COVID-19 and HIV
The COVID-19 crisis should not negatively impact the management and care of patients with HIV/AIDS. However, heightened vigilance and prudence is warranted in order to protect our patients. Local and national guidelines for triage and management of COVID-19 should not compromise needed patient care.
Ryan White HIV/AIDS Program and COVID-19
HRSA is working to keep Ryan White HIV/AIDS Program recipients, subrecipients, and partners updated on the latest information regarding COVID-19. As part of that effort, HRSA’s HIV/AIDS Bureau (HAB) has launched a Frequently Asked Question (FAQ) webpage on the HAB website, which HAB is monitoring and updating as new information is made available.
Routine follow up of HIV infected patients in the outpatient clinics:
At this moment, people with HIV should follow the same guidance as the general population, and do not need to take additional precautions.
To date, the main risk factors for severe COVID-19 are older age, defined as >65 years of age, and co-morbidities including cancer, diabetes, and chronic respiratory or cardiovascular disease. HIV infection has not specifically been identified as a risk factor but would be included when guidance refers generally to immune-compromised individuals.
- If a clinic is capable of doing a video visit. Patients who do not need to be physically seen can be asked to reschedule their appointments, can be offered a video visit, if available, or in some cases telephone visits. It is understood that patients may have various risks, differing virologic and immune strata, and that clinic architecture and settings may be more or less permissive to outpatient visits. Therefore, provider discretion is essential to appropriate decision making.
- Patients who, in the opinion of the provider, require a clinic visit, should be triaged a day before the clinic visit and asked about the following symptoms: running nose, sore throat, myalgia, fever, cough, shortness of breath, diarrhea/nausea:
- If any of these symptoms are present, further management should be decided in conjunction with the provider. This may include instructing the patient to go to the Emergency Department for screening.
- If none of the above symptoms are present, the patient may be seen in clinic. Alternatively, if only laboratory monitoring is needed, and if this may be safely arranged, the patient’s clinic visit can be rescheduled.
HIV Consult Service 24/7 Hotline (313) 575-0332
Testing Recommendations: SARS-CoV-2 (COVID-19) Testing Criteria
Currently, the CDC recommends prioritizing testing for:
Individuals who are symptomatic (fever and cough or shortness of breath) AND
- Have traveled to mainland China, Iran, Italy, Japan, and/or South Korea within 14 days OR
- Have had close contact with a laboratory-confirmed COVID-19 patient within 14 days of symptom onset OR
- Patients who are pregnant, ≥65 years, have chronic medical conditions, immunocompromised state or receiving immunosuppressive medications
Additionally, healthcare workers and skilled nursing facility residents should be tested with mild symptoms to mitigate the spread of infection.
1 Please refer to https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html for further details
2 Close contact: Approximately 6 feet of a COVID-19 case for at least 10 minutes while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case or having direct contact with infectious secretions
3 SARS-CoV-2 sample collection: Patient MUST be in negative pressure / Airborne Infectious Isolation Room for samples to be taken unless otherwise specified. Please refer patients to the ED or designated testing area
All confirmed COVID-19 inpatients require Infectious Disease consultation for management.
Henry Ford Hospital has a treatment algorithm for Confirmed COVID-19 Cases.
This treatment algorithm is similar for all patients, including those patients living with HIV and is as follows:
Currently, there are no FDA approved therapies to treat COVID-19. Supportive care and infection control measures are indicated for all hospitalized patients. Some medications have demonstrated in vitro, animal, or very limited clinical safety and efficacy data in other coronaviruses (e.g. SARS and MERS). The Division of Infectious Diseases is coordinating research/compassionate use Remdesivir. The below treatments should be started immediately (when indicated), pending Remdesivir availability.
Round ribavirin doses to the nearest 200mg increment. Enteral tube administration: Kaletra and ribavirin are available as oral suspension. Hydroxychloroquine may be crushed. These guidelines are interim recommendations and may change according to drug availability. Supportive care and infection control measures are indicated for all hospitalized patients.
Labs for Inpatients: CBC with differential, liver function tests, CRP, LDH, D-dimer, troponin, procalcitonin
ICU Patients, add: ferritin, fibrinogen, triglyceride, IL-6, DIC panel
Selected Monitoring Parameters:
Ribavirin PLUS Lopinavir/ritonavir: Anemia, leukopenia, CYP3A drug interactions
Hydroxychloroquine: Cardiotoxicity, Torsade de Pointes, depression, psychosis
See the following CDC links for more detail: CDC COVID-19 Home: https://www.cdc.gov/coronavirus/2019-ncov/index.html
Interim Guidance for Health Professionals: https://www.cdc.gov/coronavirus/2019-nCoV/clinical-criteria.html
Recommendations for all persons
- Keep a one month, or 30 day, supply of your medicine on hand at all times
- Do not stop taking your antiretroviral medications
- Influenza and pneumonia vaccinations up to date
- If you are not feeling well, call your primary provider during working hours. Nights and weekends call your health systems on call provider or nurse line.
- Try to take provisions to have an adequate food supply and resources for utility and phone bills and check to make sure medical coverage is up to date. This may mean contacting your provider, social worker, case manager, etc.
- If you have fever, cough, sore throat, running nose, stay home from work, school, and away from other public places. Be prepared to stay home. Monitor your symptoms carefully. If your symptoms get worse, call your healthcare provider immediately.
Reduce the chance of catching germs
- Wash your hands for 20 seconds (sing the Happy Birthday song twice) several times a day, after sneezing or coughing, after using the bathroom, before eating. Use hand sanitizer containing at least 60% alcohol when soap and water are unavailable.
- Avoid touching your face
- Greet people without handshakes
- Try to stay 6 feet away from anyone with a fever or cough
- Avoid crowds
- At home: Clean and disinfect doorknobs, tables, handrails, phones, i-pads, computers, etc.
For more information on Coronavirus Disease 2019 see the following links