COVID-19 and HIV: What You Need to Know

TheBody asked David Malebranche, M.D., an internal medicine physician and HIV/sexual health expert, to speak to concerns and questions many people living with HIV might have about COVID-19.

We’ve combined his guidance—which also appears within videos scattered throughout this page—with additional research and reporting from TheBody's staff to cover the most important issues regarding the coronavirus among people living with HIV.

We'll keep updating this page throughout the pandemic. If you have a question about HIV and the new coronavirus that we haven't answered yet in this article, please let us know.

This article was last updated on April 2, 2021.

HIV and Coronavirus Basics

What Is the New Coronavirus?

COVID-19 is the name scientists gave to the illness people develop after becoming infected with SARS-CoV-2, a new strain of coronavirus discovered in 2019.

There are many strains of coronavirus in the U.S.; they are behind illnesses like the common cold. COVID-19 is a little bit different: It's both more severe and more contagious than the typical flu.

This 2019 version of coronavirus most likely originated from livestock exposure.

HIV and Coronavirus Transmission

How Is the New Coronavirus Spread?

The new coronavirus is spread through respiratory droplets. If you’re within 6 feet of somebody with the virus, it can be spread from some of the aerosolized droplets that come out of their mouth when they speak, yell, sing, cough, etc. This can happen even if the person who's infected with the coronavirus isn't showing any symptoms.

These aerosolized droplets are also the reason why, even if you’re more than 6 feet away from a person who has COVID-19, you can be at risk if you’re sharing the same indoor space with them for more than a few minutes. If each of you is wearing a well-fitting mask over your nose and mouth, that can reduce the risk; so can maximizing the amount of ventilation in the room, such as by opening windows and using fans.

There’s also a small risk that COVID-19 can be transmitted by touching an object or surface with the virus on it, and then touching your nose, mouth, or eyes, but recent studies suggest this is a less common way of spreading the virus.

David Malebranche, M.D., discusses the latest on the research linking people living with HIV with a higher risk of COVID-19 and more severe symptoms.

Can the New Coronavirus Be Spread Through Sex?

Research to date has found that the novel coronavirus that causes COVID-19 can be shed through feces and semen. This has led some to wonder whether that might mean that the virus could be transmitted via anal sex, vaginal sex, or other sex practices such as rimming and fisting.

We still can’t say for certain what all of the ways are in which this coronavirus is transmitted. We do know that if the virus is shed through fecal matter and semen, there is the potential for it to be transmitted during sex. Many viruses are shed in feces, but what researchers have yet to determine is whether the bits of the COVID-19 virus found in feces or semen are actually infectious.

So in the meantime, just be careful. If you’ve been in a situation with someone who has recently been traveling, or if they’re sick with COVID-19 and you’re worried, the best practice would be to avoid sex practices—whether that be toys, rimming, or anal/vaginal sex itself—until we know more information.

If avoiding sex isn’t a realistic option for you, and masturbation ain’t cutting it either, then do your best to find ways to have sex while minimizing your COVID-19 risk. The New York City health department released some useful tips last year (they include cutting down on kissing, reducing your number of partners, and getting creative with sexual positions or the use of glory holes). Other experts have plenty of great advice to offer as well.

HIV and Coronavirus Vaccination

Are COVID-19 Vaccines Safe for People Living With HIV?

In the U.S., three COVID-19 vaccines have been granted an emergency use authorization (EUA) by federal health experts; they include vaccines developed by Pfizer-BioNTech, Moderna, and Janssen (Johnson & Johnson).

Much of the research on these COVID-19 vaccines did not involve people living with HIV (there were fewer than 200 participants living with HIV enrolled in each of the Pfizer and Moderna studies, and roughly 1200 in the Janssen study). So while it’s true we need more data, from what we know thus far, there’s no evidence that would make us think the vaccines are unsafe.

Here’s everything we know right now about COVID-19 vaccination that’s relevant to people living with HIV.

David Malebranche, M.D., explains what people with HIV should expect after being vaccinated, including side effects.

What Does a Person Living With HIV Need to Know Right Now About COVID-19 Vaccination?

The first thing to know: You should be proactive about getting a vaccine. The phased rollout process is underway in each state, and is based on the recommendations by the Centers for Disease Control and Prevention (CDC), as well as vaccine supply; Currently, all 50 states have a plan in place to open up vaccination to anyone 16 and older by May 1st. You can keep track of your own state’s vaccination policies using this Kaiser Family Foundation (KFF) reference page (scroll to the bottom).

Many clinics are not stocking COVID-19 vaccines, but you can locate one by checking with pharmacies or the website for your state's health department.

