COVID-19

We can only derive information from our experience with other viral infections, such as the seasonal flu caused by the influenza virus. People with a stable HIV infection (i.e. normal CD4 content and undetectable viral load) do not seem to be more susceptible to infections with the influenza virus. However, if an HIV-infected person has low CD4 levels (or other underlying diseases), an influenza infection may be more severe. Finally, the viral load may temporarily increase during a viral infection, especially if the patient is not on HIV inhibitors. However, this information should be taken with caution as we know that influenza virus infections and COVID-19 infections differ on several levels. 

What is COVID 19?

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). Coronavirus disease (COVID-19) is a new strain that was discovered in 2019 and has not been previously identified in humans.

Coronaviruses are zoonotic, meaning they are transmitted between animals and people.  Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans. 

Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. 

How is Coronavirus spread?

The virus is spread by respiratory droplets, which may travel up to six feet from someone who is sneezing or coughing. Close contact with an infectious person, such as shaking hands, or touching a doorknob, tabletop, or other surfaces touched by an infectious person, and then touching your nose, eyes, or mouth can also transmit the virus. The risk of infection is dependent on exposure. Close contacts of people who are infected are at greater risk of exposure, for example, healthcare workers and those who share a living space with people that are infected.

Do those living with HIV have to take extra precautions against Coronavirus?

This all depends on your current CD4 count. Compared with the general population, people with compromised immunity are at higher risk of developing more serious COVID-19 illness. The HIV population is aging, and nearly half are over 50. Those with low CD4 T-cell counts, indicating advanced immune suppression, are at greatest risk. People with HIV are more likely to develop cardiovascular disease and may do so at a younger age. Certain HIV medications, especially older drugs, can cause neutropenia, or depletion of immune system white blood cells that fight infection.

The impact of COVID-19 on people with HIV is not known. Current evidence indicates that the risk of severe illness increases with age and with certain chronic medical problems. In one case series, the median age of critically ill patients was 66 years and 72% had underlying co-morbid conditions, including cardiovascular disease, diabetes, cancer, chronic lung disease, and immunosuppression.

Although people 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 with HIV have conditions that increase their risk:
Older age – over half of people living with HIV in California are over 50 years of age;
Chronic medical problems – cardiovascular and chronic lung disease are more common in people living with HIV; and
Immune suppression – indicated by a low CD4 T-cell count or not receiving antiretroviral treatment.

What general precautions should someone take regardless of HIV status?

The basics for protecting yourself from COVID-19 are almost the same as for everyone:
• Washing hands with soap and water.
• Cover your cough or sneeze with a tissue or your elbow.
• Avoiding touching eyes, nose or mouth with unwashed hands.
• Avoiding close contact with people who are sick.
• Staying away from work, school, and other people if you become sick.
• Continuing your HIV medications to keep your immune system as healthy as possible.
Following guidance from public health officials on social distancing which can be found at: https:// www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/ncov2019.aspx.
Covid-19 Handwashing

Any other recommendations for those living with HIV during this pandemic?

Brooks’ recommendations include ensuring at least a 30-day supply of medications, keeping up to date with flu and pneumonia vaccines, and establishing a plan for clinical care if isolated or quarantined. Finally, he advised, “Maintain a social network, but remotely—social contact helps us stay mentally healthy and fights boredom.”

In a special session on COVID-19 at CROI 2020 this week, John T. Brooks, U.S. Centers for Disease Control and Prevention, in his presentation “Global Epidemiology and Prevention of COVID-19,” spoke about high-risk groups:

“Persons with medical co-morbidity and advanced age are at increased risk for severe illness and death. In the Chinese data I showed previously, persons with cardiovascular disease, diabetes, or chronic respiratory disease had a case fatality rate greater than 5%.
“Unfortunately, there aren’t data at the present time about persons who are immunocompromised, whether by medical therapy or acquired infection.

But for persons with HIV, we think the risk for severe illness would be greater for persons at lower CD4 cell counts and who aren’t virally suppressed [have undetectable viral load], since we’ve seen the same pattern in other intercurrent illnesses in people living with HIV. Nonetheless, all persons with HIV should take precautions against this new virus about which we’re still learning a lot. And I want to note that CDC estimates that equal to or more than 50% of people with HIV are over 50 years old.” 

The New York Times recently reported that “immunocompromised people with compromised immune systems are especially vulnerable to respiratory infections. That group includes those who have autoimmune disorders such as lupus and arthritis, those who have had organ transplants, patients undergoing chemotherapy and other cancer treatments, and anyone who is taking steroids as treatment.

“People with H.I.V. are not on the list as yet, however. With powerful antiretroviral drugs, many now have immune systems strong enough to stave off infections, said Dr. Monica Gandhi, an infectious disease expert at the University of California, San Francisco.
“There is some very preliminary evidence that certain H.I.V. drugs in wide use may help slow the coronavirus.”

Reference

FACT SHEET: Handwashing with soap, critical in the fight against coronavirus, is ‘out of reach’ for billions. (2020, March 3). Retrieved from https://www.unicef.org/press-releases/fact-sheet-handwashing-soap-critical-fight-against-coronavirus-out-reach-billions

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