COVID-19 and HIV co-infection: Difference between revisions
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==Overview== | ==Overview== | ||
*An observational prospective study found out that the incidence of HIV-infected individuals to be affected by SARS-CoV-2 was similar to the general population. | *An observational prospective study found out that the incidence of HIV-infected individuals to be affected by SARS-CoV-2 was similar to the general population. | ||
*Specific antiretroviral therapy did not affect COVID-19 severity. | *Specific antiretroviral therapy did not affect [[COVID-19]] severity. | ||
*[[Immunosuppression]](low CD4 cell counts) was associated with COVID-19 severity. | *[[Immunosuppression]](low CD4 cell counts) was associated with [[COVID-19]] severity. | ||
*Patients with HIV infection often have other comorbidities(lung disease, cardiovascular disease) therefore, increasing the risk for severe-COVID-19 disease. | *Patients with HIV infection often have other comorbidities(lung disease, cardiovascular disease) therefore, increasing the risk for severe-[[COVID-19]] disease. | ||
* Patients with HIV infection with CD4 cell count<200/mm3 are at increased risk for complications from other respiratory infections. However, we do not know if this is the scenario with COVID-19 | * Patients with HIV infection with CD4 cell count<200/mm3 are at increased risk for complications from other respiratory infections. However, we do not know if this is the scenario with [[COVID-19]] | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
====Risk==== | ====Risk==== | ||
*At present people with HIV who are at greatest risk of Severe COVID-19 infection are people - | *At present people with HIV who are at greatest risk of Severe [[COVID-19]] infection are people - | ||
** who have | ** who have low CD4 cell count. | ||
**not on antiretroviral therapy. | **not on antiretroviral therapy. | ||
=====Specific Populations with HIV===== | =====Specific Populations with HIV===== | ||
'''Pregnancy''' | '''Pregnancy''' | ||
*Pregnant individuals with HIV are at greater risk for severe illness, morbidity, or mortality as compared with the general population due to coronavirus infections(SARS-CoV and MERS-CoV) and other viral respiratory infections like influenza. <ref>{{cite web |url=https://aidsinfo.nih.gov/guidelines/html/8/covid-19-and-persons-with-hiv--interim-guidance-/0?utm_source=AIDSinfo&utm_medium=email&utm_campaign=3-20-20-COVID19_Guidance|title=Interim Guidance for COVID-19 and Persons with HIV |format= |work= |accessdate=}}</ref>Data related to COVID-19 is limited but pregnant individuals with HIV are suspected to be at greater risk due to SARS-COV-2 similarity with other coronaviruses (SARS-CoV and MERS).<ref>{{cite web |url=https://s3.amazonaws.com/cdn.smfm.org/media/2267/COVID19-_updated_3-17-20_PDF.pdf |title=Society for Maternal-Fetal Medicine, Dotters-Katz S, Hughes BL. Coronavirus (COVID-19) and Pregnancy: What Maternal-Fetal Medicine Subspecialists Need to Know. 2020. |format= |work= |accessdate=}}</ref><ref>{{cite web |url=https://aidsinfo.nih.gov/guidelines/html/8/covid-19-and-persons-with-hiv--interim-guidance-/0?utm_source=AIDSinfo&utm_medium=email&utm_campaign=3-20-20-COVID19_Guidance|title=Interim Guidance for COVID-19 and Persons with HIV |format= |work= |accessdate=}}</ref> | *Pregnant individuals with HIV are at greater risk for severe illness, morbidity, or mortality as compared with the general population due to coronavirus infections(SARS-CoV and MERS-CoV) and other viral respiratory infections like influenza. <ref>{{cite web |url=https://aidsinfo.nih.gov/guidelines/html/8/covid-19-and-persons-with-hiv--interim-guidance-/0?utm_source=AIDSinfo&utm_medium=email&utm_campaign=3-20-20-COVID19_Guidance|title=Interim Guidance for COVID-19 and Persons with HIV |format= |work= |accessdate=}}</ref>Data related to [[COVID-19]] is limited but pregnant individuals with HIV are suspected to be at greater risk due to [[SARS-COV-2]] similarity with other coronaviruses (SARS-CoV and MERS).