The COVID-19 pandemic is having a significant impact on all our lives. While there's evidence that things are beginning to settle down, it'll be a long time before we get back to anything like normal. We all need to continue to take measures that not only protect ourselves but also ensure we protect the most vulnerable in society.

As the lockdown is slowly lifted, we need to ensure that we avoid a second wave of infections and all play our part in preventing any more tragic deaths. It remains a worrying time and a cause of anxiety and concern – but there is much we can do to reduce the risk to ourselves and others. I’m continuing to update this blog to advise those living with HIV about what to do and I hope the information and some frequently asked questions (FAQs), below, will help answer any questions you might have.

COVID-19 is an illness caused by a new type of coronavirus that was initially detected in Wuhan City, Hubei Province, China. It has now spread around the world. Significant numbers of people are still being infected in the UK and, sadly, many have died. Public Health England is producing daily updates on COVID-19 infections in the UK.

About 80% of people with COVID-19 get a relatively mild illness. The people most at risk of serious illness and death are the elderly; those with long-term medical conditions such as lung disease, kidney disease, heart disease and diabetes; and people from black, Asian and minority ethnic (BAME) communities.

The Government has recently advised that those in the most vulnerable groups in England can now leave their home as long as they are able to maintain strict social distancing. They can spend time outdoors with their own household or, if they live alone, with one person from another household (while taking extra care to stay two metres away from other people).

There is currently no evidence that people living with HIV are more likely to catch COVID-19 than anyone else and we still need more data on whether or not the impact of COVID-19 is any worse for people living with HIV.

It's estimated that perhaps as many as one in three people with COVID-19 have no symptoms – but can still pass the virus on to others. This is why it's essential that we continue to regularly wash our hands, stay at home as much as possible, avoid any unnecessary travel and, if we do go out, stay at least two metres away from everyone else.

As the lockdown is slowly lifted these principles remain as important as ever. Read more detailed information on social distancing.

You’ll be aware that there are severe restrictions on travel and the government is advising against all but essential travel abroad. If you're planning to travel abroad, see advice for travellers on GOV.UK.

Hygiene and hand-washing in particular remain really important. Washing your hands with warm water and soap regularly, and certainly more often than you would normally, will reduce the risk of you catching or passing on the virus.

If you have symptoms, you must stay at home and self-isolate. The main symptoms to be aware of are:

• A high temperature (you feel hot to the touch on your chest or back, or your temperature measured by thermometer is 37.8°C or higher).
• A new, continuous cough.
• Loss or change to your sense of smell and taste.

You need to stay at home for seven days if you have symptoms. If you live with other people, they should stay at home for 14 days from the day the first person got symptoms.

If you live with someone who is over 70, has a long-term health condition, is pregnant or has a weakened immune system, try to find somewhere else for them to stay for 14 days. If you have to stay at home together, try to keep away from each other as much as possible. For the most up-to-date information, read the government’s advice about staying at home.

Everyone with symptoms of coronavirus can now get a test. Find out more information and how to get a test.

After 14 days, anyone you live with who does not have symptoms can return to their normal routine.

It's important that you do not go to a GP surgery, pharmacy or hospital if you have symptoms. Use the 111 online coronavirus service to find out what to do next.

If you feel you can't cope with your symptoms at home, your condition gets worse, or your symptoms do not get better after seven days, then call the NHS 111 Coronavirus Service.

Only call 111 if you cannot get help online.

• In Scotland, call your GP or NHS 24 on 111 out of hours.
• In Wales, call 111 (if available in your area) or 0845 46 47.
• In Northern Ireland, call 111. 

COVID-19 and HIV

COVID-19 infection is likely to be worse in those with a ‘weakened immune system’. This does not mean that all people with HIV are considered at increased risk. Those on HIV treatment with a good CD4 count and an undetectable viral load are not considered to have weakened immune systems. A ‘good’ CD4 count means anything over 200. If your CD4 count is less than 200, if you’re not on treatment or if you have a detectable viral load, then it's particularly important that you follow the guidance to reduce the risk of catching the virus.

