The top health concern around the world right now is COVID-19, the disease caused by a new strain of coronavirus known as SARS-CoV-2. And while there’s a lot of general information out there, very little of it is geared toward people who might be immunosuppressed, including people living with HIV.
To help those who might be seeking information and are rightfully skeptical of random Google search results, TheBody asked David Malebranche, M.D., an internal medicine physician and HIV sexual health expert, to speak to concerns and questions many people reading this might have. His video below sums up his advice as of early March.
Below the video, we'll cover the basics and additional questions we see within the community—and we'll keep updating this page throughout the outbreak. If you have a question about HIV and the new coronavirus that we haven't answered yet in this article, please let us know.
Are people living with HIV at greater risk for getting the new coronavirus?
Scientists aren't certain yet. But if you're on HIV treatment and have a relatively good CD4 count, then your immune system is in a good place to prevent infection.
If a person with HIV has the coronavirus, are they more likely to get very sick or die?
We don't have research on this yet. But as long as your immune system is healthy -- i.e., you're taking HIV medications and your CD4 count is not low -- that will help fight off infection.
Does a person's CD4 (T-cell) count affect their coronavirus risk?
There's no research on this yet. But a "normal" CD4 count -- which, depending on the person, can be anywhere from 450 to 1,100 -- can protect a person from many illnesses.
How can people with HIV protect themselves from the coronavirus?
Stay on HIV medications, and try to stay physically active and eat nutritionally. Beyond that: wash your hands, avoid travel, practice social distancing, rest, and avoid stress.
How should a person with HIV prepare for possible coronavirus infection?
Try to obtain at least a 30-day supply of HIV meds (90, if you can). Tell people close to you what medications you're on. Talk with your care provider about what to do if you get sick.
Can HIV meds prevent or treat coronavirus infection?
There is zero reliable research to date supporting the effectiveness of any HIV medications in preventing or treating COVID-19.
What should a person with HIV do if they have the coronavirus?
Keep taking your HIV meds. Stay home -- if you need to leave for medical care, call ahead. If you live with someone else, don't share any personal items. Clean surfaces frequently. Consider wearing a mask.
HIV and Coronavirus Basics
What Is the New Coronavirus?
COVID-19 is the name scientists have given for 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 more severe and more contagious than the flu, from what we understand so far.
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 who’s coughing, it can be spread from some of the aerosolized droplets that come out of their mouth.
What remains unclear is whether the virus can live long on surfaces and countertops. However, if you are in an area where many people are touching several of the surfaces (like an office), you might want to keep virus prevention at the forefront. If you touch something and then wipe your nose, your mouth, or your eyes, you could get the coronavirus that way.
Can the New Coronavirus Be Spread Through Anal Sex?
Researchers recently discovered that the novel coronavirus COVID-19 can be shed through a person’s fecal matter. This has led some to wonder whether that might mean that the virus could be transmitted via anal sex or other sex practices, like rimming or fisting.
We can’t say for certain yet exactly how this coronavirus is transmitted. We do know that if the virus is shed through fecal matter, there is the potential for it to be transmitted during anal sex. But we can't quantify the risk at this point.
So just be careful. If you’ve been in a situation with someone who has recently been traveling, if they’re sick with COVID-19 and you’re worried, the best practice would be to avoid anal sex practices—whether that be toys, rimming, or anal sex itself—until we know more information.
HIV and Coronavirus Prevention
How Can You Prevent Coronavirus Infection as a Person Living With HIV?
Wash your hands.
Avoid travel and public gatherings.
Rest and avoid stress.
Take your HIV meds.
Don't obsess over face masks.
If you’re looking for your best weapon against the virus, the first one is the tried-and-true method of washing hands. When washing your hands, use soap and water for 15 to 20 seconds—or, if soap isn't available, a hand sanitizer that is at least 60% alcohol.
Other strategies include avoiding crowds, public places, and nonessential travel.
Also important: giving 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 (a.k.a. CD4 count) is, the more your HIV is suppressed, 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.
