Does HIV increase your risk for COVID-19?

Most people living with HIV probably do not have an increased risk of contracting COVID-19 or complications of COVID-19 when compared to the general population. HIV patients who are clinically and immunologically stable on HIV treatment are assumed to have the same general risk as people unaffected by HIV. But (there is always a but!), people living with HIV who still have a compromised immune system should be extra cautious to avoid contracting COVID-19. 

These include people with HIV:

  • With a low CD4 count (<200 copies/cell).
  • With a high viral load.
  • Not taking antiretroviral treatment.
  • With a recent opportunistic infection (like TB, pneumocystis pneumonia (PCP), cryptococcal infection, etc.)

We know that people living with HIV are more vulnerable to respiratory infections when their HIV is not managed well. It is therefore very important to always take your antiretroviral treatment, but more so during this time.

Some people living with HIV may also have known risk factors for COVID-19 complications, such as an age above 65 years, diabetes and hypertension and therefore may have increased risk of COVID-19 unrelated to HIV. 

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; therefore they may be more susceptible to COVID-19 and may develop serious illness.

We will actively learn more about how HIV and COVID-19 together impact on people living with HIV.  If you are HIV positive and not on treatment yet, please visit one of the MSH doctors to start on treatment as soon as possible. It could save your life!

Preventing COVID-19 when HIV positive:

COVID-19 is prevented in people living with HIV by applying all the same measures that are applicable to the general public.  COVID-19 is a serious disease and all people living with HIV should take all recommended preventive measures to minimize exposure to, and prevent infection by, the virus that causes COVID-19.

Until more is known, people living with HIV – especially those with advanced or poorly controlled HIV disease – should be extra cautious and pay special attention to the prevention measures and recommendations. We know that this is a scary and uncertain time, more so if you are already living with a disease that decreases your immunity. Things people living with HIV can do to protect themselves and others from COVID-19 include:

  • Washing hands frequently with soap and water (for at least 20 seconds) OR use an alcohol-based hand sanitizer where access to soap and water is restricted.
  • Cough etiquette (into the elbow or a tissue that is then thrown away and hands washed).
  • Physical distancing and wear a facemask when you have to go out in public.
  • Seek medical care if you are coughing, have a fever or experience shortness of breath.
  • Avoid touching your face as this is the main way the virus enters your body.
  • Ensure that your vaccinations are up to date (especially your flu and pneumonia vaccines).
  • 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 (contact MSH today to make a virtual appointment with one of our highly trained doctors to help you start treatment as soon as possible).
  • Self-isolation if in contact with someone with COVID-19.
  • Always remember safe sex practices. Read more about this in our latest blog on Sex & COVID-19.
  • Other actions as per the government response.

HIV treatment be used to treat/prevent COVID-19:

HIV treatment has not been sufficiently proven to treat or prevent COVID-19.  Currently, there is insufficient data to assess the effectiveness of any type of antiretroviral (HIV treatment) for treating or preventing COVID-19.

It is important to note that the studies done using lopinavir boosted with ritonavir (LPV/r) or commonly known as Kaletra/Aluvia in South Africa had important limitations. The studies were small, timing, duration and dosing for treatment were varied and most patients received co-interventions/co-treatments which may have contributed to the reported outcomes.

To date, there is no proven vaccine or antiviral medicine to prevent or treat COVID-19. Please look out for the latest information on treatment and preventions at https://www.who.int OR https://www.cdc.gov.

Currently no evidence is available to justify switching from your usual antiretroviral therapy. Moreover, there is no evidence to support HIV-negative people taking antiretrovirals outside the context of pre-exposure prophylaxis (PrEP) to prevent HIV – PrEP should be taken as directed and there is no current evidence that PrEP is effective against COVID-19.

Extra supply of your HIV medication:

Multi-month supply of HIV drugs during the COVID-19 pandemic might benefit clinically stable adults, children, adolescents and pregnant and breastfeeding women as well as members of key populations (people who inject drugs, sex workers, men who have sex with men and people living in prisons and closed settings). This will reduce the frequency of visits to clinical settings and ensure continuity of treatment during disruption of movements during the coronavirus outbreak. 

Persons for whom a regimen switch is planned should consider delaying the switch until close follow-up and monitoring are possible.

HIV Check-ups during the COVID-19 pandemic?

The need for HIV-related checks-ups or follow-ups during the COVID-19 pandemic should be discussed with your healthcare provider.  The risk and benefit should be weighed. Factors to consider include the extent of local COVID-19 transmission, the health needs that will be addressed during the appointment and the person’s HIV status (e.g. CD4 cell count, HIV viral load) and overall health.

Telephone or virtual visits for routine or non-urgent care and adherence counseling may replace face-to-face encounters. For persons who have a suppressed HIV viral load and are in stable health, routine medical and laboratory visits should be postponed to the extent possible.

PrEP in the time of COVID-19:

PrEP stands for Pre-Exposure Prophylaxis – taking medication to protect you agains becoming HIV positive.  It is interesting to note that many people are stopping their PrEP during this time, purely because they are not having sex! It makes sense, but it could also be dangerous if people resume sexual activity without protectecing themselves.  Read this interesting article about PrEP in the time of COVID-19.  The articel is from very useful website about HIV: thebody.com.

We know that it is very scary to live with HIV in the midst of this COVID-19 pandemic. We are here to help you! Please contact My Sexual Health for more information.

Please find below links to Do’s and Dont’s of COVID-19 in four of the South African languages, from the University of Cape Town, Department of Medicine:

Flattening the Curve in English and Afrikaans:

Written by Dr Larisse Badenhorst – General practitioner with a special interest in sexual health and HIV
011 706 7006
www.drlarissebadenhorst.co.za
www.mysexualhealth.co.za