HIV & coronavirus

Throughout the coronavirus pandemic we’ve been supporting people living with HIV and answering questions about the impact the virus may have for them. We’ve developed our information by closely following the guidance provided by the British HIV Association (BHIVA), European AIDS Clinical Society (EACS), Public Health England, the NHS, National AIDS Trust (NAT) COVID-19 Information Network and other HIV support organisations. We’ve also used other reliable sources of information available in the public domain.

What is coronavirus and COVID-19?

Coronavirus is a new or ‘novel’ viral infection which is very easily transmitted from person to person who are in close proximity, particularly indoors. There is no natural immunity to this new virus which has enabled it to spread rapidly throughout the world.

Recent developments in vaccine research means we now have a vaccine that is safe and effective which has been authorised for use to protect against coronavirus. It will take several months for enough people to be vaccinated to keep new cases low enough to stop the spread of coronavirus, so it’s still important to stick to all the National and local restrictions that are in place.

Early symptoms of coronavirus illness include loss or change in taste or smell, development of a new continuous cough and a fever. Some people also experience shortness of breath, sore throat, nasal congestion, loss of appetite, headache, diarrhoea, nausea and vomiting. If you think you have coronavirus it’s important you have a test and self-isolate until the test result is confirmed.

Up to 60% of people who catch coronavirus don’t show any symptoms (asymptomatic) and can pass it on to close contacts without knowing. Close contacts of someone who is asymptomatic may then become unwell or seriously ill, which is the major difficulties with controlling coronavirus. Practicing social distancing, good hand and face hygiene measures and wearing face coverings in shops and on public transport are the most effective ways of stopping the spread of the virus. It’s also important to be aware of and observe local and regional Government measures to help reduce the spread of coronavirus.

COVID-19 is the illness caused by coronavirus, which is non-life threatening for the majority of people. Despite being a mild to moderate illness it can take some time to fully recover, with the average time to full health taking up to 28 days for many people. We are also starting to understand that some people experience what is terms ‘long COVID’.

COVID-19 can be life threatening for some people who are more vulnerable to the illness the virus causes. Older age and people from black and brown ethnic minorities are at greater risk of developing severe illness. People who have other health conditions particularly diabetes, obesity, high blood pressure or other long-term health conditions that affect the lungs, heart and kidneys are also at greater risk of becoming very unwell. HIV may be an independent risk factor for the development of severe COVID-19, but this is far from conclusive with more research needed.

Severe COVID-19 symptoms are characterised by breathing difficulties with the development of other complications which affect the heart, cardiovascular system and kidneys, which require hospital treatment and care. If you experience breathing difficulties, you should seek medical help as soon as possible by calling the 111 or 999 service is there is a clear risk to life. The treatment for COVID-19 has improved since the early days of the pandemic and there are 2 medicines available to help those with who experience severe breathing difficulties and illness. Specialist Doctors and nurses have a much better understanding of the care required to help people recover.

HIV & coronavirus

The majority of people living with HIV, who are taking treatment, have undetectable viral load and are generally well aren’t considered to have a weakened immune system. As the pandemic has developed there hasn’t been any conclusive evidence to suggest people living with HIV are at any additional risk of getting coronavirus than the general population where their CD4 count is above 200.

When CD4 count is below 50 the advice is to strictly adhere to social distancing measures, ensure regular hand washing and the use of hand sanitiser, to wear face coverings in shops and when on public transport and to avoid crowded areas where at all possible At the height of the pandemic individuals in this group were advised to ‘shield’ to avoid getting coronavirus as they may be at additional risk of severe COVID-19 which requires hospital admission and active help with breathing.

It’s important to remember that for the large majority of people living with HIV, as with the general population the illness caused by coronavirus is a mild to moderate form which is self-limiting and doesn’t require treatment in hospital. For those with additional risk factors (aged above 60, black or brown ethnicity, other underlying health conditions) it is possible that HIV may be an independent risk factor of severe COVID-19 developing. If you have any concerns, please talk with your HIV clinic team for further advice and support.

If you are admitted to hospital, we strongly advise you tell the medical team looking after you that you're living with HIV. This information will enable them to look after you in the best way possible and undertake the correct tests, investigations and provide you with the most suitable treatment. You should continue to take your HIV medication as usual unless otherwise directed by the medical team who should contact your clinic team or specialist HIV doctor to get further advice.

If you require additional breathing support and can't swallow, you'll be provided with essential nutrition through a tube which is inserted into your nose and goes down into the stomach. This tube (nasogastric tube) will ensure all the necessary nutrients are provided for you as well as medications you would normally to by mouth. Some HIV medications are available in liquid form, or can be crushed and dissolved in water, allowing them to be delivered to the stomach by the nasogastric tube. Please don’t worry about not being able to take your HIV medications in these circumstances as everything will be done to ensure you’re provided with appropriate medications to keep your viral load undetectable.