<ref>{{cite web |url=https://s3.amazonaws.com/cdn.smfm.org/media/2267/COVID19-_updated_3-17-20_PDF.pdf |title=Society for Maternal-Fetal Medicine, Dotters-Katz S, Hughes BL. Coronavirus (COVID-19) and Pregnancy: What Maternal-Fetal Medicine Subspecialists Need to Know. 2020. |format= |work= |accessdate=}}</ref><ref name=":0">{{cite web |url=https://aidsinfo.nih.gov/guidelines/html/8/covid-19-and-persons-with-hiv--interim-guidance-/0?utm_source=AIDSinfo&utm_medium=email&utm_campaign=3-20-20-COVID19_Guidance|title=Interim Guidance for COVID-19 and Persons with HIV |format= |work= |accessdate=}}</ref> | ||
*They are suspected to be at increased risk of preterm delivery, adverse neonatal outcomes.<ref>{{cite web |url=https://s3.amazonaws.com/cdn.smfm.org/media/2267/COVID19-_updated_3-17-20_PDF.pdf |title=Society for Maternal-Fetal Medicine, Dotters-Katz S, Hughes BL. Coronavirus (COVID-19) and Pregnancy: What Maternal-Fetal Medicine Subspecialists Need to Know. 2020. |format= |work= |accessdate=}}</ref> In a small series of pregnant women with COVID-19 adverse outcomes such as fetal distress and preterm delivery have been noted. They have also been reported with SARS-CoV and MERS.<ref name="Siston2010">{{cite journal|last1=Siston|first1=Alicia M.|title=Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States|journal=JAMA|volume=303|issue=15|year=2010|pages=1517|issn=0098-7484|doi=10.1001/jama.2010.479}}</ref><ref name="AlfarajAl-Tawfiq2019">{{cite journal|last1=Alfaraj|first1=Sarah H.|last2=Al-Tawfiq|first2=Jaffar A.|last3=Memish|first3=Ziad A.|title=Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection during pregnancy: Report of two cases & review of the literature|journal=Journal of Microbiology, Immunology and Infection|volume=52|issue=3|year=2019|pages=501–503|issn=16841182|doi=10.1016/j.jmii.2018.04.005}}</ref><ref name="WongChow2004">{{cite journal|last1=Wong|first1=Shell F|last2=Chow|first2=Kam M|last3=Leung|first3=Tse N|last4=Ng|first4=Wai F|last5=Ng|first5=Tak K|last6=Shek|first6=Chi C|last7=Ng|first7=Pak C|last8=Lam|first8=Pansy W.Y|last9=Ho|first9=Lau C|last10=To|first10=William W.K|last11=Lai|first11=Sik T|last12=Yan|first12=Wing W|last13=Tan|first13=Peggy Y.H|title=Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome|journal=American Journal of Obstetrics and Gynecology|volume=191|issue=1|year=2004|pages=292–297|issn=00029378|doi=10.1016/j.ajog.2003.11.019}}</ref> | *They are suspected to be at increased risk of preterm delivery, adverse neonatal outcomes.<ref>{{cite web |url=https://s3.amazonaws.com/cdn.smfm.org/media/2267/COVID19-_updated_3-17-20_PDF.pdf |title=Society for Maternal-Fetal Medicine, Dotters-Katz S, Hughes BL. Coronavirus (COVID-19) and Pregnancy: What Maternal-Fetal Medicine Subspecialists Need to Know. 2020. |format= |work= |accessdate=}}</ref> In a small series of pregnant women with COVID-19 adverse outcomes such as fetal distress and preterm delivery have been noted. They have also been reported with SARS-CoV and MERS.<ref name="Siston2010">{{cite journal|last1=Siston|first1=Alicia M.|title=Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States|journal=JAMA|volume=303|issue=15|year=2010|pages=1517|issn=0098-7484|doi=10.1001/jama.2010.479}}</ref><ref name="AlfarajAl-Tawfiq2019">{{cite journal|last1=Alfaraj|first1=Sarah H.|last2=Al-Tawfiq|first2=Jaffar A.|last3=Memish|first3=Ziad A.|title=Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection during pregnancy: Report of two cases & review of the literature|journal=Journal of Microbiology, Immunology and Infection|volume=52|issue=3|year=2019|pages=501–503|issn=16841182|doi=10.1016/j.jmii.2018.04.005}}</ref><ref name="WongChow2004">{{cite journal|last1=Wong|first1=Shell F|last2=Chow|first2=Kam M|last3=Leung|first3=Tse N|last4=Ng|first4=Wai F|last5=Ng|first5=Tak K|last6=Shek|first6=Chi C|last7=Ng|first7=Pak C|last8=Lam|first8=Pansy W.Y|last9=Ho|first9=Lau C|last10=To|first10=William W.K|last11=Lai|first11=Sik T|last12=Yan|first12=Wing W|last13=Tan|first13=Peggy Y.H|title=Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome|journal=American Journal of Obstetrics and Gynecology|volume=191|issue=1|year=2004|pages=292–297|issn=00029378|doi=10.1016/j.ajog.2003.11.019}}</ref> | ||
