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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 currently 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

Health Care Workers Should:

· Verify that patients have adequate supplies of all medications and expedite additional drug refills as needed.

· Devise a plan to evaluate patients if they develop COVID-19-related symptoms, including for possible transfer to a health care facility for COVID-19-related care.

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.

Please see this link for the complete interim guidance, including guidance for specific populations of people living with HIV, guidance for properly managing people living with HIV who develop COVID-19, and further general guidance for HIV clinicians: https://aidsinfo.nih.gov/guidelines/html/8/covid-19-and-persons-with-hiv--interim-guidance-/0.

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