in Practice (American Medical Association)
General Provider Telehealth and Telemedicine Tool Kit (American Academy Family Physicians)

Tuberculosis Resources

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)