Some people have been identified as being extremely vulnerable to COVID-19 and have been advised to be ‘shielded’ and protected from the virus, which means staying at home at all times and avoiding face-to-face contact. Although people living with HIV are not included in the list of extremely vulnerable people who need to be shielded, we and the British HIV Association (BHIVA) advise that those with a CD4 count less than 50 or those diagnosed with an opportunistic infection in the last six months should also follow the shielding advice.

This advice has changed because the Government considers the risk of getting COVID-19 is now lower than when the shielding advice was introduced. However, some experts are concerned that the numbers of new diagnoses are not dropping fast enough and there remains a risk that the infection rate will increase again. BHIVA and us share this concern, but we also recognise how isolated people may feel at this time and how difficult it can be to completely shield yourself.

Our advice is that if are shielding based on HIV (i.e. if your CD4 count is less than 50 or you’ve had a recent serious HIV-related illness) or if you have well-controlled HIV but are shielding for other reasons:

1. If you are physically and psychologically able to continue to shield, then please do so.
2. If you wish to follow the Government’s advice in England and socialise outdoors, please be especially vigilant in maintaining social distancing, careful and frequent hand washing and avoiding any contact with people who have symptoms or are known to have COVID-19.

For now, we’re advising taking a cautious approach.

It’s important to note that the shielding advice is slightly different in Scotland and Wales but the advice in Northern Ireland is the same as for England.

Effective treatment means that the vast majority of people living with HIV have an undetectable viral load and a good CD4 count. We usually don’t do the CD4 count test anymore because we know that, as long as you remain undetectable, your CD4 count won't fall. As a result, it may be a number of years since you last had your CD4 count checked. Don’t worry about this: you don’t need to have a CD4 count done now. As long as your viral load remains undetectable, your CD4 count will be as good as it was when it was last tested – and probably better.

As a result of COVID-19 HIV clinics have had to significantly reduce their face-to-face appointments and this is likely to continue for some time in order to reduce risk of infection and to deliver services in a socially distanced way.

Rest assured that our priority is, and will always be, your health but we will have to do things very differently over the coming months and years. Different clinics will take slightly different approaches, but it likely that more appointments will take place by phone or video consultation with face-to-face appointments kept to a minimum.

If you’re well and have an undetectable viral load we may do blood tests less frequently but we will always ensure that you have enough medication (which, at the end of the day, is the most important thing). There's no need to stockpile medication – in fact this could put unnecessary strain on the system. We have no concerns about the supply of medication, so just ensure that you always have at least a month’s worth of medication at home. We cannot supply more than six months of HIV medication at a time as this may also have an impact on supply.

If you have any questions regarding what your local clinic is doing, then check their website or give them a call.

Conclusion

We'll continue to update this blog when we have more information to give you. I’m also providing some links in the FAQs below to other reliable sources of information.

Look after yourselves and look out for each other. Our best defence against the virus is still staying at home as much as possible, following government advice about limiting social contact, keeping two metres away from other people when we go out, regular hand washing, self-isolating if necessary and taking care of those most vulnerable and isolated.

What is COVID-19?

COVID-19 is a new type of coronavirus. Coronaviruses are a family of viruses that cause diseases in animals and sometimes in humans. COVID-19 causes a respiratory (lung) infection.

What are the symptoms of COVID-19?

Most people with COVID-19 have mild respiratory symptoms. The common symptoms are cough, temperature, shortness of breath and the loss of your sense of taste or smell.

It’s important to remember that these symptoms are similar to other illnesses that are much more common – such as the cold or flu – and don’t necessarily mean you have COVID-19.

How is COVID-19 transmitted?

COVID-19 is spread in droplets through coughing and sneezing or being very close to someone who is infectious. The virus can also live outside the body on hard surfaces for short periods of time which is why regularly handwashing is so important to reduce the risk of transmission.

What can I do to reduce the risk of catching it?

Simple things can reduce your risk of catching COVID-19. Regular hand-washing with soap and water (for at least 20 seconds) is an effective way of stopping the spread of viruses. 

