Coronavirus disease (COVID-19), HIV & hepatitis C: What you need to know

CATIE (Canada), 17 March 2020

  • An HIV-positive person on effective treatment is not expected to be at higher risk of becoming seriously ill with COVID-19
  • A person with untreated HIV or a low CD4+ cell count may be at higher risk of becoming seriously ill with COVID-19
  • People with HIV or hepatitis C are more likely to have other conditions that carry a greater risk of becoming seriously ill with COVID-19

 

 

Update on COVID-19 for PLHIV

SAMESH, March 19, 2020

SAMESH, SHINE SA, and Thorne Harbour Health are encouraging people living with HIV (PLHIV) to take additional precautions in the face of the changing landscape around 2019 novel coronavirus (COVID-19).

We want to ensure the ongoing health and wellbeing of all PLHIV who are more vulnerable to COVID-19. This means minimising the risk of exposure to the virus.

While everyone is at risk of contracting COVID-19, the consequences of infection are more severe for some vulnerable groups. This includes PLHIV who are:

  • Aged over 60 years old
  • Living with a detectable viral load or a CD4 count below 500
  • Diabetic
  • Smokers
  • Living with hepatitis B or C
  • Living with a comorbidity such as heart or lung issues

Those PLHIV on treatment with an undetectable viral load (and no other significant health condition) are at no greater risk of serious health consequences due to COVID-19 than the general population. That being said, they should still take the advice of the health department in exercising precautions such as handwashing, working from home where possible, limiting time on public transport, and avoiding large groups or crowded areas.

Those PLHIV who fall into one of the vulnerable groups listed above should limit contact with others to avoid potential exposure to COVID-19.

If you are living with HIV and are concerned you might be at risk, you should:

  • Maintain regularly scheduled medical appointments, but consider asking your doctor about telehealth consultations
  • Ensure you have between 1-3 month supply of any medications you currently take
  • Avoid stockpiling medications beyond a 1-3 month supply as this could cause unnecessary shortages
  • Be wary of advice or articles in social media — do not modify the medications you currently take without first consulting your doctor
  • Contact your doctor about getting vaccinations for influenza and pneumococcal when available
  • Keep in touch with friends, colleagues, and family via phone calls and video chat — consider scheduling regular catch ups
  • Stay in touch – our organisations will continue to release more information and resources as the situation continues to evolve

This public health issue can be stressful, but our communities have a long history of staying informed and collective action to ensure we look after our health as well as the wellbeing of those around us. Let’s keep this legacy going as we look after ourselves and those around us

Delayed linkage to HIV care among asylum seekers

Kronfli, N., Linthwaite, B., Sheehan, N. et al. Delayed linkage to HIV care among asylum seekers in Quebec, CanadaBMC Public Health 191683 (2019). https://doi.org/10.1186/s12889-019-8052-y

Abstract:

Background

Migrants represent an increasing proportion of people living with HIV in many developed countries. We aimed to describe the HIV care cascade and baseline genotypic resistance for newly diagnosed asylum seekers referred to the McGill University Health Centre (MUHC) in Montreal, Quebec, Canada.

Methods

We conducted a retrospective cohort study of patients linked to the MUHC from June 1, 2017 to October 31, 2018. We calculated the median time (days; interquartile range (IQR)) from: 1) entry into Canada to immigration medical examination (IME) (i.e. HIV screening); 2) IME to patient notification of diagnosis; 3) notification to linkage to HIV care (defined as a CD4 or viral load (VL) measure); 4) linkage to HIV care to combination antiretroviral therapy (cART) prescription; and 5) cART prescription to viral suppression (defined as a VL < 20 copies/mL). We reviewed baseline genotypes and interpreted mutations using the Stanford University HIV Drug Resistance Database. We calculated the proportion with full resistance to > 1 antiretroviral.

Results

Overall, 43% (60/139) of asylum seekers were newly diagnosed in Canada. Among these, 62% were late presenters (CD4 < 350 cells/μl), 22% presented with advanced HIV (CD4 < 200 cells/μl), and 25% with high-level viremia (VL > 100,000 copies/ml). Median time from entry to IME: 27 days [IQR:13;55]; IME to notification: 28 days [IQR:21;49]; notification to linkage: 6 days [IQR:2;19]; linkage to cART prescription: 11 days [IQR:6;17]; and cART to viral suppression: 42 days [IQR:31;88]; 45% were linked to HIV care within 30 days. One-fifth (21%) had baseline resistance to at least one antiretroviral agent; the K103 N/S mutation was the most common mutation.

Conclusions

While the majority of newly diagnosed asylum seekers were late presenters, only 45% were linked to care within 30 days. Once linked, care and viral suppression were rapid. Delays in screening and linkage to care present increased risk for onward transmission, and in the context of 21% baseline resistance, consideration of point-of-care testing and immediate referral at IME screening should be made.

HIV and viral hepatitis disclosure [in South Australia] – factsheet

SA Health, updated 2019

Deciding to disclose your HIV or viral hepatitis (hepatitis B or hepatitis C) status is a personal choice. There are few situations where you are legally required to disclose your HIV or viral hepatitis status, however, there may be times when it’s in your best interests to disclose your status even if you are not legally required to do so.

 

Healthcare providers should discuss U=U with all their HIV-positive patients

aidsmap/nam, 18/03/2019

Healthcare providers should inform all patients with HIV they cannot transmit HIV to a sexual partner when their viral load is undetectable, argue the authors of  a strongly worded comment in The Lancet HIV.

The authors note that despite overwhelming scientific data supporting the undetectable = untransmittable (U=U) message, significant numbers of healthcare providers do not educate their patients about U=U when telling them their viral load is undetectable.

 

 

 

Gaps And Policy Barriers To Engagement With The HIV Cascade Of Care

Identifying and Plugging the Leaks: Gaps And Policy Barriers To Engagement With The HIV Cascade Of Care

CTAC (Canadian Treatment Action Council), 2018

This project explored what issues impact engagement by people living with HIV with healthcare in Ontario. The goal was to identify policy issues that impact treatment access for people living with HIV, and to identify opportunities to make the healthcare system more accessible.

The HIV Cascade of Care is a useful description of the different steps that a person living with HIV will need to take in order to achieve an undetectable viral load and optimal health outcomes, from infection and diagnosis through to Antiretroviral Therapy (ART) initiation and viral suppression.

We know people drop out of the HIV Cascade of Care – e.g. why those starting treatment don’t stay on it. By seeking out policy barriers and developing solutions we can enable people to live long, healthy, and happy lives.

The project has five recommendations around barriers to engagement in the HIV Cascade of Care.

Download report here