What and where are the BHIVA statements on HIV and coronavirus?
The British HIV Association (BHIVA) is an UK organisation focussed on the treatment and care of HIV positive people. It is largely for doctors and other medical professionals but also include community workers.
BHIVA produces guidelines for all aspects of HIV treatment.
So far, BHIVA have posted ten online statements about COVID-19. They are collected on this page where future updates will be added.
A summary of each main document is also included below.
This emphasised that many HIV positive people often have similar additional risks to the general population. For example, older age or having other health problems.
It also detailed new research projects to collect information about HIV positive people who catch coronavirus.
British HIV Association (BHIVA) statement on considerations for critical care for people with HIV during COVID-19 (31 March 2020)
This stressed that being on effective ART meant HIV positive people have a similar life expectancy to beingHIV negative.
This was essential so that if limited resources limits access to care for people with coronavirus, HIV positive people are not excluded.
management of a pregnant woman living with HIV and infant testing during Coronavirus (COVID-19) (25 MArch 2020).
This covers management of HIV positive pregnant women during the coronavirus crisis and testing advice for the infant depending on level of risk.
This statement updates government advice for the general population to stay home.
- People should only go outside for food, health reasons or work (where this absolutely cannot be done from home).
- To stay 2 metres (6 feet) away from other people;
- Wash your hands as soon as you get home.
This information looks at how to protect against COVID-19 depending on your CD4 count. Having a CD4 count less than 50 cells/mm3 makes someone “extremely vulnerable”. This means following advice for “shielding” – basically isolating at home for three months with support to get supplies and food.
- People with a CD4 count <50 or opportunistic illness in last 6 months: follow shielding advice for extremely vulnerable. This includes avoiding face-to-face contact for 12 weeks – and will need support to do this.
- People with CD4 <200, detectable viral load or not on ART: follow social distancing advice very closely.
- People with CD4 >200 and undetectable on ART: follow general population advice (ie social physical distancing).
This joint statement is to emphasise consistent expert opinion across Europe that HIV is not an additional risk for COVID-19 if someone is on effective ART. Having a CD4 count below 200 cells/mm3 or not being on ART is likely to increase the risk though.
There is no evidence to support any benefit from HIV meds against coronavirus. Neither ART nor PrEP will protect against or treat coronavirus.
Liverpool University have published a new website (covid19-druginteractions.org) for the experimental drugs being studied to treat COVID-19.
This update answers eight common questions about COVID-19 for HIV positive people. It includes that HIV drugs are not effective against coronavirus, to continue taking ART as usual, and that there are no problems with supplies of HIV meds. Self-distancing is important (not self-isolation), as is following advice for general population to reduce risk.
This update mainly refers people to the UK Government website to explain how to respond to the advice to limit social interactions.
Following CROI 2020, there continues to be no evidence that people with HIV are at higher risk of COVID-19, or severe disease if affected, and no evidence regarding the impact of viral load or CD4 on either of these.
You may have read that the HIV drug lopinavir/ritonavir (Kaletra) is being studied as a possible treatment for COVID-19 but this is based on very limited evidence for similar viruses. So far there is no good evidence that lopinavir/ritonavir is beneficial, and no evidence that other HIV drugs will help. For anyone taking HIV drugs for treatment or prevention, we recommend continuing to take treatment as recommended, and not increasing the dose or switching to other medications unless otherwise indicated.
There has been one case report published of a man with HIV and diabetes who was hospitalised with COVID-19, treated with lopinavir/ritonavir and who subsequently recovered. However, this provides no further information on the impact of either HIV per se, or lopinavir/ritonavir, on COVID-19.
We continue to recommend following national advice and encouraging people with HIV to ensure they have had their flu and appropriate pneumococcal vaccines (as per BHIVA vaccine guidelines.) We also advise that patients have at least 30-days medication available and sufficient supply to allow for possible travel restrictions or quarantine, if they are planning to leave the UK.
Individual organisations will be making their own contingency plans, and most non-urgent services are being asked to minimise face-to-face appointments. As the set-up and capacity of services will vary significantly, we cannot give specific recommendations, but if people have examples of good practice they wish to share, BHIVA can facilitate this. Sensible steps include updating your website if you have one, using out-of-office replies to direct patients to appropriate advice and ensuring all patient-facing staff are aware of the latest national information and guidance.
We advise against prescribing longer than usual medication supplies as stocks can be fragile at any time. Please also note, for those of you based in England, NHSE have instructed us to avoid signing new people up to Homecare as they need to focus on maintaining current capacity.
- Following the regularly updated advice from Public Health England, Health Protection Scotland, Public Health Wales, the Department of Health Northern Ireland and the Health Service Executive Ireland.
- Ensuring people with HIV have received influenza and pneumococcal vaccination in line with BHIVA vaccine guidelines.