{"id":37387,"date":"2020-03-27T11:46:19","date_gmt":"2020-03-27T11:46:19","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=37387"},"modified":"2020-05-15T10:30:24","modified_gmt":"2020-05-15T10:30:24","slug":"us-interim-guidelines-on-covid-19-and-hiv","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/37387","title":{"rendered":"US interim guidelines on COVID-19 and HIV"},"content":{"rendered":"

Simon Collins, HIV i-Base<\/span><\/strong>
\n\"\"<\/a><\/span><\/strong><\/p>\n

On 20 March 2020, the US Department of Health and Human Services (HHS) published interim guidelines on special considerations about COVID-19 for people living with HIV and their health providers. [1]<\/strong><\/p>\n

\"\"<\/span><\/strong>The document was drafted by the same writing groups that publish other leading US HIV treatment guidelines for adults and children.<\/p>\n

It provides guidance under six main headings, summarised below, but please refer to the full online document for details.<\/p>\n

1. Guidance for all people living with HIV<\/h2>\n

This covers general information about risk for HIV positive people.<\/span><\/p>\n

This is similar to that provided by BHIVA and WHO in that people on effective ART have similar risk as the general population. [2, 3] <\/span><\/p>\n

Those not on ART or with a low CD4 count (defined as <200 copies\/mL) should cautiously be assumed to have a higher risk. Similar advice to reduce risk by washing hands and limiting social physical interactions are recommended.<\/span><\/p>\n

The importance of older age (>65 years) and other serious health conditions is emphasised (especially lung, heart, liver and kidney disease). Smoking is also listed as an important risk.<\/span><\/p>\n

HIV positive people should keep at least one to three months of ART at home, and use home delivery when possible. Unless urgent, changing ART should be delayed until follow-up appointments are easier to arrange. <\/span><\/p>\n

As with other guidelines, there is no recommendation to use lopinavir\/r, especially as a recent study to treat COVID-19 was not successful.<\/span><\/p>\n

Routine monitoring is less important for people on stable ART. Telephone or virtual appointments are recommended when possible. Any clinic visit should consider the risk and benefits of seeing a doctor compared to the risk of catching coronavirus.<\/span><\/p>\n

The guidelines also refer to non-technical information produced for HIV positive people by the US CDC:
\n<\/span>https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/specific-groups\/hiv.html<\/span><\/a><\/p>\n

2. Guidance for specific populations<\/h2>\n

This section recognises the limited data in most settings and links to specialist information from other organisations. The sections on pregnancy and children do not suggest higher risks than for the general population. <\/span><\/p>\n

Links:<\/span><\/p>\n

\u2022\u00a0\u00a0\u00a0 People <\/span><\/b>with HIV and in opioid treatment programmes
\n<\/b>https:\/\/www.samhsa.gov\/medication-assisted-treatment<\/a><\/p>\n

\u2022\u00a0\u00a0\u00a0 Pregnant women with HIV
\n<\/span><\/b>https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/specific-groups\/pregnant-women-and-children.html?<\/span><\/a>
\n<\/span>https:\/\/www.smfm.org\/covid19<\/a>
\n<\/span>https:\/\/www.acog.org\/clinical\/clinical-guidance\/practice-advisory\/articles\/2020\/03\/novel-coronavirus-2019<\/span><\/a><\/p>\n

\u2022\u00a0\u00a0\u00a0 Children with HIV
\n<\/span><\/b>https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/hcp\/pediatric-hcp.html<\/span><\/a><\/p>\n

3. Guidance for self-isolation or people in quarantine due to exposure to coronavirus<\/h2>\n

This includes guidelines for both <\/span>health workers with HIV positive clients (ensuring ART supply and planning for future COVID-19 symptoms).<\/p>\n

Information for people living with HIV includes updating your doctor and including information about your current ART supply.<\/p>\n

4. Guidance for people who have fever or respiratory symptoms<\/h2>\n

This section defers to online US CDC recommendations for health workers and people with symptoms.<\/i><\/span><\/p>\n

Health workers:
\n<\/span><\/em>https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/infection-control\/control-recommendations.html?<\/span><\/a><\/p>\n

People with HIV:<\/em>
\n<\/span>https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/symptoms-testing\/symptoms.html<\/span><\/a><\/p>\n