Also, it’s important to do the following:

• Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze.
• Put any used tissues into the bin immediately.
• Avoid contact with people who have symptoms of coronavirus.
• Stay at home as much as possible and follow social distancing guidelines by staying at least two metres away from others when you go out.
• Only travel on public transport if it's absolutely necessary. Wear a face covering when you do.
• Use the phone, online services, or apps to contact your GP surgery or other NHS services.

Am I at greater risk if I’m HIV positive?

There's currently no evidence that people living with HIV are any more likely to catch COVID-19 than anyone else and you should follow the advice being given to the general population. 

If you are on treatment, with an undetectable viral load and a good CD4 count (i.e. over 200), then there should be no greater risk. 

If you’re living with HIV and do not have an undetectable viral load or have a low CD4 count it's even more important to ensure you follow the guidance and reduce the chance of getting infected.

We're also advising that if you have a CD4 count below 50 or if you have been diagnosed with an opportunistic infection (or ‘AIDS-defining illness') in the last six months you should follow the advice about ‘shielding’ that's being given to others who are the most vulnerable to infection. This means staying at home and avoiding face-to-face contact.

Guidance in England and Northern Ireland now allows those who are shielding to spend time outdoors with their own household or, if they live alone, with one person from another household (while taking extra care to stay two metres away from other people). Although infection rates are dropping, we and BHIVA advise taking a cautious approach for now and if you are physically and psychologically able to continue to shield you should do so.

Can COVID-19 be treated?

COVID-19 is a new type of virus and at present there's no specific treatment or vaccine. As COVID-19 is a virus, antibiotics will not treat it. 

Most people with COVID-19 get mild flu-like and respiratory symptoms and will recover without the need for hospital care. Simple measures such as rest, food, fluids and paracetamol, if you have a fever, will be enough. Treatment aims to relieve the symptoms while your body fights the illness. You would also need to stay in isolation away from other people until you have recovered.

It is expected that most people with COVID-19 will be able to self-treat at home.

Do HIV drugs treat COVID-19?

There are research trials investigating the use of some HIV medication against COVID-19 but there is currently no evidence that they are effective. There is also no evidence that being on HIV medication will stop you getting COVID-19.

You should continue taking your treatment at the recommended dose. Don't increase the number of tablets you take. This will not help if you get COVID-19, it will not protect you from getting it and it will only increase the risk of harmful side-effects.

Don't share your HIV medicine with anyone who has COVID-19 or who is worried about getting it.

Does taking PrEP treat COVID-19?

There is also no evidence that the drugs used for PrEP, tenofovir (TDF) and emtricitabine (TFC), will treat COVID-19.

A clinical trial in Spain is looking into whether TDF/FTC will prevent COVID-19 or reduce the severity of the illness in healthcare workers. However, doing a trial does not mean that the drugs will work – it just means that it is being explored as a possibility.

We don’t advise people to start TDF/FTC to prevent or treat COVID-19. Currently the best protection remains staying at home, isolating from others and regular handwashing.

What should I do if I think I have COVID-19?

If you think you have COVID-19 then you should stay at home and self-isolate. The symptoms you need be aware of are either:

• A high temperature (you feel hot to touch on your chest or back).
• A new, continuous cough.
• Loss or change to your sense of smell and taste.

If you're concerned about yourself or someone else and want to get some advice, use the 111 online coronavirus service to find out what to do next.

What should I do if I’m planning to travel abroad?

If you’re planning to travel abroad and are concerned about the coronavirus, you should check the country by country travel advice on GOV.UK.

Where can I get more information?

It's important to get information from a reliable source such as the NHS or the government (the Department of Health). We'll also be updating the information on our website if and when the situation changes and the advice is different.

Here are some sources of information:

• General information on COVID-19 from NHS.
• UK government advice about COVID-19.
• Information on COVID-19 from Department of Health and Social Care.
• Information for people living in Scotland.
• Information for people living in Wales.
• Information for peopleliving in Northern Ireland.
• All coronavirus statements from BHIVA.

You can also contact our THT Direct helpline on 0808 802 1221.