What to Know About HIV and COVID-19

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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 COVID-19 risk favors, prevention strategies, and treatment options for people living with HIV. Research on the relationship between HIV and COVID-19 is ongoing.

Rapid testing for COVID-19

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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: Published in May 2020, this study—with a sample of 33 people with HIV and COVID-19—found that people taking antiretroviral therapy (ART) did not see excessive rates of mortality or morbidity from COVID-19.
  • The second study: This set of case studies from Istanbul Turkey, 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.

The review included data collected across geographic regions, with a range of healthcare quality and access, and ART regimens. Collectively, these data indicate that HIV infection may be associated with increased risk of COVID-19 diagnosis, but comorbidities appear to play a larger role than HIV-specific variables in outcomes of COVID-19.

Does ART Protect You From COVID-19?

ART does not appear to protect a person with HIV from COVID-19 disease acquisition, progression, or death.

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:

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.

For example, if someone with HIV has additional comorbidities, they may be eligible for one of the anti-SARS-CoV-2 monoclonal antibodies available through Emergency Use Authorization from the FDA.

Additionally, both remdesivir (currently the only FDA-approved antiviral treatment for COVID-19) and dexamethasone (a steroid commonly used in the management of patients with COVID-19 who require supplemental oxygen) should be made available to patients with HIV and being treated for COVID-19.

Frequently Asked Questions

Here are the answers to three frequently asked questions about HIV and COVID-19.

Should I get a COVID-19 vaccine if I have HIV?

Yes, absolutely you should. Anyone living with HIV is advised to get a COVID-19 vaccine, regardless of CD4 or viral load, because the potential benefits outweigh potential risks. That is taking into account the fact that people living with HIV were participants in the clinical trials for the two mRNA vaccines currently available (Pfizer/BioNTech and Moderna), but specific safety and efficacy information for this subgroup have not been fully reported.

When it comes to COVID-19 prioritization, people living with HIV are considered to have an underlying medical condition, meaning that they would be eligible along with other 16- to 64-year-olds in their state with qualifying pre-existing conditions.

Can antiretroviral therapy be used to treat COVID-19?

At this point, while some ART drugs are being studied for the treatment of COVID-19, there is not yet any evidence that any of the therapies are effective in this capacity. This is, however, an area that is currently being examined in ongoing research.

Finally, while ART itself may not be able to treat COVID-19, it is crucial that people with HIV keep up with their ART regimen and discuss it with their healthcare professional in light of their COVID-19 diagnosis.

Do people with HIV have a higher chance of serious complications and/or worse outcomes from COVID-19?

No clear consensus has emerged from the early clinical data that is currently available on outcomes for people with HIV and COVID-19. For example, data from the Veterans Aging Cohort Study indicate that there was no difference in COVID-19-related hospitalization, intensive care unit admission, intubation, or death in patients with or without HIV. 

However, other studies show that people with HIV and COVID-19 tend to have more severe outcomes than those with only COVID-19. For example, in a multicenter cohort study of 286 patients with HIV and COVID-19 in the United States, lower CD4 count (i.e., <200 cells/mm3), despite virologic suppression, was associated with a higher risk for the composite endpoint of ICU admission, mechanical ventilation, or death.

Additionally, people with HIV in a cohort study in New York had higher rates of hospitalization and mortality with COVID-19 compared with people without HIV.

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, with the understanding that the COVID-19 vaccine cannot be given within two weeks of receiving another type of vaccine

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

A Word From Verywell

Even a year into the pandemic, all of the unknowns associated with COVID-19 can make anyone anxious—let alone someone with an immune system disorder like HIV.

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.

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11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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