The environment surrounding the coronavirus disease 2019 (COVID-19) pandemic seems to change by the minute. The full extent to which HIV-positive individuals can be affected if they contract COVID-19, because they are immunocompromised, is not known. HIV-positive individuals are at higher risk, in general, due to their disease status. people living with HIV who are on treatment with a normal CD4 T-cell count and suppressed viral load may not be at an increased risk of serious illness, many people with HIV have other conditions that increase their risk. However, at present, extensive information on if this risk is elevated with COVID-19 because of immune suppression remains an unknown. As with other patients with comorbid conditions or who suffer from respiratory infections, low CD4 counts (below 200 cells/mm3 indicates AIDS) and lack of treatment adherence increases the overall risk of getting very sick.
• COVID-19 is the name scientists have given for the illness people develop after becoming infected with SARS-CoV-2, a new strain of coronavirus discovered in 2019.
- 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.
- Vaccinations (e.g. influenza, pneumococcal) should be offered to all PLHIV and be up to date.
- 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.
- There is currently no strong data to suggest that people living with HIV (PLHIV) are at a higher risk of acquiring SARS-CoV-2 or developing more severe COVID-19 if they do acquire it, especially if their immune system is not compromised, although people with underlying conditions and a weaker immune system may be most vulnerable to COVID-19 infection
- 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.
- There is currently no approved treatment for COVID-19, no immune therapeutics, and no vaccine. Treatment is symptomatic (e.g. rest, hydration, antipyretics) and transmission prevention measures should be adopted
- 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.
The best way to prevent COVID-19 is to avoid being exposed to SARS-CoV-2. PLHIV should take the same prevention measures for COVID-19 recommended for all people according to PAHO/WHO guidance. 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.
As the COVID-19 outbreak evolves and new evidence emerges, recommendations and guidance documents will be regularly updated. It is important to always consult official and reliable sources for the most up to date information and orientation on the COVID-19 response.