What about face masks? Unfortunately, we don’t really know if they prevent you from contracting the coronavirus. Especially those flimsy masks that they’re selling in various places on the internet or in pharmacies nowadays.
But if someone is sick with a fever and coughing and short of breath, using a mask will help prevent them from passing it to someone else.
On March 20, David Malebranche, M.D., answered several questions we received in the prior week about HIV and the new coronavirus. His answers have also been added into this article.
Can My HIV Meds Protect Me From COVID-19?
To be honest, we really don’t know right now.
There are some early reports that researchers are attempting to use Kaletra, a combination of lopinavir and ritonavir, to fight the virus. This combination was once helpful in fighting severe acute respiratory syndrome, or SARS, a respiratory virus just like COVID-19.
However, a recent study of Kaletra in a group of 199 people who had moderate to severe illness with COVID-19 found that the drug combo was not particularly good at fighting the new coronavirus.
There had also been some thought that Prezista (darunavir), a commonly used HIV medication, may have some effect on the new virus. But the maker of that drug recently put out a statement saying there's no sign that works against COVID-19.
So right now, no HIV med that we know has any effect against 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.
If your viral load is undetectable, you can still be susceptible to the flu and COVID-19, so practice physical distancing and washing your hands.
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
eating the right food
There’s no proven science behind alternative or herbal therapies—and they may, in fact, interact with your prescription medications. So please speak with your doctor before adding a supplement or non-medical therapy to your regimen.
Also, please take care of your mental health. A lot of people may begin to feel isolated, depressed, or anxious during this time of social distancing. 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 ask your personal health care provider. You can also check the Centers for Disease Control and Prevention’s designated coronavirus website. Current tests detect for the virus itself, rather than whether you’ve just been exposed. They are relatively accurate, but reports indicate they may have as much as a 10% false-negative rate.
We know that some people in the U.S. might not trust their governmental institutions at this juncture. But if you are looking for information, the Centers for Disease Control and Prevention (CDC) is actually giving the most accurate, up-to-date information that we have.
HIV Care and Staying Healthy in the Coronavirus Era
How Can I Work With My HIV Care Provider to Prepare for 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.
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.
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, first call your primary care provider or a health care facility to get tested. There are also several steps you can take to stop the spread of the novel coronavirus, whether you're waiting for test results or have tested positive:
Call ahead before seeing the doctor.
Avoid all risk of contact with others.
Consider a face mask.
If you are going into any medical facility, either to get tested or just to see a doctor, it’s a good practice to 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. 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.
Though face masks are not super beneficial as a preventative tool, they do have benefits if you are already sick, so look into wearing one to stop the spread of respiratory droplets. If a face mask is not available, make sure to cover your coughs and sneezes with your elbow, as described above. And, of course, wash your hands.
Other ways to minimize spread include not sharing personal household items and cleaning all “high touch” surfaces frequently. That means having your own:
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:
You have not had a fever for 72 hours.
Your other symptoms have improved.
More than 7 days have passed since your first symptoms.
Can People Living With HIV Safely Travel During the Coronavirus Pandemic?
Well, let’s just put it this way: Nobody should be traveling, whether they have a chronic illness or not. So, best keep your all your activities hyperlocal—like, inside your own home—for now.
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 all of them, we can go back to the basics for answers: Wash your hands, wash your hands, wash your hands.
When you cough, put the crease of your elbow against your mouth—and if you see someone coughing in a public space, ask them to do it, too. Don't cough over your hands, because your hands end up touching things. That’s general practice—that’s not just for avoiding COVID-19.
In addition, keeping a cool head is the best option. Don’t panic. Don’t freak out on all the things that are being portrayed in the media right now.
Manage your HIV: Stay on your meds, keep your immune system healthy, keep working out.
Keep exercising. If your gym is still 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.
Coronavirus shedding in feces: “Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient,” JAMA. March 4, 2020. jamanetwork.com/journals/jama/fullarticle/2762692
Kaletra as SARS treatment: "Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings," Thorax. Feb. 25, 2004. thorax.bmj.com/content/59/3/252