*Vertical Transmission of COVID-19 has not been found.<ref>{{cite web |url=https://aidsinfo.nih.gov/guidelines/html/8/covid-19-and-persons-with-hiv--interim-guidance-/0?utm_source=AIDSinfo&utm_medium=email&utm_campaign=3-20-20-COVID19_Guidance|title=Interim Guidance for COVID-19 and Persons with HIV |format= |work= |accessdate=}}</ref><ref name="ChenGuo2020">{{cite journal|last1=Chen|first1=Huijun|last2=Guo|first2=Juanjuan|last3=Wang|first3=Chen|last4=Luo|first4=Fan|last5=Yu|first5=Xuechen|last6=Zhang|first6=Wei|last7=Li|first7=Jiafu|last8=Zhao|first8=Dongchi|last9=Xu|first9=Dan|last10=Gong|first10=Qing|last11=Liao|first11=Jing|last12=Yang|first12=Huixia|last13=Hou|first13=Wei|last14=Zhang|first14=Yuanzhen|title=Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records|journal=The Lancet|volume=395|issue=10226|year=2020|pages=809–815|issn=01406736|doi=10.1016/S0140-6736(20)30360-3}}</ref><ref name="WangHu2020">{{cite journal|last1=Wang|first1=Dawei|last2=Hu|first2=Bo|last3=Hu|first3=Chang|last4=Zhu|first4=Fangfang|last5=Liu|first5=Xing|last6=Zhang|first6=Jing|last7=Wang|first7=Binbin|last8=Xiang|first8=Hui|last9=Cheng|first9=Zhenshun|last10=Xiong|first10=Yong|last11=Zhao|first11=Yan|last12=Li|first12=Yirong|last13=Wang|first13=Xinghuan|last14=Peng|first14=Zhiyong|title=Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China|journal=JAMA|volume=323|issue=11|year=2020|pages=1061|issn=0098-7484|doi=10.1001/jama.2020.1585}}</ref><ref name="FengZhang2020">{{cite journal|last1=Feng|first1=Ling|last2=Zhang|first2=Jingyi|last3=Cao|first3=Yong|last4=Liu|first4=Weiyong|last5=Chen|first5=Ling|last6=Guo|first6=Lili|last7=Wang|first7=Shaoshuai|title=A Case Report of Neonatal 2019 Coronavirus Disease in China|journal=Clinical Infectious Diseases|year=2020|issn=1058-4838|doi=10.1093/cid/ciaa225}}</ref> | *Vertical Transmission of [[COVID-19]] has not been found.<ref>{{cite web |url=https://aidsinfo.nih.gov/guidelines/html/8/covid-19-and-persons-with-hiv--interim-guidance-/0?utm_source=AIDSinfo&utm_medium=email&utm_campaign=3-20-20-COVID19_Guidance|title=Interim Guidance for COVID-19 and Persons with HIV |format= |work= |accessdate=}}</ref><ref name="ChenGuo2020">{{cite journal|last1=Chen|first1=Huijun|last2=Guo|first2=Juanjuan|last3=Wang|first3=Chen|last4=Luo|first4=Fan|last5=Yu|first5=Xuechen|last6=Zhang|first6=Wei|last7=Li|first7=Jiafu|last8=Zhao|first8=Dongchi|last9=Xu|first9=Dan|last10=Gong|first10=Qing|last11=Liao|first11=Jing|last12=Yang|first12=Huixia|last13=Hou|first13=Wei|last14=Zhang|first14=Yuanzhen|title=Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records|journal=The Lancet|volume=395|issue=10226|year=2020|pages=809–815|issn=01406736|doi=10.1016/S0140-6736(20)30360-3}}</ref><ref name="WangHu2020">{{cite journal|last1=Wang|first1=Dawei|last2=Hu|first2=Bo|last3=Hu|first3=Chang|last4=Zhu|first4=Fangfang|last5=Liu|first5=Xing|last6=Zhang|first6=Jing|last7=Wang|first7=Binbin|last8=Xiang|first8=Hui|last9=Cheng|first9=Zhenshun|last10=Xiong|first10=Yong|last11=Zhao|first11=Yan|last12=Li|first12=Yirong|last13=Wang|first13=Xinghuan|last14=Peng|first14=Zhiyong|title=Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China|journal=JAMA|volume=323|issue=11|year=2020|pages=1061|issn=0098-7484|doi=10.1001/jama.2020.1585}}</ref><ref name="FengZhang2020">{{cite journal|last1=Feng|first1=Ling|last2=Zhang|first2=Jingyi|last3=Cao|first3=Yong|last4=Liu|first4=Weiyong|last5=Chen|first5=Ling|last6=Guo|first6=Lili|last7=Wang|first7=Shaoshuai|title=A Case Report of Neonatal 2019 Coronavirus Disease in China|journal=Clinical Infectious Diseases|year=2020|issn=1058-4838|doi=10.1093/cid/ciaa225}}</ref> | ||
