HIV and COVID-19

Contributed By:
Dr Mallika Mootoo, MD
Pediatrician/ HIV Clinician
St. Joseph Mercy Hospital

The Human Immunodeficiency Virus (HIV) is the virus which causes HIV infection. The abbreviation “HIV” can refer to the virus or to HIV infection. The virus targets a person’s immune system and attacks and eventually destroys the infection -fighting CD4 cells. As more and more CD4 cells are destroyed the immune system becomes weakened, making it difficult for the body to fight off infections and certain cancers. Without treatment, HIV can gradually destroy the immune system and lead to AIDS.
Acquired Immunodeficiency Syndrome (AIDS) is the most advanced stage of HIV infection.
HIV is transmitted through contact with HIV infected bodily fluids. It is spread mainly by having unprotected sex with someone who has HIV, sharing a needle with an HIV infected person and from mother to child during pregnancy, delivery and/or breast feeding.
HIV infection is a lifelong disease for which there is still no cure. There is, however, effective anti-HIV medication which when taken correctly, allow people with HIV to live long and healthy lives.
Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. People on ART take a combination of HIV medicines every day.
ART is recommended for everyone who has HIV. ART prevents HIV from multiplying, which reduces the amount of HIV in the body (called the viral load). Having less HIV in the body protects the immune system and prevents HIV infection from advancing to AIDS. ART can’t cure HIV, but HIV medicines help people with HIV live longer, healthier lives.
ART also reduces the risk of HIV transmission. A main goal of ART is to reduce a person’s viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. People with HIV who maintain an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative partner through sex.

COVID-19 is an infectious disease caused by a new coronavirus called SARS-CoV-2. The World Health Organisation (WHO) first learned of this new virus on 31 December 2019, following a report of a cluster of cases of ‘viral pneumonia’ in Wuhan, People’s Republic of China. In March 2020 the WHO declared COVID-19 a pandemic.
The virus that causes COVID-19 is mainly transmitted through droplets generated when an infected person coughs, sneezes, or exhales. These droplets are too heavy to hang in the air, and quickly fall on floors or surfaces.
You can be infected by breathing in the virus if you are within close proximity of someone who has COVID-19, or by touching a contaminated surface and then your eyes, nose or mouth.
To date more than 100 Million people have been infected worldwide and more than 2.2 Million people have died from this disease.
COVID-19 and HIV
We are still learning about COVID-19 and how it affects people with HIV. Based on what we know so far, we believe that people with HIV who are on effective treatment have the same risk for COVID-19 as people who do not have HIV.
Older adults and people of any age who have serious underlying medical conditions including diabetes, hypertension, cardiovascular disease, pulmonary disease or obesity might be at increased risk of severe illness. Chronic smokers are also at risk for more severe disease.
People living with HIV who are either not on treatment or are not adhering to their treatment regimen have a compromised immune system and are therefore at risk of having severe disease should they be infected with SARS CoV2 virus.
This includes people with a:
Low CD4 count (<350 cells),
High viral load (>1000c/ul)
And/or a recent opportunistic infection (eg: Pulmonary Tuberculosis).
People living with HIV who are not on treatment or failing their current treatment regimen, are also more susceptible to respiratory tract infections. For this reason, it is important for HIV+ patients to remain on their medication as prescribed by their healthcare provider.
Similarily to the general population, older people with HIV who have other underlying health conditions should adhere to the prescribed treatment regimens for those conditions.

Being Prepared For COVID-19

COVID-19 Vaccines
Many new vaccines have been developed to help stop the spread of this pandemic. In December 2020 several countries started giving emergency approval for the vaccines to be used. We are also hopeful that we will soon start offering vaccines to everyone.
The vaccines which have been approved for use are all considered safe for people living with HIV. 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 your body to develop immunity to the virus that causes COVID-19 – so you are able to fight it off 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.

Key Points:
• People living with HIV and on effective antiretroviral treatment (ART) do not appear to be at greater risk of getting COVID-19.
• Our understanding of the risk of developing severe COVID-19 in people living with HIV is evolving. Current evidence suggests that HIV is less of a risk factor for severe COVID-19 than other health conditions.
• People living with HIV not on treatment or virally suppressed may be at a greater risk. Speak to a healthcare professional for more information on how to stay healthy.
• As with the general population, older people living with HIV and those with other underlying health conditions should take extra precautions to prevent illness.
• Try to have at least a 30 days’ supply of ART in your home. If possible, ask for three months.
• The current COVID-19 vaccines are believed to be safe for people living with HIV.
• We are continuing to learn about COVID-19. Remember to keep in touch with your healthcare provider and follow government advice.

Article submitted
as part of the
Ministry of Health’s
public information
and education