Dr Tariq Jagnarine
Family Medicine, Endocrinology/ Diabetes

There are over 102 million cases of COVID-19 worldwide, and with numbers growing rapidly, it is important to focus on prevention strategies to mitigate the spread of COVID-19, especially in countries with a high prevalence of HIV, like Guyana. There is great concern about the impact of COVID-19 among the nearly 40 million people living with HIV (PLHIV) worldwide. While several researches conclude that there is no higher prevalence of COVID-19 among PLHIV, having HIV does not confer protection against severe manifestations of COVID-19. Additionally, several studies looked at antiretroviral drugs used against HIV to treat SARS-CoV-2, and these have shown no major mortality benefit. The clinical course of COVID-19 among PLHIV does not seem to be different from what it is in the general population. However, there are areas of concern, included among them being high inflammatory states from both conditions, which could result in complications. The global focus on the COVID-19 pandemic, including the race for a viable and effective vaccine and research into treatment options, has the potential to synergistically drive progress for research in HIV infection.
HIV care delivery has been adversely impacted in Guyana, affecting our UNAIDS target, during this pandemic; but has created an opportunity for accelerating effective strategies, like multi-month antiretroviral treatment. Decentralising HIV care in low-resource settings and incorporating telemedicine in high-resource settings can be critical in mitigating the ripple effects to healthcare systems in the future.

* People with HIV appear to have a slightly increased risk of dying from COVID-19 if they have detectable viral loads and low CD4 counts.
* People with HIV and underlying health conditions, such as obesity, poorly controlled diabetes, high blood pressure, and cardiovascular disease, can be at a higher risk of contracting COVID-19.
* People with CD4 cell counts below 50, or with an underlying opportunistic illness in the last six months, may need to take extra precautions to protect themselves from the coronavirus.

While everyone is at risk of contracting COVID-19, the consequences of infection are more severe, and can even result in death, for some vulnerable groups. This includes PLHIV who are:
* Aged over 60 years old
* Living with a detectable viral load, or are not on HIV treatment
* Diabetic
* Smokers
* Living with a comorbidity such as heart or lung issues.
Since the disease is new, and no long-term study has been done to assess lasting impact and consequences of COVID-19, PLHIV need to be extra careful and adhere to the Ministry of Health’s (MOH’s) guidelines on COVID-19.

* People with a CD4 count over 200, who are taking HIV treatment and have an undetectable viral load, are considered at no greater risk than the general population. They should follow general advice: to stay at home and maintain social distancing.
* People with a CD4 count below 200, or who are not taking HIV treatment, or who have a detectable viral load, may be at higher risk of severe illness. Nonetheless, they should still follow the same general advice.
* People with a very low CD4 count – below 50, or who have had an opportunistic illness in the last six months, are extremely vulnerable to COVID-19, and need to practise all of the Ministry of Health’s advice.

* As much as possible, stay at least one metre away from people outdoors, and maintain an even greater distance indoors.
* Wear a face mask when around others.
* Avoid places that are crowded, confined, or involve close contact with others, especially indoors.
* Wash hands frequently and properly with soap and water, or use an alcohol-based hand sanitiser.
* Avoid touching the face.
* Avoid people who are feeling unwell.
* Clean and disinfect surfaces regularly.
* Cover the nose and mouth with a clean tissue when sneezing or coughing, or sneeze into an elbow. Throw away the tissue sneezed into and wash hands.
* Try to stock-up on antiretroviral treatment, or any other medication that needs to be taken for at least 30 to 90 days.
* Make sure all vaccinations are up-to-date (such as flu and pneumonia vaccines).
* Try to get in touch with the health-care facility and peer supporters.
* Have a plan regarding staying at home for long periods, including how to get food and medicine.
* Eat well, and exercise as best as possible (even at home).
* Have mental health checks, and seek social support if needed.

The COVID-19 vaccines already approved for use or under development are considered safe for people living with HIV. Generally, to be approved, vaccines must pass multiple safety trials, and be reviewed by national regulators to ensure they are both safe and effective. Several of the COVID-19 vaccine trials included people living with HIV. As with the general population, for people living with HIV, the vaccines help the body to develop immunity to the virus that causes COVID-19; this allows persons to fight off the virus if exposed. Even after being vaccinated, it is important to continue to take steps to prevent COVID-19 transmission, until cases of the virus have fallen to a safe level in Guyana.
Even before the COVID-19 crisis, a high percentage of people living with HIV were engaged in the informal economy. They faced high levels of discrimination in employment, and had high rates of unemployment – which was significantly impacted by lockdown measures. Women are overrepresented among the informal economy workers in the hardest hit sectors. The rate of relative poverty is expected to increase by approximately 34 percentage points globally for workers in the informal economy. With further increases in income inequality among workers, an even greater proportion of informal economy workers would be left behind.
As lockdowns end, and recovery plans are put in place, it is important to ensure that people living with HIV, and key populations, do not face stigma and discrimination in resuming their jobs or reintegrating into the labour market. Given the high unemployment rates of people living with HIV, targeted income-generation programmes as part of their COVID-19 response and recovery plans are encouraged.