Metro Weekly

Health advocates: People with HIV not at higher risk of COVID-19, but urged to exercise caution

People are encouraged to take precautions, such as hand-washing and social distancing, to protect themselves

coronavirus, covid-19, hiv
COVID-19 – Photo: Harvard Medical School.

Local health experts say that people living with HIV do not have any more severe reactions to COVID-19 than those without HIV, provided their viral load is undetectable due to regularly taking antiretrovirals.

However, such individuals are still being told to exercise caution in their daily lives so they do not become infected.

Dr. Sebastian Ruhs, the director of the Infectious Diseases Center of Excellence at Chase Brexton Health Care in Baltimore, notes that there’s no difference in the risk posed to a healthy LGBTQ person and a healthy heterosexual person — although some LGBTQ people may be at higher risk due to other underlying health conditions or lifestyle choices, such as smoking or vaping, that might compromise their pulmonary health.

“There’s a lot we don’t know. While not a lot of people with HIV have been infected at this point, to draw any clear conclusions,” Ruhs notes. “The current data that we have is that someone who has a normal CD4 and is on medication to maintain an undetectable viral load does not behave any different from someone who is HIV-negative. So the risk for that population isn’t any higher. In that respect, corona appears to behave in a manner like other seasonal viruses do.”

Transgender people also appear not to be more susceptible to COVID-19, but are asked to follow similar behaviors to reduce the possibility of infection or spread.

However, LGBTQ advocates have previously voiced concerns that the LGBTQ community may be at higher risk due to higher rates of smoking, higher rates of HIV and certain types of cancer, and difficulty accessing health care, either due to discrimination by providers or, in some cases, insufficient insurance coverage.

Read moreLGBTQ people are ‘particularly vulnerable’ to coronavirus effects, advocacy groups warn

People who are at higher risk of infection, regardless of HIV status, are those who suffer from underlying health issues, such as COPD or other pulmonary diseases, autoimmune conditions — such as lupus or multiple sclerosis, for example — or people recovering from chemotherapy to treat cancer, Ruhs notes.

If someone does have one of these pre-existing conditions, they should consult their physicians on how best to protect themselves from infection.

People living with HIV who are not adherent to their medications or have fallen out of care are urged to resume care and get back to undetectable status if possible.

“As we are preparing ourselves for possible seeing more cases, we need to think what could be corona and what couldn’t. Coronavirus presents with fever or feeling febrile, dry cough, and shortness of breath,” notes Ruhs. “If someone has more localized symptoms,” — such as a productive cough, or a runny/stuffy nose — “it’s probably not corona.

Those who begin exhibiting symptoms consistent with COVID-19 should call a doctor and inform them of their symptoms before going into the doctor’s office, and follow whatever medical advice the doctor gives them.

Ruhs notes that people living with HIV should be up-to-date with their vaccines, specifically seasonal flu and pneumonia vaccine. 

“No one who has [COVID-19] wants to have the flu at the same time, and with post-pulmonary viral infections, the risk is always higher of getting bacterial pneumonia afterward,” he says. “The pneumonia shot can really reduce those risk factors.”

David Fessler, the director of clinical practice at Whitman-Walker Health, says that people can practice “social distancing,” whereby people avoid large public gatherings, which can help “flatten the curve” of the epidemic by delaying its spread and distributing it more evenly over a long period of time.

When people must go out in public, such as to the grocery store, they can take precautions by wiping down “high-touch” surfaces where the virus could linger.

“In terms of prevention, a lot of the messaging from CDC and other organizations still applies, especially for those with underlying health conditions,” Fessler says. “Cleaning the hands with soap and water for at least 20 seconds, avoid touching high-touch services, [using] sanitizer, and some degree of social distancing by avoiding large crowds can help.”

Whitman Walker’s 1525 building – Photo: Todd Franson.

Fessler says that health organizations, including Whitman-Walker, are urging people to make sure they have an adequate supply of needed medicines, including any regular prescriptions, as well as over-the-counter medications like Advil or Tylenol that can be used to treat the [cough and fever-related] symptoms of COVID-19 if a person does become sick.

As a precautionary measure, people who are not infected are urged to make sure they have enough groceries or basic staples that would be sufficient for a period of time, in order to avoid going out in public.

If a person does become sick, they are encouraged to stay hydrated and get enough rest so the body can recuperate.

“Most cases [of COVID-19] are mild enough to manage at home. We’d recommend rest and taking lots of fluids, as we would for any other respiratory conditions,” says Fessler. “But people should watch out for shortness of breath, which indicates a higher level of concern.”

If people begin having problems breathing, they should seek help from urgent care or the emergency room, notes Fessler.

“We are encouraging our patients to call us first, and have conversations with a doctor about their symptoms,” he says, noting that COVID-19 is not the only respiratory ailment affecting people during these late winter/early spring months. “As testing becomes more broadly available, we will be able to test to differentiate between illnesses.”

Socially, Fessler says there’s merit in avoiding going out to bars or places where large amounts of people might congregate.

“A lot of experts are saying, ‘try to avoid groups larger than 50,'” he notes. “It’s something to think carefully about as the virus ramps up in the coming days and weeks.”

Prior to publication, the Trump administration issued new recommendations urging Americans to avoid going to bars and restaurants, and avoid gathering in groups of larger than 10 people.

See also: D.C. mayor orders all nightclubs to close and taverns to limit customers

Charles Brown, a family nurse practitioner who works for Us Helping Us, People Into Living, Inc., says holistic remedies can help those who become infected with COVID-19 but do not present with severe symptoms that would require hospitalization, such as shortness of breath.

“Like mother used to say, chicken noodle soup and anything that’s going to help, any of the things you normally due when you have viruses such as the flu, push the fluids, and that type of thing,” Brown says. 

“When it comes to people with HIV, the biggest thing is making sure people are adhering to treatment, what their doctor has recommended for the HIV, to keep them virally suppressed and undetectable,” says Brown.

“The people we are most worried about are those who have not been taking their medication as prescribed. They are going to be most susceptible,” he adds. “But those with HIV who are taking their medication as prescribed, and are up-to-date on their vaccinations, whether it’s pneumonia, tetanus, or pertussis, who are up-to-date on their flu shots, should be okay.”

He advises people to avoid large crowds where the virus may be more easily transmitted, including by those who are asymptomatic.

“The bottom line is: everyone is susceptible to this virus,” Brown says. “Because we don’t know some of the logistics about everything, other than thinks like hand-washing, covering your mouth when you cough, those simple precautions that are being put out by the CDC and NIH, and the people that are on this task force for COVID-19.”

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