What HIV/AIDS patients need to know about COVID-19

HIV patients with a high viral load and low CD4+ count (less than 200 cells per cubic millimetre of blood) - have advanced HIV infection or AIDS. HIV/AIDS patients who are not on antiretroviral therapy are at higher risk of contracting any and all infections. They are also at higher risk of complications of respiratory diseases, as per the US Department of Health and Human Services.

COVID-19 is a highly contagious viral infection which produces respiratory symptoms like shortness of breath. The more serious symptoms of this disease include pneumonia. CD4 is the immune system cell that HIV targets specifically. The CD4 count in people who don't have HIV infection is between 500 to 1500 cells/mm³ but in the case of HIV/AIDS, this count can fall below 200 cells per mm³.

So, are HIV-positive people at greater risk?

According to the World Health Organization (WHO), there is no evidence of an increased risk of COVID-19 in HIV patients who are already taking antiretroviral drugs. Though, older individuals and those with chronic diseases are at risk.

In China, a case study was done on an HIV-positive person who recovered from COVID-19. The patient also had diabetes and was being treated with antiretroviral drugs lopinavir and ritonavir and metformin. (Read more: Why COVID-19 is more dangerous for diabetics) 

A prepublication study argues that since HIV-positive people are immunocompromised, they don’t get as much inflammation as a healthy person would in response to the COVID-19 virus - SARS-CoV-2. (Inflammation is a part of our immune system's natural response to an infection or injury.)

For this reason, the prepublication study adds, they do not have clinical symptoms of the disease. The study also suggests that antiretroviral drugs and corticosteroids may be helpful in preventing or treating COVID-19.

However, the WHO has advised against the use of corticosteroids for COVID-19 since there is scientific evidence on their ineffectiveness, and regular use is associated with side effects.

Read more: Who can get tested for COVID-19

Antiretroviral drugs are given to HIV patients to control the viral load in their body. These drugs do not kill the virus but block the viral replication cycle. The WHO recommends immediate administration of antiretroviral therapy to anyone diagnosed with HIV irrespective of what their CD4+ count is.

Currently, the use of antiretroviral drugs in the prevention or treatment of COVID-19 is controversial. A recent study published in The New England Journal of Medicine indicated that lopinavir and ritonavir are not as effective against COVID-19.

That said, a British National in India was treated successfully with this combination and both these drugs are candidates in the multi-country SOLIDARITY trial launched by WHO to find therapies and treatment for COVID-19.

Read more: COVID-19 FAQs

The International AIDS society recommends that HIV patients take all the precautions that a healthy person needs to take for COVID-19. That is:

• Wash hands properly with soap and water or sanitize them with a 60% alcohol-based hand sanitizer.
• Follow good respiratory hygiene.
• Do not touch your face, especially your eyes, nose and mouth.
• Practice social distancing.

In addition to these:

• HIV and AIDS patients should also keep on taking their routine medications to maintain their immunity.
• Also, if you are HIV-positive and are not on antiretroviral drugs yet, start the treatment as soon as possible.
• Buy and keep one month's supply of antiretroviral medications - or even three to six months' worth - where possible.
• Those who are at risk of getting HIV should get tested for it. Make sure to call in advance to set an appointment with the clinic or testing faculty.
• If you are an HIV-positive person with another chronic disease, make sure to take all your medications for the other disease too since older people and those chronic diseases are particularly at risk of getting the more severe COVID-19 symptoms.

Read more: COVID-19 prevention tips for older adults and those with chronic diseases