Managing Your Health During the COVID-19 Pandemic: Information for people living with HIV

Last updated March 10, 2022
 

What is COVID-19?

COVID-19 is a disease caused by the virus SARS-CoV-2. The virus can affect people differently.

Common symptoms of COVID-19 are:

• fever
• dry cough
• tiredness
• sore throat

Less common symptoms include:

• aches and pains
• diarrhea
• headache
• loss of taste or smell

Some people who get COVID-19 never develop symptoms, but they can still transmit the virus to others.

Most people will experience mild-to-moderate illness and will recover on their own. However, some people will go on to develop severe illness. Severe illness may require hospitalization and intensive care. A small proportion of people who develop severe illness may die from COVID-19 infection.

While anyone can experience severe illness from COVID-19, certain risk factors significantly increase the chance that a person will have severe illness, These risk factors are discussed below in the context of HIV.

What are the risk factors for serious illness for people living with HIV?

For people living with HIV, there are three main risk factors that can increase the risk of serious illness from COVID-19: a weakened immune system, underlying health conditions and older age.

Weakened immune system

A person with HIV who is on HIV treatment with an undetectable viral load and a strong immune system (CD4 count above 200) is not expected to be at higher risk of severe illness from COVID-19. However, a person who is not on HIV treatment and/or has a low CD4 count may be at increased risk of severe illness from COVID-19.

Underlying health conditions

Some people living with HIV may have other underlying health conditions that are known to increase the risk of serious illness from COVID-19. These health conditions include:

• cancer
• dementia
• diabetes
• heart disease
• high blood pressure
• kidney disease
• liver disease
• lung disease
• obesity

Older age

The risk of serious illness from COVID-19 increases for everyone with age (regardless of HIV status). 

Our understanding of underlying risk factors is evolving. For the most current list of risk factors, visit: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/people-high-risk-for-severe-illness-covid-19.html

How is COVID-19 transmitted?

SARS-CoV-2 is the virus that causes COVID-19. The virus is transmitted by people who have active viral infection. The risk of onward transmission is highest during the first 1-2 weeks after becoming infected, when there is a large amount of virus present in the airways. During this time, the virus can be transmitted even when there are no symptoms of COVID-19. People who have had a previous COVID-19 infection or who have been vaccinated can still contract the virus and transmit it to others. 

SARS-CoV-2 is transmitted primarily through small droplets (including aerosols) from the mouth, throat and nose of a person who is infected with the virus. Transmission occurs mainly through contact with the droplets, either directly or indirectly, from a person who has the virus. It can also be transmitted through contact with contaminated objects or surfaces.

Direct transmission through interacting with people

The virus is transmitted through small droplets from the mouth, throat and nose of people when they breathe, talk, sing, laugh, cough or sneeze. When an individual is near someone who has the virus, these droplets containing the virus can enter their body through viral receptors in their eyes, nose or mouth. The virus cannot enter the body through skin. The closer and more prolonged the interaction, the greater the chance of transmission. 

Indirect transmission through aerosols   

Very small droplets of the virus (aerosols) may remain suspended in the air for longer periods of time, similar to the way cigarette smoke can linger in the air. There is an increased risk of transmission when aerosols containing the virus accumulate over time, particularly in indoor spaces with poor ventilation. Aerosols have been shown to transmit across distances longer than 2 metres.

Contact with surfaces

Although the majority of transmissions happen through small droplets in the air, it is also possible for transmission to happen through contact with objects and surfaces containing the virus. Objects and surfaces can become contaminated when someone with the virus has coughed or sneezed on them. Transmission may happen if someone touches a contaminated surface or object and then touches their eyes, nose or mouth without washing their hands first.

How can transmission of the virus be prevented?

The best way to avoid getting sick with COVID-19 is to avoid exposure to the virus. Try to avoid close contact with anyone who may have been exposed to the virus or has symptoms of COVID-19, such as a sore throat, fever or cough.

Existing prevention methods only provide partial protection from transmission of the virus. The following methods should be combined to help prevent transmission:

• MASKS
  Wear a well-fitting new or clean face mask when you are in public and you may interact with others. Different types of masks are available that have different levels of effectiveness for preventing transmission. Respirators (such as N95 masks) are the most effective, followed by surgical masks, and then non-medical masks (such as cloth masks). Try to choose the best-fitting and best-quality mask that is available to you.
• You should also wear a new or clean face mask when you are in an indoor space with people not in your household or social circle. Some jurisdictions have made it mandatory to wear face masks or coverings in public areas, while others have withdrawn mask mandates. For more information on masks, visit: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks/about-non-medical-masks-face-coverings.html
• VACCINATION
  Get vaccinated for COVID-19, including booster doses as they become available. Vaccination greatly reduces the risk of severe illness, hospitalization and death from COVID-19. Vaccination may also help to prevent transmission of the virus. Since the risk of transmission is not entirely eliminated through vaccination, people who have been vaccinated should still follow other prevention methods mentioned here.
• VENTILATION AND AIR FILTRATION IN INDOOR SPACES
  Good ventilation can help to prevent transmission through aerosols in indoor spaces. Good ventilation ensures that aerosols that may contain the virus are continuously filtered out of the room. This in turn reduces the accumulation of virus in the air and lowers the risk of transmission. Methods of ventilation include improving airflow by opening windows and doors, as well as using good air filtration systems, such as those that use HEPA filters.
• SOCIAL DISTANCING AND LIMITING SOCIAL GATHERINGS
  Social circles, sometimes called “bubbles,” are limited groups of people that you have close physical contact with, including members of your household and those outside your home. Some jurisdictions mandate the size of social circles for gathering depending on the prevalence of COVID-19. Avoid or reduce your time in indoor spaces with people outside of your household or social circle and avoid crowded outdoor spaces. Maintain a distance of at least two metres from people outside your household or social circle to help prevent transmission of the virus. Note that very small aerosols can travel farther than two metres, so social distancing is not a substitute for masking; rather, these prevention tools should be combined.  
• GENERAL HYGIENE
  Hand washing remains a part of general public health messaging. Wash your hands frequently with soap and water or use hand sanitizer, and avoid touching your face with unwashed hands. Hand washing is a useful way to prevent the transmission of various pathogens, however, it is not effective on its own as a prevention measure for COVID-19.