What Can a Person Living With HIV Do After Getting a COVID-19 Vaccine?

While we’re still learning how vaccines will affect the spread of the coronavirus, if you’ve been fully vaccinated, the CDC has issued guidelines that allow you to gather indoors with other fully vaccinated people without wearing a mask. That recommendation extends to gathering indoors with one other household, for example, relatives who live together, so long as they are not at an increased risk for severe illness from COVID-19. Under other circumstances, including when you’re in public, continue to mask up, stay at least 6 feet away from others, and avoid crowds and poorly ventilated spaces.

Also important: Although the vaccines have been shown to be effective at preventing severe illness, hospitalization, and death, scientists are still learning how well the vaccines protect you from getting and spreading COVID. Early data show the vaccines may work against some variants but could be less effective against others. If you are vaccinated, you should still take steps to protect yourself and others in many situations. Here’s the latest on what you can and cannot do if you’ve been vaccinated.

David Malebranche, M.D., shares his personal guidance on getting an appointment for a COVID-19 vaccine.

HIV and Coronavirus Prevention/Treatment

How Can You Prevent Coronavirus Infection as a Person Living With HIV?

In short:

• Wear a mask.
• Stay 6 or more feet away from others.
• Avoid trips and public gatherings.
• Wash your hands often.
• Rest and avoid stress.
• Take your HIV meds.
• Get vaccinated, as soon as you have access to a vaccine.

Whenever you're going to be around people you don't live with, wear a mask that fits snugly over your nose and mouth. It should also be thick enough that you can't blow out a candle through it.

If you're around people you don't live with, maintain a distance of at least 6 feet, even while you're both masked. The risk of transmission also goes up the longer you share an indoor space with a person who has the coronavirus, so try to limit the amount of time you spend inside with others, and do your best to ensure that the space you're in is well ventilated (e.g., windows are open, fans are on, and you can feel air moving). And the more people you share an indoor space with, the riskier it gets, so try to reduce the number of people you're sharing a space with as much as you can.

When washing your hands, use soap and water for 20 seconds—or, if soap isn't available, a hand sanitizer that is at least 60% alcohol.

Other strategies include avoiding crowds, poorly ventilated public places, and nonessential travel.

Also important: Give your body the rest it deserves. The main thing is to keep your immune system healthy. Getting enough sleep, resting, keeping stressful people and situations out of your life, getting your mental health checked up on.

Take your HIV medications and stay virally suppressed. The higher your T-cell count (aka CD4 count) is, the more your HIV is suppressed, and the stronger your immune system will be. That will help you avoid exposure not only to something like the new coronavirus, but to all other viruses—like the flu—and other kinds of parasites and fungal infections.

If you are living with HIV and not currently on medication, now might be a good time to seek treatment! Plenty of HIV care centers are still accepting new patients. And there are programs to help with medical visit and medication costs if you are uninsured or not high income.

Can HIV Meds Protect Me From COVID-19 or Make It Less Severe?

Not directly. But HIV treatment is extremely important in general!

Early in the pandemic, there was some hope that a few different HIV medications might have a protective effect against the new coronavirus. But as more and more research has taken place, we haven't seen proof that any specific HIV treatment regimen or antiretroviral can reduce the risk of becoming infected with the new coronavirus or reduce the severity of COVID-19 once a person has it.

That said, we do know that people whose immune systems are weakened are at greater risk for COVID-19—and we've known for many years that HIV medications are excellent at preventing HIV from weakening a person's immune system. So it's highly likely that, by keeping your HIV viral load undetectable and keeping your CD4 count up, HIV treatment can have a huge indirect effect on your body's ability to fight off COVID-19.

Am I Considered Immunocompromised if I Have HIV But I’m Undetectable?

That depends on your T-cell count (aka your CD4 count) and immune system function.

When you have HIV, your immune system is in a constant state of inflammation. A “normal” T-cell count is anywhere from 450 to 1,100, so if your CD4 count is in the 500s or 600s and you’re jealous of your friends who are in the 900s or higher—don’t be! But, if you’re sick with another cold or pneumonia, or another medical condition—or if you have a lot of mental or emotional stress—these can compromise your immune system and lower your T-cell count, even when your HIV meds are working well.

If your viral load is undetectable, you can still be susceptible to the flu and COVID-19, so whenever you're going to be around others, please mask up, practice physical distancing, and wash your hands often.

Should I Be Worried if I’m Undetectable But My CD4 Count Isn’t High?

As we just noted, your T-cell count can vary due to a lot of factors that have nothing to do with HIV. People who see their T-cell counts dip might think that it’s a problem with their HIV medications, when it may just be a life change.

