Why it is important to include HIV status and HIV testing in managing COVID-19
17 April 2020. Related: COVID-19: HIV and COVID-19 coinfection, COVID-19.
Simon Collins, HIV i-Base
The importance of HIV status being recorded for people diagnosed with pneumonia or other respiratory problems and who are hospitalised as part of the management of COVID-19 has been highlighted in a blog to the BMJ. [1]
There are several reasons for this.
Firstly, for those of us who are HIV positive, it will ensure that antiretroviral treatment (ART) is maintained during any period in hospital, including in intensive care. Interrupting ART will let viral load rebound which will increase immune inflammation at a time when this is one of the main difficulties in managing COVID-19. The lock down restrictions on physical movement means that HIV positive people with COVID-19 might be seen in a hospital with less HIV experience. We need to know HIV is considered in all settings.
Secondly, it will start to generate a dataset that will inform statements and guidelines about the impact of COVID-19 on people living with HIV. All the generally optimistic statements and guidelines have emphasised the lack of actual data and that they are based on expert opinion. [2]
Thirdly, HIV will be a complicating factor for COVID-19 in people who are not on ART, and by definition this will include people who have not yet been diagnosed. Even though NICE guidelines include HIV testing for anyone admitted to intensive care with pneumonia and respiratory failure, this really needs to be emphasised. [3] A recent dataset set of 290 people hospitalised for COVID-19 included 2 people who were HIV positive but 47 people where HIV status was unknown or not recorded. [4]
Finally, at a time when doctors, nurses and laboratories involved in HIV testing and sexual health services are being diverted to deal with coronavirus, this will provide another chance for HIV diagnoses in people not currently aware of their status.
It will also make sure that the skills and experience from HIV services are included in the response to COVID-19.
References
- Geretti AM, Collins S, Kelly S, Waters L. COVID-19 and HIV: Calling attention to the importance of ensuring HIV status and testing is included in the management of COVID-19. BMJ web blog. (7 April 2020).
https://blogs.bmj.com/sti/2020/04/07/covid-19-and-hiv-calling-attention-to-the-importance-of-ensuring-hiv-status-and-testing-is-included-in-the-management-of-covid-19 - BHIVA statements on HIV and COVID-19.
https://www.bhiva.org/Coronavirus-COVID-19 - NICE. HIV testing: encouraging uptake. Quality standard [QS157] (07 September 2017).
https://www.nice.org.uk/guidance/qs157/chapter/Quality-statement-3-HIV-indicator-conditions - International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC). Online report. (Accessed 5 April 2020).
https://isaric.tghn.org/covid-19-clinical-research-resources