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Cure Registry Newsletter: COVID-19 and People Living with HIV

Welcome to the second installment of the AVRC’s Cure Registry Newsletter! We hope that you are safe, well, and taking care of yourself during these trying times. While there is a great deal of information available on the COVID-19 epidemic, we wanted to take this opportunity to provide you with accurate, reliable knowledge on COVID-19 as it relates to people living with HIV. We hope this newsletter will answer some of your questions and provide you with helpful guidance as we continue to navigate the epidemic together.

Common Questions and Answers on COVID-19 and People Living with HIV

Are people living with HIV at increased risk of contracting COVID-19?

Currently, there is no evidence that the risk of infection or complications of COVID-19 are different among people living with HIV who are clinically and immunologically stable on antiretroviral treatment when compared with the general population. People living with advanced HIV, 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, including COVID-19.

Although people living with HIV who are on treatment with a normal CD4 T-cell count may not be at an increased risk of serious illness, many people living with HIV may have other conditions that increase their risk:

· Older age – over half of people living with HIV in California are over the age of 50

· Chronic medical problems – cardiovascular and chronic lung disease are more common in people living with HIV

· Immune suppression – indicated by a low CD4 T-cell count or not receiving antiretroviral treatment

How can people living with HIV protect themselves?

People living with HIV should take many of the same safety precautions as the general population to protect themselves against COVID-19:

· Following social distancing guidelines and stay-at-home orders accordingly

· Washing hands with soap and water for at least twenty seconds

· Clean and disinfect frequently touched surfaces daily

· Cover your cough or sneeze with a tissue or your elbow

· Avoiding touching eyes, nose, or mouth with unwashed hands

· Avoiding physical contact with people who are sick

· If you smoke or vape, consider quitting

· Continuing your HIV medications to keep your immune system as healthy as possible


What can I do if I’m at higher risk for COVID-19?

In addition to the general precautions to protect yourself listed above, you should:

· Make sure that you have adequate supplies and refills for your antiretrovirals and other medications

· Stay at home and only leave your home for essential tasks, but maintain a social network remotely/electronically to help you stay socially connected and mentally healthy

· When leaving your living space for essential tasks like grocery shopping or health care visits, do your best to keep a distance of six feet between yourself and other people, especially if they appear to be sick

· Avoid inviting other people into your living space

· Avoid all non-essential travel

· Establish a plan for clinical care, including the use of telemedicine, to conduct health care visits from home when possible

General Guidance for COVID-19 and People Living with HIV

The U.S. Department of Health and Human Services has released some guidance for COVID-19 and people living with HIV. Although information on COVID-19 is rapidly evolving, here are some highlights and key points from this latest guidance:

Guidance for All People Living with HIV

· People aged >60 years and those with diabetes, hypertension, cardiovascular disease, or pulmonary disease are at highest risk of developing serious disease and potentially life-threatening disease related to COVID-19.

· Some people living with HIV have other conditions (e.g., cardiovascular disease or lung disease) that increase the risk for a more severe course of COVID-19. Chronic smokers are also at risk of more severe disease.

· There are very limited data, but at present these data do not indicate that the disease course of COVID-19 is different in people living with or without HIV.

· Until more is known, additional caution for all people living with HIV, especially those with advanced HIV or HIV that is not virally suppressed, is warranted.

· People with HIV should follow all applicable recommendations of the U.S. Centers for Disease Control and Prevention (CDC) to prevent COVID-19, such as social distancing and proper hand hygiene. These recommendations are regularly updated.

Antiretroviral Therapy

People living with HIV should:

· Maintain on-hand at least a 30-day supply—and ideally a 90-day supply—of antiretroviral (ARV) drugs and other medications.

· Talk to their pharmacists and/or healthcare providers about changing to mail order delivery of medications when possible.

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

· If protease inhibitors (PIs) are not already part of a person’s ARV regimen, their regimen should not be changed to include a PI to prevent or treat COVID-19, except in the context of a clinical trial and in consultation with an HIV specialist.

Clinic or Laboratory Monitoring Visits Related to HIV Care

· Together with their health care providers, people living with HIV and their providers should weigh the risks and benefits of attending, versus not attending in-person, HIV-related clinic appointments at this time. 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 people who have a suppressed HIV viral load and are in stable health, routine medical and laboratory visits should be postponed to the extent possible.

Guidance for People Living with HIV in Quarantine due to Coronavirus Exposure

People Living with HIV Should:

· Contact their health care provider to report that they are self-isolating or in quarantine.

· Specifically, inform their health care provider how much ARV medications and other essential medications they have on hand.

Guidance for People Living with HIV who have COVID-19 Symptoms and are Seeking Evaluation and Care

People Living with HIV Should:

· Follow CDC recommendations regarding symptoms.

· If they develop a fever and symptoms (e.g., cough, difficulty breathing), they should call their health care provider for medical advice.

· Call the clinic in advance before presenting to the clinic.

· Use respiratory and hand hygiene and cough etiquette when presenting to the healthcare facility and request a face mask as soon as they arrive.

· If they present to a clinic or an emergency facility without calling in advance, they should alert registration staff immediately upon arrival of their symptoms so that measures can be taken to prevent COVID-19 transmission in the health care setting. Specific actions include placing a mask on the patient and rapidly putting the patient in a room or other space separated from other people.

We look forward to continuing to update you with the latest information about COVID-19 and people living with HIV. The AVRC is regularly posting updates about COVID-19 on its blog page, which can be viewed here: https://www.pirc.ucsd.edu/newsletter/categories/covid-19

If you have any questions or comments pertaining to any of the information in this Cure Registry Newsletter, please email avrcmarketing@health.ucsd.edu.

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