Everyone has a different body and a different immune system, so there's no need to compare your CD4 count to someone else’s. For people living with HIV, each person’s set point might be different from someone else’s. But most important is how you feel medically and clinically.

(When we say “set point,” that means the state of your immune system when you were first diagnosed with HIV. Some people may not see their T cells go up too high because their set point was very low.)

What Other Things Can I Do to Raise My CD4 Count and Protect My Immune System From COVID-19?

There’s no magic pill or concoction to raise CD4 count, but engaging in a healthy lifestyle can improve your number. That means:

• engaging in exercise
• not drinking or taking other drugs
• not smoking
• eating the right food

When it comes to vitamin supplements, the science is still unclear about how much they can help protect people from coronavirus infection or make COVID-19 less severe. There's been some very early research suggesting a small potential benefit from some supplements, but no conclusive or reliable data yet.

So what we're left with is general advice: If you have a vitamin or mineral deficiency, the right supplement may help erase that deficiency—which may in turn help make your immune system stronger and better able to fight off disease. But there's no clear evidence that taking supplements when you don't need them will help stave off the coronavirus or stop COVID-19 in its tracks.

In addition, keep in mind that some forms of alternative or herbal therapies can interact with your prescription medications, including HIV meds. So please speak with your care provider before adding a supplement or non-medical therapy to your regimen.

Also, please take care of your mental health. If you're like a lot of people living with HIV right now, you may feel isolated, depressed, or anxious during this time of social distancing, economic worries, and long-lasting life disruptions. Your immune system reacts to your mental health and can become stressed or weaker during periods of emotional turmoil. If you have a therapist or a spiritual advisor, please speak with them about your mental and emotional health.

HIV and Coronavirus Testing

How Can You Get Tested for the New Coronavirus?

If you want to know about where you can get a test, your best bet is to start local:

• Ask your personal health care provider.
• If that fails, see if your mayor or town/city/county officials have posted information about how to get tested locally. (Note that pharmacies and emergency clinics often offer COVID-19 testing, though you might need to schedule an appointment in advance.)
• Check out the website for your state's health department.
• Check the CDC’s designated coronavirus website.

Keep in mind that there are many different types of tests produced by many different companies. Some test for the novel coronavirus itself, while others test for signs that your body has developed antibodies to fight off infection (which can signal whether you were infected in the past). Some are also more reliable than others. In addition, many testing centers require you to wait several days after a potential COVID-19 exposure before you can get tested (because it can take a while for the test to detect signs of infection), so it’s helpful to get as much info as you can in advance about the types of tests available near you.

Given the history of how the government initially handled the pandemic, it makes sense that some people may be distrusting as a result. But if you are looking for information, the CDC is providing some of the most accurate, up-to-date information that we have.

HIV Care and Staying Healthy in the Coronavirus Era

How Can My HIV Care Providers Help Me Manage COVID-19 Quarantines, Shutdowns, and Social Isolation?

Anybody with a chronic health condition—not just HIV—should talk to their doctor and other health care providers about how they can best take care of their health during this period. That means talking with providers about:

• Refilling at least a 30-day supply of all medications, including HIV meds (ask if 90 days is possible).
• Staying up-to-date on vaccinations (that includes a flu shot).
• Planning for how to receive clinical care during isolation, including telehealth or other at-home options.
• Whether it's safe to delay upcoming check-ins, lab tests, or regimen switches.

Many HIV care centers are open for in-person visits right now, and have taken extensive precautions to keep you (and them!) as safe from COVID-19 as possible in the process—potentially including having patients wait in their cars or outdoors rather than inside a waiting room. If you’ve put off important medical appointments, such as getting your HIV viral load checked, feel free to give your local care providers a call for more information, and find an arrangement that fits best with your comfort level.

What Do I Do if I’m Living With HIV and Feeling Sick?

If you are feeling sick, but have not yet been tested for COVID-19, that's your first priority: get yourself tested ASAP. Set up a virtual or in-person visit with a care provider to explain your symptoms and get checked out.

In the meantime, there are several steps you can take to stop the spread of the coronavirus, whether you're waiting for test results or have tested positive:

• Avoid all risk of contact with others.
• If you're living with anyone else and neither of you can stay somewhere else, try to completely isolate in one room.
• Keep wearing masks whenever you might be around other people.
• Don't share: Make sure any objects you touch are only touched by you, or are disinfected thoroughly before anyone else uses them.

If you are going into any medical facility, either to get tested or just to see a doctor, call ahead of your appointment to let them know you are showing potential symptoms. This gives the doctor’s office a heads up to protect themselves and patients.