'''Older Adults''' | '''Older Adults''' | ||
<br /> | |||
==Diagnosis== | |||
==Presentation== | ==Presentation== | ||
* There hasn't been any observable difference in clinical presentation among people with HIV infection as compared to the general population. | * There hasn't been any observable difference in clinical presentation among people with HIV infection as compared to the general population. | ||
*Common symptoms for COVID-19 are | *Common symptoms for [[COVID-19]] are | ||
**Fever or chills | **[[Fever]] or chills | ||
**Cough<ref>{{cite web |url://www.chkd.org/uploadedFiles/Documents/COVID-19/CHKD%20MIS-C%20Guideline%20D2.pdf ></ref> | **[[Cough]]<ref><nowiki>{{cite web |url://www.chkd.org/uploadedFiles/Documents/COVID-19/CHKD%20MIS-C%20Guideline%20D2.pdf ></nowiki></ref> | ||
**Shortness of Breath or difficulty breathing | **Shortness of Breath or difficulty breathing | ||
**Fatigue | **[[Fatigue]] | ||
**Muscle or Body aches | **Muscle or Body aches | ||
**Headache | **[[Headache]] | ||
**New loss of taste or smell | **New loss of taste or smell | ||
**Sore Throat | **[[Sore Throat]] | ||
**Congestion or runny nose | **Congestion or runny nose | ||
**Nausea or vomiting | **[[Nausea or vomiting]] | ||
**Diarrhea | **[[Diarrhea]] | ||
==Recommendations for Patients with HIV== | ==Recommendations for Patients with HIV== | ||
*Maintain the supply for antiretroviral therapy for a minimum of 30 days. | *Maintain the supply for antiretroviral therapy for a minimum of 30 days and ideal supply for 90 days.<ref name=":0" /> | ||
*Virtual visit and telemedicine should be considered for non-urgent care and non-adherence counseling | *Virtual visit and telemedicine should be considered for non-urgent care and non-adherence counseling<ref name=":0" /> | ||
* People with suppressed HIV viral load and in stable health, should postpone their routine medical care and laboratory visits to the extent possible. | * People with suppressed HIV viral load and in stable health, should postpone their routine medical care and laboratory visits to the extent possible.<ref name=":0" /> | ||
*If they develop symptoms of COVID-19 like fever, cough, shortness of breath, etc they should seek medical advice. | *If they develop symptoms of [[COVID-19]] like [[Cough and fever|fever, cough]], shortness of breath, etc they should seek medical advice.<ref name=":0" /> | ||
*They should make sure their vaccination status is updated. | *They should make sure their vaccination status is updated. <ref name=":0" /> | ||
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Revision as of 04:03, 11 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Harmeet Kharoud M.D.[2]
Synonyms and keywords:
Overview
- An observational prospective study found out that the incidence of HIV-infected individuals to be affected by SARS-CoV-2 was similar to the general population.
- Specific antiretroviral therapy did not affect COVID-19 severity.
- Immunosuppression(low CD4 cell counts) was associated with COVID-19 severity.
- Patients with HIV infection often have other comorbidities(lung disease, cardiovascular disease) therefore, increasing the risk for severe-COVID-19 disease.
- Patients with HIV infection with CD4 cell count<200/mm3 are at increased risk for complications from other respiratory infections. However, we do not know if this is the scenario with COVID-19
Epidemiology and Demographics
Risk
- At present people with HIV who are at greatest risk of Severe COVID-19 infection are people -
- who have low CD4 cell count.
- not on antiretroviral therapy.
