BHIVA update guidance for HIV care during second wave of COVID-19

14 October 2020. Related: COVID-19: guidelines, COVID-19.

BHIVA

BHIVA is updating guidance for HIV clinics as NHS organisations are now having to reinstate plans to manage the epidemic because of the rising number of COVID-19 cases.

1. We advise that the time between routine monitoring (blood & urine tests) of HIV patients should not be longer than 12 months.
2. Services should do all they can to support people to come to clinic for check-ups. This includes explaining and discussing any risks of not doing so. It also includes reassuring them about COVID infection control measures and offering alternatives where possible. These could include blood tests and monitoring by a GP, using existing community services, such as an HIV community nurse, or liaising with other clinics and hospital services.
3. Where it is not possible to undertake the usual monitoring, ART should still be prescribed in all but exceptional cases. Patients should be advised that, without monitoring, there is a risk of a reaction to medication. This risk is low but could include changes in the liver and kidney and/or an increase in viral load. These could increase the risk of serious illness (including death), the development of resistance to HIV medication so that it does not work effectively, and so a risk of passing HIV on to sexual partners. However, for nearly everyone, the risk of interrupting medication is far greater than less frequent monitoring. The longer that HIV has been undetectable though, the less likely it is to rebound. In the same way, the longer someone has been well on a medication the less likely that any new problems will occur. These discussions on the risks of reduced monitoring, should be clearly recorded in the patient’s notes.
4. Where there is pressure on staffing and other parts of HIV clinical services due to COVID-19, we repeat our previous advice that the services (a)-(f) listed below must be maintained.
   • Blood/urine tests must be provided so that all patients can be monitored at least once a year. Urgent testing must also be available including, for example, where there are new symptoms or concern that the level of the HIV virus in the blood is rising, or for patients with advanced HIV.
   • Care for people newly diagnosed with HIV, starting antiretroviral drugs (ART) according to BHIVA guidelines.
   • Changing ART medication, when this change means that the patient must be regularly checked for any reaction to the new drugs.
   • Monitoring and providing advice to women with HIV during pregnancy.
   • Specialist services for people with HIV who also have TB, cancer or other health issues that should be treated urgently.
   • Monitoring of mental health, alcohol or drug issues and domestic abuse, referring patients for the right support where necessary.

   Services should also be able to review patients who are at greater risk because of health problems from other conditions that could lead to complications with COVID-19, or problems affecting the management of their HIV, for example the virus being detected in their blood or their CD4 being low, suggesting that their immune system is weaker. This could include ‘check in & chat’ services being offered by staff who are self-isolating from COVID-19.

5. All clinics should make sure that up to date information is available for patients.
6. We recommend all services ensure patients, and their GPs, know about the guidance to offer pneumococcal and annual influenza vaccinations.
7. We encourage all services to ask patients about, and record COVID history in their medical notes:
   • Confirmed COVID-19 cases.
   • Suspected COVID-19 cases.
   • Positive COVID tests.
   • Examples of harm related to COVID-19 or service changes secondary to COVID-19.

Reference

BHIVA. ‘2nd COVID peak’ guidance for HIV clinics – plain English version. (8 October 2020).
https://www.bhiva.org/BHIVA-2nd-COVID-peak-guidance-for-HIV-clinics

This report was first published on 8 October 2020.