Golden Rule Services

Guidance for all Persons with HIV

• In current reports, individuals aged >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, is warranted.
• 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. These recommendations are regularly updated.
• Information on COVID-19 prevention in children with HIV for pediatric health care providers and the general public is available from CDC.
• CDC also provides information about COVID-19 prevention during pregnancy.

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 mortality.
  
  

Clinic or Laboratory Monitoring 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 health.
• 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.

Persons with HIV and in Opioid Treatment Programs:

• Clinicians caring for persons with HIV who are enrolled in opioid treatment programs (OTPs) should refer to the Substance Abuse and Mental Health Service Administration (SAMHSA) website for updated guidance on avoiding treatment interruptions. State methadone agencies are also responsible for regulating OTPs in their jurisdictions and may provide additional guidance.

Guidance for Specific Populations

Pregnant Individuals with HIV:

• Currently, there is limited information about pregnancy and maternal outcomes in individuals who have COVID-19.
• Immunologic and physiologic changes during pregnancy generally increase a pregnant individual’s susceptibility to viral respiratory infections, possibly including COVID-19. As observed with other coronavirus infections, the risk for severe illness, morbidity, or mortality with COVID-19 may be greater among pregnant individuals than among the general population.2
• Although limited, currently available data do not indicate that pregnant individuals are more susceptible to COVID-19 infection or that pregnant individuals with COVID-19 have more severe illness.6,7 Adverse pregnancy outcomes, such as fetal distress and preterm delivery, were noted in a small series of pregnant women with COVID-19 infection and have been reported with SARS and MERS infections during pregnancy.3-5
• Findings from a small group of pregnant women with COVID-19 did not find evidence for vertical transmission of COVID-19, although at least one case of neonatal COVID-19 has been described.7-9
• Information on pregnancy and COVID-19 is available from CDC, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists.
  
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