What to Know About HIV and COVID-19

The understanding of COVID-19 is ever-evolving, and the relationship between human immunodeficiency virus (HIV) and COVID-19 is no exception. Based on the limited data that is currently available, the Centers for Disease Control and Prevention (CDC) has identified some risk factors, prevention strategies, and treatment options for people living with HIV. Research on the relationship between HIV and COVID-19 is ongoing.

HIV and COVID-19 Risk

The CDC has indicated that people with HIV who are on effective HIV treatment have the same risk of being infected by COVID-19 as people without HIV. This is based on data from two limited studies:

• The first study, which was published in May 2020, looked at people living with HIV who had COVID-19. Researchers found that people taking antiretroviral therapy (ART) did not see excessive rates of mortality or morbidity from COVID-19.
• The second study, which is a set of case studies published in April 2020, also found that people with HIV who took their ART correctly were not at elevated risk of COVID-19 infection.

The largest study of COVID-19 risk for people living with HIV was a review published in January 2021 that examined the outcomes of 6,947 individuals with HIV and COVID-19 co-infections during the first six months of the pandemic.

Collectively, these data indicate that HIV infection may be associated with an increased risk of COVID-19 diagnosis, but comorbidities appear to play a larger role than HIV-specific variables in outcomes of COVID-19.

The CDC does, however, indicate that in some instances, someone with HIV is at an increased risk of contracting COVID-19. This includes those:

• With HIV who have a low CD4 cell count (<350 copies/cell)
• With high viral load
• Not on effective antiretroviral therapy

People with HIV would have the same level and type of risk of exposure than anyone else with a chronic illness that requires in-person doctor appointments. For example, many people living with HIV who are already on an established and effective HIV treatment regimen would be able to opt for telehealth appointments more frequently than those with newly diagnosed HIV, or those with additional complications.

Given that HIV creates a greater risk for any infectious disease, it is especially important for people with HIV to:

• Continue taking their antiretroviral therapies consistently
• Keep an eye out for potential COVID-19 symptoms (and seek medication attention when necessary)
• Take the same precautions recommended for the wider population, including wearing a face mask, staying six feet apart from people outside their household, and washing hands frequently

Complications of HIV and COVID-19

If a person has both HIV and COVID-19, there is the potential for complications and challenges to arise. The National Institutes of Health (NIH), however, notes that recommendations for the triage, management, and treatment of COVID-19 in people with HIV are the same as those for the general population.

To minimize any potential harm or complications, if a person living with HIV is admitted to the hospital because of a severe case of COVID-19, they should let the hospital staff know that they are HIV-positive.

Opportunistic Infections

In people with later-stage HIV and suspected or documented COVID-19, HIV-associated opportunistic infections (OIs) can arise as complications—particularly in situations where the patient has a fever.

Because CD4 cell counts can fall during COVID-19, clinicians should remember to give opportunistic infection prophylaxis if the CD4 cell count falls below 200.

Comorbidities

As discussed earlier, comorbidities appear to play a larger role in complications with COVID-19 than HIV itself. These comorbidities can include:

• Obesity
• Diabetes mellitus
• Cardiovascular disease
• Pulmonary disease
• Smoking history
• Sickle cell disease

People living with HIV and one or more of the comorbidities indicated above should discuss all their diagnoses and current treatment regimens with their healthcare professional.

Medication

Other than OIs, complications related to both HIV and COVID-19 medications are also a concern.

Regardless of whether or not a person is hospitalized, once they test positive for COVID-19, they should continue taking all ART as previously prescribed. But if clinicians think it would be best for the patient with HIV and COVID-19 to begin treatment specifically for COVID-19, they must pay careful attention to:

• Potential drug-drug interactions
• Overlapping toxicities among COVID-19 treatments
• Antiretroviral (ARV) medications
• Antimicrobial therapies
• Other medications

Similarly, clinicians treating COVID-19 in people with HIV should consult with an HIV specialist before adjusting or switching ART medications.

HIV and Long-COVID

Currently, little is known about whether people with HIV have a higher chance of dealing with long-COVID. Also referred to as COVID “long-haulers,” long-COVID refers to a situation where someone becomes infected with COVID-19 and experiences residual COVID-19 symptoms for several months or more.

Some people with the earliest diagnosed cases of COVID-19 have been dealing with long-COVID symptoms for more than a year at this point.

Research specifically looking into people with HIV who also have long-COVID is, however, on the way, thanks to funding from amfAR, the Foundation for AIDS Research. The studies will focus on answering two questions:

• What are the risks for COVID “long-haulers” who are living with HIV?
• What, if any, effect does SARS-CoV-2 have on the HIV reservoir?

HIV Treatments and COVID-19

As discussed above, it is crucial that people with HIV who contract COVID-19 continue to take their usual ART medications. As far as treatments for COVID-19, those living with HIV should speak with their doctor before beginning any type of treatment, including those available over the counter, like Tylenol.

In general, people with HIV may benefit from the treatments being used in people with COVID-19 who don’t have HIV—although clinicians must pay extra attention to any potential interactions with ART.

Additionally, remdesivir, baricitinib (both FDA-approved treatments for COVID-19), and dexamethasone (a steroid commonly used to manage patients who require supplemental oxygen) should be made available to patients being treated for COVID-19 depending on disease severity.

How to Stay Safe

People living with HIV can take certain steps to help protect themselves from becoming infected by COVID-19. These include:

• Taking all ART medication as directed
• Eating right
• Getting at least 8 hours of sleep per night
• Reducing stress as much as possible
• Having telehealth appointments instead of in-person medical visits whenever possible
• Staying up-to-date with influenza and pneumococcal vaccinations, as well as COVID-19 primary series vaccinations and updated boosters

Of course, regardless of whether or not a person has HIV, it’s crucial to follow the general guidelines for avoiding COVID-19 transmission, including:

• Wearing a face mask
• Staying at least 6 feet away from people outside of your household
• Avoiding crowds and poorly ventilated spaces
• Washing your hands often
• Covering coughs and sneezes
• Getting vaccinated when you can

Summary

People with HIV—especially those whose infection is well managed with ART—appear to have a similar risk of infection as those without HIV. The more research that is completed on HIV and COVID-19, the better healthcare professionals will be able to help people with HIV prevent, manage, and treat COVID-19 infections.

The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.