Community transmission of COVID-19 will vary with time and between regions as the number of active cases rises and falls. When community transmission is very high, additional prevention measures may be recommended. Consult local public health authorities for the latest guidance on how to prevent transmission of the virus that causes COVID-19.

Should I get vaccinated against COVID-19 if I have HIV?

It is important to consider getting vaccinated against COVID-19 if you have HIV. Many people with HIV have or are at an increased risk for developing the underlying conditions that increase their chances of developing COVID-19 or severe disease if they become infected with the virus that causes COVID-19. 

COVID-19 vaccines are safe and effective for people with HIV.

Current guidelines recommend that people living with advanced HIV who have a compromised immune system receive a third dose (booster) as part of the primary series of vaccination. This is because for individuals with advanced HIV, two doses of the vaccine may be insufficient in eliciting a robust immune response to COVID-19. If you are not on HIV treatment and have a very low CD4 count, discuss a third dose with your healthcare provider. Some experts additionally recommend starting HIV treatment to prevent HIV-related complications and to potentially improve vaccine effectiveness.

For more information on COVID-19 vaccines, see Frequently asked questions about vaccines for the prevention of COVID-19.

What else can I do to protect my health during the COVID-19 pandemic?

It is important for people living with HIV to stay engaged in healthcare to remain healthy and minimize their risk of serious illness from COVID-19.

Early HIV diagnosis and ongoing treatment are important for everyone living with HIV to improve and maintain their health. People with untreated HIV may experience additional complications with COVID-19. If you are not already on HIV treatment, consider starting treatment as soon as possible. If you are on treatment, ongoing adherence is also important. This means taking your medications regularly as prescribed without missing doses. If you are having trouble sticking to your treatment schedule, be sure to discuss this with your healthcare provider so that together you can find solutions.

It’s important to stay engaged with your HIV care team and manage any related health conditions, as these may increase the risk for serious illness from COVID-19. The list of health conditions that increase the risk of more severe illness with COVID-19 may change as we learn more about the disease.

It’s also important to stay up to date on vaccinations, including the annual influenza vaccine, as these can help prevent complications if you become ill with COVID-19.

There are many other ways to look after your physical and mental health during the pandemic. Make sure to try to get fresh air and regular exercise outside your home if you are able to do so. It can also be helpful to establish a routine. It’s important to regularly connect with others, especially if you live alone; try using video or phone calls to stay in touch with friends or family. If you find yourself feeling depressed or anxious, talk to your healthcare provider.

Consider preparing for the possibility that you may be asked to self-isolate because you have been in contact with someone with COVID-19 or because you yourself have become infected with COVID-19. Guidelines for isolation and quarantining are changing as we learn more about the illness. Discuss with your network of family, friends and support workers how you can get food, medications and/or other support during self-isolation.

Will COVID-19 affect my HIV care?

Because of physical distancing measures during the COVID-19 pandemic, there may be some changes to your HIV care. Your regular monitoring appointments with your healthcare provider or lab tests may be less frequent. Video and phone calls may replace face-to-face appointments with your healthcare team. You may notice some healthcare workers wearing glasses, goggles or face shields—they do this to reduce the risk of droplets entering their eyes. Despite these changes, it is very important to stay engaged in HIV care.

There may be some changes to the way your medications are dispensed. It is recommended that people with HIV be given enough medication to last three months or more to avoid unnecessary trips to the pharmacy. Discuss your options with your healthcare provider and your pharmacist to make sure you always have enough medication on hand.

How is COVID-19 treated?

There are treatments available for people with COVID-19. This is an area of ongoing research. If you require medication assistance as a result of COVID-19, you can discuss treatment options with your doctor

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

Each province and territory has a COVID-19 helpline or website that provides information on what to do if you think you have COVID-19.

If you suspect you have been exposed to COVID-19, you should isolate yourself and follow recommendations from your province or territory. If you are diagnosed with COVID-19, you may be contacted by a public health worker who will ask for details about anyone you may have come into contact with. These people should also be tested for COVID-19 and self-isolate until they receive the results.

If you have COVID-19, follow the advice of your local public health authorities regarding how long you should self-isolate. Remember to drink plenty of fluids and rest well. If you have a fever, take painkillers to help bring it down.

Seek immediate medical attention if your symptoms become severe, such as if you have shortness of breath, chest pain or a persistent high fever.

Research has found that during the COVID-19 pandemic, some people are not seeking medical care to address health problems other than COVID-19. To stay on top of these issues during the pandemic, it is important to remain engaged in your healthcare and to discuss all of your symptoms with your healthcare provider.

The information on this page is based on available research related to the transmission and prevention of COVID-19. This resource will be updated as new evidence emerges. Last updated March 2022.

Resources

Navigating the sixth wave of COVID-19 as a person living with HIV - CATIE Blog