Protecting yourself and others from coronavirus

Looking after your general health is the best way to reduce the health risks associated with coronavirus and COVID-19 illness. Taking your HIV treatment as prescribed, remaining active, managing your weight and giving up smoking can all help.

It’s still not too late to have the annual seasonal flu vaccination which is also recommended by BHIVA as is the pneumonia vaccination which is effective for between 5 and 10 years for those living with HIV. If you live in England your GP will usually give you these vaccinations. Other arrangements may be in place in Wales, Scotland and Northern Ireland.

Whilst vaccines are available for coronavirus it will take many months to roll-out across the UK. People living with HIV have been automatically placed in priority level 6 and are expected to receive the vaccination after the most vulnerable groups (priority 1-4). All the UK authorised vaccines are safe for use in people living with HIV and the British HIV Association (BHIVA) recommend having the coronavirus vaccination when it is offered.

We’ve put together a 6-point plan to help you stay safe and well whilst coronavirus and COVID-19 continues to be a public health concern:

Stay safe – social distancing, regular hand washing, using hand sanitiser and wearing face coverings or masks are the most effective ways to avoid catching or passing on coronavirus.

Stay well – seek medical help if you think you have coronavirus or for any non-coronavirus illnesses and health conditions. Don’t delay contacting your GP about other health problems and if it’s an emergency use the 999-ambulance service. Stokes, heart attacks and other serious health conditions need immediate attention.

Stay vigilant – get regular updates on the advice provided by local authorities and Government departments across England, Wales, Scotland and Northern Ireland as there are likely to be different arrangements in place.

Get tested – if you think you have coronavirus get tested as soon as possible and self-isolate until you get the test result back. If the test is positive you should continue to self-isolate as per the current guidelines. Widespread mass testing using ‘lateral flow tests’ is becoming available for people who don’t have any symptoms, which may be important if you can’t work from home. Up to a third of people have coronavirus but don’t have any symptoms (asymptomatic infection) but can still pass the virus on to other people.

Get vaccinated – In line with the advice provided by BHIVA we strongly recommend you have the coronavirus vaccination when it is offered to you. If you have a CD4 cell count below 50, are recovering from a severe HIV related illness or have other long-term health conditions you may be considered as extremely clinically vulnerable will be invited to have the vaccination as part of the priority 4 group. Please talk to your GP or clinic team if you believe you should be in this group or have been advised to shield at any time during the pandemic.

Seek support – changes to our way we live our lives during the pandemic have had a big impact on the emotional health and wellbeing for many people. We’re here to support people living with or affected by HIV through our online peer support service. This is available to anyone living in the UK or UK nationals working and living abroad.

Your HIV and sexual health care

At the start of the pandemic the majority of HIV services were significantly changed to enable clinic teams to support the COVID-19 effort. In the majority of areas across the UK these arrangements have been greatly eased, although services are by no means back to how they were prior to lockdown measures being put in place.

Routine in-clinic appointments continue to be replaced by telephone consultations although blood testing is now once again available. There are generally no walk-in services available, with clinics offering telephone triage to provide the best information and support.

Clinics will always see people who are newly diagnosed with HIV and those who have complex health problems which require additional support and monitoring. Changes to medication will usually be avoided unless clinically necessary to reduce the need for blood testing and additional clinic visits.

Repeat medication requests can be made without the need to have blood taken where this is necessary as it’s important you don’t have a break in your treatment. It's advisable to have your routine blood tests done if you can and to not go beyond a period of 12 months without getting them checked. You should ensure you keep 30 days’ supply of your medication on hand, but don’t stockpile as this could results in shortages developing. You should contact your clinic well in advance to ensure you don’t run out of HIV medication or your GP for any other prescription items.

If you get your medication by home delivery this will continue as normal but may take a little longer to be delivered. If you usually collect HIV medication from clinic or hospital pharmacy, you can still visit by appointment if you don’t have any COVID-19 symptoms. Your clinic will have suitable arrangements in place to get medications to you at home if you’re unable to attend in person.

Sexual health services aren’t generally providing walk-in services. For those who don’t have symptoms, where available, online postal testing services should be used. If you have symptoms contact your local clinic by telephone in the first instance. This also applies if you require emergency contraception, PEP or PrEP. Clinic teams will arrange for you to visit the clinic by appointment to access the appropriate service where required.

Further support and information

We’ve put together a FAQ sheet to help answer these as best we can. We’ve based our answers on the available information provided by the British HIV Association (BHIVA), European AIDS Clinical Society (EACS), Public Health England, the NHS, HIV support organisations and other reliable sources of information available in the public domain.

Plushealth online peer support

Plushealth FAQ sheet

Plushealth wellbeing information

My community forum

Peer.support@plushealth.org.uk

NHS coronavirus Information

NHS track and trace service information

NHS Coronavirus (COVID-19) vaccine

If you have a health emergency (heart attack, stroke, severe problems with breathing) or another risk to life please call 999. Please don’t delay getting emergency help when it’s needed!