Specific Populations with HIV
Pregnancy
- Pregnant individuals with HIV are at greater risk for severe illness, morbidity, or mortality as compared with the general population due to coronavirus infections(SARS-CoV and MERS-CoV) and other viral respiratory infections like influenza. [1]Data related to COVID-19 is limited but pregnant individuals with HIV are suspected to be at greater risk due to SARS-COV-2 similarity with other coronaviruses (SARS-CoV and MERS).[2][3]
- They are suspected to be at increased risk of preterm delivery, adverse neonatal outcomes.[4] In a small series of pregnant women with COVID-19 adverse outcomes such as fetal distress and preterm delivery have been noted. They have also been reported with SARS-CoV and MERS.[5][6][7]
- Vertical Transmission of COVID-19 has not been found.[8][9][10][11]
Older Adults
Diagnosis
Presentation
- There hasn't been any observable difference in clinical presentation among people with HIV infection as compared to the general population.
- Common symptoms for COVID-19 are
- Fever or chills
- Cough[12]
- Shortness of Breath or difficulty breathing
- Fatigue
- Muscle or Body aches
- Headache
- New loss of taste or smell
- Sore Throat
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea
Recommendations for Patients with HIV
- Maintain the supply for antiretroviral therapy for a minimum of 30 days and ideal supply for 90 days.[3]
- Virtual visit and telemedicine should be considered for non-urgent care and non-adherence counseling[3]
- People with suppressed HIV viral load and in stable health, should postpone their routine medical care and laboratory visits to the extent possible.[3]
- If they develop symptoms of COVID-19 like fever, cough, shortness of breath, etc they should seek medical advice.[3]
- They should make sure their vaccination status is updated. [3]
Medical Therapy
References
- ↑ "Interim Guidance for COVID-19 and Persons with HIV".
- ↑ "Society for Maternal-Fetal Medicine, Dotters-Katz S, Hughes BL. Coronavirus (COVID-19) and Pregnancy: What Maternal-Fetal Medicine Subspecialists Need to Know. 2020" (PDF).
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 "Interim Guidance for COVID-19 and Persons with HIV".
- ↑ "Society for Maternal-Fetal Medicine, Dotters-Katz S, Hughes BL. Coronavirus (COVID-19) and Pregnancy: What Maternal-Fetal Medicine Subspecialists Need to Know. 2020" (PDF).
- ↑ Siston, Alicia M. (2010). "Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States". JAMA. 303 (15): 1517. doi:10.1001/jama.2010.479. ISSN 0098-7484.
- ↑ Alfaraj, Sarah H.; Al-Tawfiq, Jaffar A.; Memish, Ziad A. (2019). "Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection during pregnancy: Report of two cases & review of the literature". Journal of Microbiology, Immunology and Infection. 52 (3): 501–503. doi:10.1016/j.jmii.2018.04.005. ISSN 1684-1182.
- ↑ Wong, Shell F; Chow, Kam M; Leung, Tse N; Ng, Wai F; Ng, Tak K; Shek, Chi C; Ng, Pak C; Lam, Pansy W.Y; Ho, Lau C; To, William W.K; Lai, Sik T; Yan, Wing W; Tan, Peggy Y.H (2004). "Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome". American Journal of Obstetrics and Gynecology. 191 (1): 292–297. doi:10.1016/j.ajog.2003.11.019. ISSN 0002-9378.
- ↑ "Interim Guidance for COVID-19 and Persons with HIV".
- ↑ Chen, Huijun; Guo, Juanjuan; Wang, Chen; Luo, Fan; Yu, Xuechen; Zhang, Wei; Li, Jiafu; Zhao, Dongchi; Xu, Dan; Gong, Qing; Liao, Jing; Yang, Huixia; Hou, Wei; Zhang, Yuanzhen (2020). "Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records". The Lancet. 395 (10226): 809–815. doi:10.1016/S0140-6736(20)30360-3. ISSN 0140-6736.
- ↑ Wang, Dawei; Hu, Bo; Hu, Chang; Zhu, Fangfang; Liu, Xing; Zhang, Jing; Wang, Binbin; Xiang, Hui; Cheng, Zhenshun; Xiong, Yong; Zhao, Yan; Li, Yirong; Wang, Xinghuan; Peng, Zhiyong (2020). "Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China". JAMA. 323 (11): 1061. doi:10.1001/jama.2020.1585. ISSN 0098-7484.
- ↑ Feng, Ling; Zhang, Jingyi; Cao, Yong; Liu, Weiyong; Chen, Ling; Guo, Lili; Wang, Shaoshuai (2020). "A Case Report of Neonatal 2019 Coronavirus Disease in China". Clinical Infectious Diseases. doi:10.1093/cid/ciaa225. ISSN 1058-4838.
- ↑ {{cite web |url://www.chkd.org/uploadedFiles/Documents/COVID-19/CHKD%20MIS-C%20Guideline%20D2.pdf >