Interim US guidance for coinfection COVID-19 and HIV

Simon Collins, HIV i-Base

On 21 April 2020, the US Department for Health and Human Services (HHS) updated their guidelines for management of people with HIV and COVID-19 coinfection. [1]

This included new recommendations that people living with HIV who are diagnosed with COVID-19 have an excellent prognosis, and they should be clinically managed the same as persons in the general population with COVID-19, including when making medical care triage determinations.

Other guidelines are similar to many earlier BHIVA recommendations. [2]

Deferring monitoring in people on stable ART and reducing face-to-face consultations unless urgent – with a preference to have virtual or telephone appointments.
Following similar guidelines to general populations for reducing risk of infection and transmission.
Additional caution in individuals aged >60 years and those with diabetes, hypertension, cardiovascular disease, pulmonary disease, or obesity and in current smokers.
Additional caution in those with CD4 counts <200 cells/mm³ or with detectable viral load.
Ensuring continued supply of ART, preferable at least 90 days and at least one month.
Keeping influenza and pneumococcal vaccinations up to date.
To follow Substance Abuse and Mental Health Service Administration (SAMHSA) guidelines for maintaining access to opioid substitution therapy. (https://www.samhsa.gov/medication-assisted-treatment/statutes-regulations-guidelines/covid-19-guidance-otp)
That HIV positive people with COVID-19 should also contact their HIV provider, whether hosptialised or managing symptoms at home with self-isolation.
That ART should be continued if hospitalised for COVID-19, including access to investigational HIV medicines if part of a research study.
That HIV should not be an exclusion criterion for enrolling in investigational treatments for COVID-19.
That people with HIV may need additional assistance with food, housing, transportation, and childcare during times of crisis and economic fragility. To enhance care engagement and continuity of ARV therapy, clinicians should make every attempt to assess their patients’ need for additional social assistance and connect them with resources, including navigator services when possible.
During this crisis, social distancing and isolation may exacerbate mental health and substance use issues for some persons with HIV. Doctors should assess and address these patient concerns and arrange for additional consultations, preferably virtual, as needed.

For more information please refer to full guidelines.

Reference

Interim Guidance for COVID-19 and Persons with HIV. (Updated 21 April 2020).
https://aidsinfo.nih.gov/guidelines/html/8/covid-19-and-persons-with-hiv–interim-guidance-/0 (summary)
https://aidsinfo.nih.gov/guidelines/html/8/covid-19-and-persons-with-hiv–interim-guidance-/554/interim-guidance-for-covid-19-and-persons-with-hiv (full version).
BHIVA guidelines and statements on COVID-19.
https://www.bhiva.org/Coronavirus-COVID-19

Links to other websites are current at date of posting but not maintained.