Guidance for all Persons with HIV
- In current reports, individuals aged over 60 years and those with
diabetes, hypertension, cardiovascular disease, or pulmonary disease
are at highest risk of life-threatening COVID-19, the illness caused by
the virus known as SARS-CoV-2.
- The limited data currently available do not indicate that the
disease course of COVID-19 in persons with HIV differs from that in
persons without HIV. Before the advent of effective combination
antiretroviral therapy (ART), advanced HIV infection (i.e., CD4 cell
count <200/mm3) was a risk factor for complications of other respiratory infections. Whether this is also true for COVID-19 is yet unknown.
- Some people with HIV have other comorbidities (e.g.,
cardiovascular disease or lung disease) that increase the risk for a
more severe course of COVID-19 illness. Chronic smokers are also at risk
of more severe disease.
- Thus, until more is known, additional caution for all persons
with HIV, especially those with advanced HIV or poorly controlled HIV,
- Every effort should be made to help persons with HIV maintain an adequate supply of ART and all other concomitant medications.
- Influenza and pneumococcal vaccinations should be kept up to date.
- Persons with HIV should follow all applicable recommendations of the U.S. Centers for Disease Control and Prevention (CDC) to prevent COVID-19, such as social distancing and proper hand hygiene.
Antiretroviral Therapy: Persons with HIV Should:
- Maintain on-hand at least a 30-day supply—and ideally a 90-day supply—of antiretroviral (ARV) drugs and other medications.
- Talk to their pharmacists and/or healthcare providers about changing to mail order delivery of medications when possible.
- Persons for whom a regimen switch is planned should consider
delaying the switch until close follow-up and monitoring are possible.
- Lopinavir/ritonavir (LPV/r) has been used as an off-label
treatment for patients with COVID-19 and clinical trials are underway
globally. If protease inhibitors (PIs) are not already part of a
person’s ARV regimen, their regimen should not be changed
to include a PI to prevent or treat COVID-19, except in the context of a
clinical trial and in consultation with an HIV specialist. In a small
open-label trial, 199 hospitalized patients with COVID-19 were
randomized to either 14 days of LPV/r plus standard of care or standard
of care alone. No statistically significant difference was seen between
the two groups, with regards to time to clinical improvement or
Clinic or Lab Visits Related to HIV Care:
- Together with their health care providers, persons with HIV and
their providers should weigh the risks and benefits of attending, versus
not attending in-person, HIV-related clinic appointments at this time.
Factors to consider include the extent of local COVID-19 transmission,
the health needs that will be addressed during the appointment, and the
person’s HIV status (e.g., CD4 cell count, HIV viral load) and overall
- Telephone or virtual visits for routine or non-urgent care and adherence counseling may replace face-to-face encounters.
- For persons who have a suppressed HIV viral load and are in
stable health, routine medical and laboratory visits should be postponed
to the extent possible.
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