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Coronavirus (COVID-19) and HIV

Responses to common questions from the British HIV Association (BHIVA)

 

What is Coronavirus?

Coronaviruses (CoV) are a large family of viruses that can infect mammals and birds. Seven strains can infect humans, typically causing mild illness (1 in 6 cases of the common cold are caused by coronaviruses) and more rarely serious illness.

There are currently no coronavirus vaccines or antiviral drugs but research teams across the globe are working tirelessly to change that. There have been headlines about using the HIV drug lopinavir/ritonavir (uncommonly used for treatment in the UK) to treat coronavirus but no good evidence yet that it will work. The drugs used for PrEP are not active against coronavirus.

COVID-19 is a new condition caused by the SARS-CoV-2 strain of the coronavirus, which spreads very easily from person-to-person (much more so than some other types of coronavirus). Nobody has existing immunity to it. Although the estimated death rate of about 1 in 100 people sounds low compared to some infections, if very large numbers of people are infected that would result in a high number of deaths. Current data suggests that 1 in 5 people develop more severe illness, and large numbers needing hospital treatment could rapidly overwhelm health care systems – this is happening in Italy now. People most at risk of serious illness and death are the elderly and people with long-term medical conditions such as lung disease, kidney disease and diabetes.

However, about 80% of people with COVID-19 have relatively mild illness, which can lead to diagnosis of infection being delayed or missed altogether, which increases the risk of passing the virus on. Data from Japan estimates 1 in 3 people with COVID-19 have no symptoms – making control even harder.

In February the World Health Organisation (WHO) declared COVID-19 a ‘Public Health Emergency of International Concern’ – giving WHO the legal right to make recommendations about dealing with it and (hopefully) stimulating funding and Government action. On 11th March 2020 WHO declared COVID-19 a pandemic, which is an epidemic that has spread over several countries or continents, usually affecting large numbers of people.

1. The risk to people with HIV

There has been no evidence that people living with controlled HIV are at a greater risk of catching COVID-19, or of becoming very unwell, than anyone else of the same age and general health. It is sensible to assume people who are not undetectable on treatment or have a low CD4 count (less than 200) might be at higher risk.

2. COVID-19 and HIV medication

Although there are research trials investigating the use of HIV antiretroviral medications against COVID-19, there is no strong evidence that they are effective. There is no evidence that being on HIV medication will stop you getting COVID-19.

  • You should continue taking recommended treatment at the same dose: do NOT increase the number of tablets you take. This will not help you if you get COVID-19 neither will it protect you from getting it. It could in fact be harmful to exceed the normal dose.
  • Ensure you have 30 days’ supply of medication.
  • Do not share your HIV medicine: with anyone who has COVID-19 or who is worried about getting it.
  • There is no problem with supplies of HIV medications: there is no suggestion that there will be any shortage of HIV medication. Where clinics are moving towards non-urgent telephone consultations, they will put in place measures to ensure that repeat medication is readily available and if you are registered with home delivery services already, they can be delivered to you, otherwise you may need to collect it or ask someone else to collect it for you as home delivery companies may not have capacity to take on new deliveries. We cannot supply more than six months of HIV medication at a time as this may have an impact on supply.

3. COVID-19, HIV and the immune system

People on HIV treatment with a good CD4 and undetectable viral load are not usually considered to have a “weakened immune system” as specified in the recent PHE guidance (16 March 2020.) BHIVA aims to provide specific advice for people living with HIV based on viral load and CD4 count as things become clearer, and government guidance is updated with specific reference to HIV. At the moment (17 March 2020) please refer to the advice given in the BHIVA statement: https://www.bhiva.org/comment-from-BHIVA-and-THT-on-UK-Government-Guidance-on-Social-Distancing

We recommend following PHE’s “social distancing” advice, which does not necessarily mean “self-isolation,” as in the Guidance issued for Vulnerable People here: https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults

Physical distance reduces infection and advice is changing rapidly so check government advice regularly.

4. The newly diagnosed and those who are just starting treatment

People who have recently been diagnosed with HIV should talk to their HIV consultant about any worries they may have about their immune system. However, as said in point 3 above, people with an undetectable viral load are not usually considered to have a weakened immune system. Your consultant will ensure that you are monitored safely.

5. People with other health conditions, such as diabetes, heart or lung conditions

If you have any concerns about other health issues apart from your HIV, and how these might affect you, then check the NHS website for the latest advice (see point 8) or contact your clinic bearing in mind many services may have reduced capacity due to staff being sick, in isolation or helping out in other parts of the NHS.

6. Keeping mentally and physically healthy

If you get COVID-19, the fitter you are, the better the outcome. Stopping smoking will definitely help, as will stopping vaping (although this is still preferable to smoking – see https://www.nhs.uk/smokefree for advice.) Take exercise where and when you can, and if you do have to self-isolate, you can find exercise suggestions online at https://www.nhs.uk/livewell.

It is normal be worried – everyone is – and taking care of your mental health is also important, with useful advice in this article: https://www.bbc.co.uk/news/health-51873799

7. How to protect yourself and others from COVID-19

There is useful information on https://www.nhs.uk/conditions/coronavirus-covid-19/

8. What to do if you think you have COVID-19

First check the latest advice, either from a reputable news site, or from the NHS at https://www.nhs.uk/conditions/coronavirus-covid-19/

The advice is to stay at home if you have either:

  • a high temperature – you feel hot to the touch on your chest or back or your temperature is 37.8 degrees celsius or more if you have a thermometer;
  • a new, continuous cough – this means you’ve started coughing repeatedly.

Do NOT go to a GP surgery, pharmacy or hospital.

You do NOT need to contact 111 to tell them you’re staying at home.

You can access advice online from https://111.nhs.uk/covid-19/. Testing for coronavirus is not currently recommended as it is not needed if you’re staying at home.

If you feel you cannot cope with your symptoms at home, your condition gets worse, or your symptoms do not get better after 7 days, then call the NHS 111 Coronavirus Service.

Only call 111 if you cannot get help online.