People living with HIV with advanced disease, those with low CD4 and high viral load and those who are not taking antiretroviral treatment have an increased risk of infections and related complications in general. It is unknown if the immunosuppression of HIV will put a person at greater risk for COVID-19, thus, until more is known, additional precautions for all people with advanced HIV or poorly controlled HIV, should be employed,.
At present there is no evidence that the risk of infection or complications of COVID-19 is different among people living with HIV who are clinically and immunologically stable on antiretroviral treatment when compared with the general population. Some people living with HIV may have known risk factors for COVID-19 complications, such as diabetes, hypertension and other noncommunicable diseases and as such may have increased risk of COVID-19 unrelated to 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.
To date, there is a case report of a person living with HIV who had COVID-19 and recovered and a small study on risk factors and antiretrovirals used among people living with HIV with COVID-19 from China. This study reported similar rates of COVID-19 disease as compared to the entire population and increased risk with older age, but not with low CD4, high viral load level or antiretroviral regimen. 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 people have also developed severe disease from the coronavirus infection.
PLHIV are advised to take the same precautions as the general population,:
People living with HIV who are taking antiretroviral drugs should ensure that they have at least 30 days and up to 6-month supply of medicines and ensure that their vaccinations are up to date (influenza and pneumococcal vaccines). Adequate supplies of medicines to treat co-infections and comorbidities and addiction should also be ensured.
Several studies have suggested that patients infected with the virus causing COVID-19, and the related coronavirus infections (SARS-CoV and MERS-CoV) had good clinical outcomes, with almost all cases recovering fully. In some cases, patients were given an antiretroviral drug: lopinavir boosted with ritonavir (LPV/r). These studies were mostly carried out in HIV-negative individuals.
It is important to note that these studies using LPV/r 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.
While the evidence of benefit of using antiretrovirals to treat coronavirus infections is of very low certainty, serious side effects were rare. Among people living with HIV, the routine use of LPV/r as treatment for HIV is associated with several side effects of moderate severity. However, as the duration of treatment in patients with coronavirus infections was generally limited to a few weeks, these occurrences can be expected to be low or less than that reported from routine use.
It is important to assure continuous access to essential HIV prevention, testing and treatment services also where measurements of confinement are implemented within the public health response to the COVID-19 pandemic. While access to essential services should be maintained, adapted and evidence-based measures to reduce possible transmission should be considered and implemented. These include:
Generally, vulnerable populations, including members of key populations, as well as homeless and/or displaced people may be at increased risk of infection – because of additional comorbidities impacting on their immune system, reduced ability to apply measures of confinement and social distancing, as well as generally limited access to health services. It is critical that services that reach these populations such as community-based services, drop-in centres and outreach services can continue providing life-saving prevention (distribution of condoms, needles and syringes), testing and treatment while securing safety of staff and clients. Services can be adapted according to above considerations where applicable.