HIV & COVID-19 UPDATE - October 2020

Oct 1

New info about health outcomes of people living with HIV, and who have COVID-19 infection.

Updated: October 5, 2020

Zahid Somani, Pharmacist-Owner of The Village Pharmacy, gives an overview of new research on COVID-19 for people living with HIV, along with practical tips to stay healthy during the COVID-19 outbreak.

Am I more at risk for COVID-19 if I am HIV positive?

According to CATIE and trusted sources in the US and UK, people living with HIV are not at greater risk for COVID-19 infection than the general population.

But, you are at greater risk of becoming seriously ill with COVID-19 if:

you are HIV-positive and are not on treatment
you are on HIV treatment but have a CD4 cell count under 200, or between 200 and 500
you have other underlying conditions like high blood pressure, heart disease, obesity, chronic respiratory illness, poorly controlled diabetes, kidney disease or liver disease
you are HIV-positive and have Hepatitis C
you are HIV-positive and 60 years old or older

New Information about HIV and COVID-19

A new study published in the journal Clinical Infectious Diseases on September 22, 2020, looked at outcomes of 286 people with HIV, who were also infected with COVID-19. Of these, 164 were admitted to hospital. Symptoms commonly included fever, fatigue, shortness of breath, GI symptoms and mental confusion. Fifty of the hospitalized patients had a severe outcome such as being admitted to the ICU, requiring a ventilator or dying from COVID-19.

This registry of patients was collated from 36 institutions, 33 of which were in the US. A number of important findings have emerged from this research as follows:

**HIV viral suppression may not protect patients from severe outcomes of COVID-19 if they have a low CD4 count and/or other underlying health concerns.**

In the study, patients who had a low CD4 count, or underlying health conditions, were more likely to have poor outcomes after admission to hospital with COVID-19. This was true even though 94% of patients were on treatment for HIV, and 89% were virally suppressed.

Low CD4 Counts & COVID-19

A low CD4 count, by itself, was linked to hospitalization and more severe outcomes relating to COVID-19. The Clinical Infectious Studies article shows that people with CD4 counts below 200 were three times more likely to be admitted to hospital with COVID-19, or suffer a severe outcome when compared to people whose CD4 counts were above 500. Those with CD4 counts in between 200 and 500 were at slightly higher risk of hospitalization as well.

What does this mean for you? If you are concerned about your CD4 count, ask your doctor about getting blood work done. You may need to switch medications if your current regimen isn’t working. And, you may need to take extra care to avoid exposure to the COVID-19 virus.

HIV & Other Health Conditions Plus COVID-19

For people living with HIV and who have other health conditions, there is more evidence of poorer outcomes from COVID-19. The most common conditions include high blood pressure, obesity, diabetes, asthma, kidney disease, heart disease, and liver disease, including hepatitis.

Two large studies in the UK showed that people living with HIV had a higher risk of dying from COVID-19 infection than others. Both studies showed that factors such as obesity, poorly controlled diabetes and high blood pressure were important risk factors in people with HIV.

The Clinical Infectious Diseases article states that underlying conditions were very common. In fact, 86% of people with HIV and COVID-19 had additional health conditions. Those with three or more were three-and-a-half times more likely to be hospitalized when compared to people with HIV and no other conditions. They were also five times more likely to have a severe outcome.

What does this mean for you? 50% of people living with HIV in Canada are over the age of 50, so conditions like heart disease and diabetes are increasingly common. If you have any concerns about your health, talk to your doctor.

What can you do now to protect yourself?

Maintain your doctors visits:

Many of the patients I see at the pharmacy have let their doctors appointments slide. It’s so important to maintain your visits with your doctor, talk about any concerns you have, and get your blood work completed, especially with this new information about HIV, CD4 counts, underlying health conditions & COVID-19 coming to light.

Doctors have all adapted to life under COVID-19 restrictions. They are fully available for appointments over the telephone. Your doctor can provide prescriptions and blood work requisitions during your telephone appointment. In-person appointments are at the doctor’s discretion..

If you don’t have a doctor and need one, get in touch with us at The Village Pharmacy and we can give you a few names of OHIP-covered doctors that are taking telephone and virtual appointments..

Take your medications every day.

Now more than ever, please make sure you’re in the best health possible. Taking your medications for HIV and other conditions every day, is something in your control.

If you need help remembering to take your medications, there are a few things your pharmacist can do to help. Ask your pharmacist about blister packaging for your medications. We can do these in weekly or monthly packs. Also ask about scheduling your prescriptions so you pick them up all at the same time. Both of these tools can help make sure you don’t skip any doses, take them at the right times every day and don’t run out.

What should I do if I start experiencing symptoms?

If you are feeling unwell, get tested for COVID-19 at a screening centre. New protocols are in place for screening people with and without COVID-19 symptoms. Check the City of Toronto link here for details: COVID-19 Testing or call Telehealth at 1-866-797-0000 if you are not sure.

How do I protect myself from getting the COVID-19 virus?

Know the symptoms

Fever / chills
Dry cough
Muscle aches and tiredness
Difficulty breathing
Loss of taste or smell
Less common: sore throat, headache and diarrhea

Take Action to Protect Yourself

Wear a good quality face mask when you leave the house. The ones with ventilators built in don’t provide adequate protection. Use tightly woven 100% cotton face masks, or disposable surgical face masks. Prices have come down significantly and good options are widely available
Keep two arms-length distance (or about 6 feet) away from others
Keep away from others who are sick
Minimize your time in public indoor spaces
If you leave your house, wear a mask, practice physical distancing, and avoid crowds indoors or out. If you need to go to the grocery store or other public place, try going first thing in the morning instead of in the middle or end of the day. Better, take advantage of delivery services when possible

Personal hygiene & wellness

Continue to take your HIV and other prescription medications, as prescribed. If possible, try to keep an extra 30 days supply on hand. Call ahead for prescription refills from your pharmacy
Wash your hands for 20 seconds each time, throughout the day
Don’t touch your face!
Exercise regularly
Eat nutritious foods
Connect with friends & family virtually
Avoid stress

Download the COVID-19 app

The COVID-19 app will proactively notify you if you have been exposed to someone with COVID-19. It is free. It is safe. It doesn’t use or track your personal information. It is secure. The more people that use the app, the more effective it is.

Download COVID Alert: Canada's exposure notification app