Coronavirus and HIV – HIV update, 15 April 2020

Coronavirus and HIV

Medical authorities have continued to share what they know about the specific situation of people with HIV in the coronavirus pandemic.

The World Health Organization (WHO) has said there is currently no evidence that people living with HIV who are stable on HIV treatment and have a healthy CD4 count, without other health issues, have a greater risk of being infected with or dying from the COVID-19 coronavirus than the general population.

However, WHO also warns that people with advanced HIV disease, a low CD4 count, a high viral load, or who are not taking HIV treatment are at increased risk from infectious diseases in general. WHO suggests that people in these circumstances should take additional precautions against coronavirus.

Also, many people living with HIV are in their sixties or seventies, and have other health problems such as diabetes or high blood pressure that are known to raise the risks of infection or of severe coronavirus disease.

It’s important to stress that we have very little solid information to guide us at the moment. WHO’s opinion may change as new studies emerge.

But for the moment it may be that “no news is good news”. As the coronavirus has spread to Europe and North America, we haven’t heard about it affecting people with HIV more than other groups.

And the most detailed study on HIV and coronavirus so far has appeared. It comes from Wuhan, the Chinese city at the origin of the current outbreak. Clinicians made phone contact with 1174 people living with HIV in the city and found that 12 reported symptoms such as fever, cough and tiredness, suggestive of the new coronavirus. Testing showed that eight individuals (0.7%) had the infection, broadly comparable to the proportion in the wider population in the city. All of those with coronavirus had an undetectable viral load and most had CD4 counts above 350.

Six had a mild case of coronavirus disease, one had a severe case, and one died.

Those who had coronavirus tended to be older (average 57 years vs 36 years for those without disease), but the researchers do not report on additional health problems such as kidney or lung disease that they may have had.

Social distancing and the extra pressure that coronavirus is putting on health services are leading HIV clinics to reorganise their services. For example, the main HIV clinic in Geneva, Switzerland has reported on the steps it has taken. All patients have been contacted by phone to discuss ongoing arrangements, access to antiretrovirals, protective measures against coronavirus and any anxieties they have about the situation.

Appointments will now be done by phone or video link. Drugs will be provided by home delivery or at neighbourhood pharmacies. HIV testing services are being scaled back.

Help to stop smoking

Smoking is responsible for more deaths in people with HIV than HIV itself. People living with HIV are more likely to smoke than the general population and may be at greater risk of smoking-related illnesses, including heart disease, lung disease and some cancers.

Finding ways to help people with HIV stop smoking is therefore a priority for doctors, but there are questions about the best way to do this. For example, two recent studies found that when clinicians simply talked about stopping smoking and encouraged their patients to attend a stop smoking service, it had only a modest impact.

In a new study, smokers living with HIV were offered an intensive six-week course to help them quit and were given nicotine replacement gums or patches. A comparison group only got the nicotine replacement therapy.

Quit rates were examined three years later: such a long-term follow-up is a strength of the study. The researchers found that 10% of people were randomised to take part in group therapy, but only 4% of individuals in the control group had stopped smoking.

This does show how challenging stopping smoking is – far more people went back to smoking than remained abstinent – but also that the extra support from the course did help.

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