New BHIVA statements on HIV and COVID-19 (December 2021)
Simon Collins, HIV i-Base
On 17 December 2021, BHIVA posted and updated six guidance documents related to HIV and COVID-19 related to four aspects of care.
Two of these include different versions for health workers and people living with HIV.
1. Considerations for critical care for people with HIV during COVID-19
These guidelines are for health workers with limited experience of HIV but who are managing HIV positive people diagnosed with COVID-19.
They cover the importance of equitable access to care for people living with HIV and includes specialist information on potential interactions between some HIV medicines and corticsteroids.
2. BHIVA guidance for HIV services during COVID surges
These guidelines outline how HIV services should be organised and delivered for as long as COVID-19 is affecting NHS services.
They outline core outpatient and other services that people with HIV should continue to receive, including monitoring and access to ART. This includes access to specialist care for HIV and TB, malignancies and other services.
This also includes access to mental health alcohol/drug issues and domestic abuse with clear pathways for appropriate referral and/or signposting where issues are identified.
The guidelines are mainly for people responsible for providing services but are also important for HIV positive people to see how their care might change.
3. JCVI recommendations on COVID vaccines, third doses and boosters
- Update for service users 17 December 2021
- Update for health workers and service providers
These statements looks at the difference between third doses and booster doses and include details for how to access both.
Booster doses ate recommended for all people living with HIV. Third doses are only recommended for some people living with HIV.
4. BHIVA updates on treatments for COVID-19
- Information for people living with HIV
- Information for health workers
Guidance on new treatments for COVID-19 including access is also provided with one version for people living with HIV and another for health workers.
This information is expected to change quickly and both documents recommend checking NHS, NICE, JCVI & GOV.UK websites for updates, especially about access.
All treatments have guidelines for when they can be used. Some need to be used within 3-5 days of symptoms. Some treatments are available for all HIV positive people, but acces to others depends on having additional risk factors. Some are available as part of routine NHS care and some through your GP.
There are now several COVID treatments from three drug classes.
- Antivirals: target SARS-CoV-2 (the virus that causes COVID-19) to stop it reproducing.
Remdesevir: by injection into a vein and used in some hospitalised people only.
Molnupiravir: given as a course of tablets and available through the PANORAMIC trial or routine NHS care.
- Neutralising monoclonal antibodies (nMAB): are proteins designed to ‘mop up’ SARS-CoV-2 so that it can’t infect cells. They reduce the risk of hospital admission if given early and of dying from COVID.
Casirivimab + imdevimab: injection into a vein, this combination treatment is less effective against the Omicron variant, so it is only used in some hospitalised people;
Sotrovimab: given by injection into a vein, used in some hospitalised people and also available for non-hospitalised people (see below).
- Anti-IL-6 monoclonal antibodies: these are used to reduce levels of inflammation in some hospitalised people. There are two types, tocilizumab and sarilumab