COVID-19, Intensive Care and HIV

 

Prepared by Dr Nicholas Medland (RAG Chair) and members of the RAG’s Clinical Care – HIV and SRH Sub-Groups and the Taskforce Chair.

 

UPDATED ON: 7 May 2020.

Disclaimer: The recommendations provided are the opinions of the authors and are not intended to provide a standard of care, or practice. This document does not reflect a systematic review of the evidence but will be revised to include relevant future systematic review findings. The recommendations are not intended to replace national guidance. 

 

 

Up to 20% of patients with COVID-19 require hospital admission and up to 5% require intensive care and ventilator support. If capacity is overwhelmed, not everyone who requires care is able to receive it.

This information is for clinicians assessing patients who may require hospital admission or intensive care and are either known to be HIV positive or positive on testing in hospital.

1.    People with well-controlled HIV have a normal life expectancy.
2.    Most patients on HIV treatment have undetectable viral load which means that there is zero HIV transmission risk in the health care setting and no special precautions are required.
3.    Most patients on treatment have a CD4 count greater than 200 cells/uL and an undetectable viral load, are not at increased risk of severe COVID-19 
4.    Some patients, particularly those not on HIV treatment and/or with CD4 less than 200 cells/uL may be at risk of atypical tuberculosis which may be difficult to distinguish from COVID-19
5.    Patients with well-controlled HIV do not have worse outcomes from COVID-19 and respond well to intensive care support.
6.    HIV is not a predictor of mortality in patients with acute lung injury
7.    COVID-19 may temporarily suppress CD4 cell count.

1.    HIV status, per se, should not be included as a prognostic indicator when assessing for escalation of care.
2.    Patients with HIV should be admitted for intensive care and/or ventilator support as required.
3.    Additional infection control measures are not required in patients with HIV as universal precautions are used with all patients.
4.    HIV medications can cause drug interactions, some of which can be serious in the intensive care setting.A pharmacist should be consulted. Interactions can be checked at https://www.hiv-druginteractions.org 
5.    Smear-negative and atypical tuberculosis should be excluded in patients with low CD4 cell count with geneXpert sputum test where possible.
6.    All patients with HIV and COVID-19 should continue taking ART if possible. 
7.    Bactrim prophylaxis should be commenced in all patients who experience a significant CD4 count decline due to COVID-19 infection