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BHIVA, DAIG, EACS, GESIDA & Polish Scientific AIDS Society Statement on risk of COVID-19 for people living with HIV (PLWH)
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Monday 25th May 2020
https://www.bhiva.org/BHIVA-DAIG-EACS-GESIDA-Polish-Scientific-AIDS-Society-statement-on-risk-of-COVID-19-for-PLWH
COVID-19 & HIV
Case series of HIV-patients with COVID-19 have been published from China, Spain, Germany, Italy and the United States (1-6). So far there is no clear evidence for a higher COVID-19 infection rate or different disease course in people with HIV than in HIV-negative people. Of note, most HIV case series report a younger age in their study population than in HIV-negative hospitalised COVID-19 patients but comparable rates of comorbidities. In a UK cohort study reporting outcomes on 16,749 hospitalised patients with COVID-19 only 1% involved PLWH, but HIV did not adversely impact survival [7].
Current evidence indicates that the risk of severe illness increases with age, male gender and with certain chronic medical problems such as cardiovascular disease, chronic lung disease, obesity and diabetes. Although people with HIV who are on treatment with a normal CD4 T-cell count and suppressed viral load may not be at an increased risk of serious illness, many people with HIV have other conditions that increase their risk. Indeed, almost half of people living with HIV in Europe are older than 50 years and chronic medical problems, including cardiovascular and chronic lung disease, are more common in people living with HIV. Smoking is a risk factor for respiratory infections; smoking cessation should therefore be encouraged for all patients. Influenza and pneumococcal vaccinations should be kept up to date.
It has to be assumed that immune suppression, indicated by a low CD4 T-cell count (<200/µl), or not receiving antiretroviral treatment, will also be associated with an increased risk for a more severe disease presentation. Data in such patients however, is sparse as most HIV-coinfected COVID-19 patients so far have been under antiretroviral therapy and successfully treated with mostly suppressed HIV-RNA levels. For patients with low CD4-counts (<200/ml), or who experience a CD4-decline during a COVID-19 infection, remember to initiate opportunistic infection (OI) prophylaxis. This is not aiming at preventing a more severe course of COVID-19 but rather complications through additional opportunistic infections. More information regarding recommendations for prophylaxis and treatment of specific opportunistic infections can be found in the BHIVA/EACS guidelines for HIV/AIDS.
The ongoing discussion about potential COVID-19 vertical transmission remains controversial. Although few case reports have claimed perinatal transmission several other large case series could not find any case of vertical transmission [8-11]. Pregnant women with critical COVID-19 who deliver during their disease course mostly deliver preterm via caesarean section [11]. So far clinical outcome of the newborn however, has been uneventful.
Existing national guidelines should be followed in terms of reducing risk for acquiring a COVID-19 infection and managing symptoms [12-15].
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