Make sure to stay home—and leave only for medical care. Avoid public transportation, including ride share cars and taxis. While at home, stay away from friends and family, and keep the home as well-ventilated as you can. Stay in a specific “sick room” if you can and use a separate bathroom if possible. If possible, stay away from pets and animals, and ask a loved one to care for pets.

Face masks can be very important in helping reduce the chances of transmitting coronavirus to anyone who spends time breathing the same air as you. If a face mask is not available, make sure to cover your coughs and sneezes with your elbow. And, of course, wash your hands often.

Other ways to minimize spread include not sharing personal household items and cleaning all “high touch” surfaces frequently. That means having your own:

• dishes
• drinking glasses
• cups
• eating utensils
• bedding

Also make sure to wash these items as often as possible.

Clean any surface—especially those in your kitchen, bathroom and “sick room”—every day.

Please stay in contact with your doctor about when you can stop home isolation. The CDC recommends leaving home only after all three of these criteria are met:

• At least 10 days have passed since your first symptoms.
• You have not had a fever for 24 hours—without needing to take medications to keep your temperature down.
• Your other symptoms have improved.

Can People Living With HIV Safely Travel During the Coronavirus Pandemic?

We'll be real with you here: There's a lot of grey area when it comes to COVID-19 risk and travel. Anyone who says it's definitely safe or definitely unsafe is oversimplifying things; the reality is that coronavirus risk is complicated, and that can make decisions about traveling (e.g., for work, for vacations, or to visit loved ones) really hard.

As we've talked about in this article, the evidence that people living with HIV are at any greater risk for (or from) COVID-19—especially if they're on HIV treatment and their CD4 count is high—is conflicting. So choosing to travel is more about making the same risk calculations as anybody else would need to make—and that includes reducing the dangers of COVID-19 as much as possible by following this advice:

• Wear a mask at all times on mass transit—buses, trains, airplanes, etc.—as well as in indoor waiting areas.
• If you're in a car along with people who you don't live with—unless you’re all fully vaccinated or they fall into the category of your one other household, such as relatives who live together—wear a mask, try to keep the drive brief, and ventilate the car (i.e., bring in outside air).
• Avoid spending too much time in any indoor area with others, especially if it's relatively small—unless you’re all fully vaccinated or they fall into the category of your one other household, such as relatives who live together.

David Malebranche, M.D., shares what we know so far about the long-term health of people living with HIV after they've recovered from COVID-19.

Takeaway Advice on HIV and the New Coronavirus

We've seen many different types of questions about coronavirus risk, both from people who are living with HIV and people who are not. For most of them, we can go back to the basics for answers: Wear a mask, keep your distance, wash your hands, and and get vaccinated as soon as you have access to a vaccine.

As we saw throughout 2020 and now in 2021, America's approach to COVID-19 testing, prevention, policy, and now vaccination has been messy and inconsistent—and that's left millions of us confused about the best decisions to make to protect ourselves and the people we care about, while still finding ways to live our lives. But there has been a lot of good research and important science done in the past year, and we've learned an awful lot about how the new coronavirus works, how to reduce our risk of getting or transmitting it, and how to dramatically reduce the chances of dying if we're infected. While this has been and can be a frustrating time, scientists are evolving their knowledge every day on how to best prevent and treat this virus. This article is based on that expertise, which includes a lot of simple but important advice:

• Wear a mask. They still work.
• When you've been outside your home or bring new objects into your home, wash your hands thoroughly (20 seconds, with soap).
• Do your best to reduce the amount of time or interactions you have with people you're not living with.
• When you do spend time with others, keep those masks securely on, stay physically distanced, and try to limit time spent indoors (especially in small or poorly ventilated spaces).*
• Keep yourself tuned in to what your town, city, county, and state are doing—as well as how coronavirus infection and hospitalization numbers are trending in your area.
• If you have symptoms or think you were potentially recently exposed to the coronavirus, get youself tested.
• Keep managing your HIV: Stay on your meds, keep your immune system healthy, stay on top of your medical appointments.
• Keep managing your general health, including exercise. (If you’re in an area where gyms are open, or you're exercising somewhere other people have recently exercised, bring hand sanitizer, wash your hands vigorously, and wipe down equipment before and after using it.)

• If you’re fully vaccinated you may gather indoors with other fully vaccinated people or with one other household (so long as they are not at an increased risk for severe illness from COVID-19) without wearing a mask.

We've got vaccines available, and they'll continue to be distributed over the coming months. Stay safe, hang in there until we've got widespread immunity, and let's all be here to meet each other once we finally come out on the other side.