HIV and COVID-19

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HIV and COVID-19 scared me a lot, when together, with my medical history, smoking and two pulmonary embolisms, what I've had most since the end of 2019 is fear! That's why I'm posting here more information about…

…HIV and COVID-19! 

I told my wife, Mara, and I also told a long-time friend who “found me” online, that the combination of HIV and COVID-19 is and will, almost certainly, be a game changer! The world and all its ills, without the Coronavirus and the world after the coronavirus, which it will generate, is generating 15 million new jobs today, April 1, 2020 and it's no joke about April XNUMXst!

A virus that will hopefully bring an awareness of the need for support and respect, may be the arrival of the long awaited return!!!!

Perhaps it will be, the world of society where good labor relations! From love to others. Value other people's lives.

Well, I overdid myself, I ended up going on tour! The fact is that, for these or those reasons, we have to painfully fight, face and win, the capitalized Corona Virus and, in the same way, HIV!

Still digressing, I have access to a video that I intend to incorporate into this text, at the end of it, as it is well established that we are going through, with statements from the UN and WHO, the worst moment of ours after the Second World War, which only ended , once and for all with the detonation of two Hydrogen bombs and, one of them, devastated and calcined a city and 250.00 inhabitants instantly, in a fraction of a second!

Digressions done, let's get to the text:

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People with COVID-19 and HIV in Brazil and HIV

This interim guidance reviews special considerations for people with HIV and their healthcare providers in the United States regarding COVID-19. Information and data about COVID-19 is evolving rapidly. This guidance includes general information to consider. Clinicians should consult up-to-date sources for more specific recommendations regarding COVID-19.

Guidance in reference to COVID-19 for people with HIV in Brazil

In current reports, individuals aged > 60 years and with diabetes, hypertension, cardiovascular disease or lung disease are at increased risk of death, with causes related to COVID-19 caused by SARS-CoV-2.

• Data limited to currently available do not indicate that the course of COVID-19 disease in people with HIV differs from that in people without HIV.
• Before the advent of effective combination antiretroviral therapy (ART), advanced HIV infection (i.e., CD4 cell count <200/mm3) was a risk factor for complications from other respiratory infections.
• It is not yet known whether this is also true for COVID-19.
• Some people with HIV have other co-morbidities such as, for example, cardiovascular disease or lung disease that increase the risk of a more severe course of COVID-19 disease.
• Chronic smokers are also at risk for a more serious course.
• So, until more is known, Yes, additional care is needed for all people with HIV, especially those with advanced HIV or poorly controlled HIV.
• Every effort should be made to help people with HIV maintain an adequate supply of ART and all other concomitant medications.
• As flu and pneumococcal vaccines must be kept up to date.
• People with HIV must follow all applicable recommendations to prevent the spread of COVID-19 and they are the same:

The Text Continues after this reading tip. Right-click the title and click open in another tab. It's something else to read, which is relevant to this reading.

Thank you for coming here. You, coming to the blog, reading it, looking for me or Beto Volpe.

People! You are the ones who keep me here, despite everything and everyone!!! Even my aunt, such a wise, cultured woman, who literally traveled the world!!!!

God, what a great responsibility you gave me!

A Little More about COVID-19 in Brazil and people with HIV

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Antiretroviral therapy

People with HIV should:

Eu I will say something more about this duty later.

• Keep at least a 30-day supply on hand – and ideally a 90 day supply – of antiretroviral (ARV) medicines and other medicines.
• Talk to your pharmacists and/or healthcare providers about changing mail delivery when possible. I know it may seem like an episode from beyond imagination, but it doesn't hurt to try or at least ask one of these pharmacy professionals to prepare your medication withdrawal while you are in the “open air”.
• People for whom a regime switch is planned should consider delaying the switch until close monitoring and monitoring is possible..
• Lopinavir/ritonavir (LPV/r) has been used as an off-label treatment for patients with COVID-19 and clinical trials are ongoing around the world. They were and have failed painfully. I have things to be translated. But I'm running against time! 
• If protease inhibitors (PIs) are not already part of a person's ARV regimen, their regimen should not be amended to include a PI to (purportedly) prevent or treat COVID-19, except in the context of a clinical trial and in consultation with an HIV specialist. 
• In a small open-label study, 199 patients hospitalized with COVID-19 were randomized to 14 days of LPV/r plus standard of care or standard of care alone. There was no difference statistically significant between the two groups in relation to time to clinical improvement or mortality.1

In Clinical or Laboratory Monitoring visits Related to HIV Care:

• Together with their healthcare professionals, people with HIV and their care providers -opens in another tab, healthcare professionals should weigh the risks and benefits of attending, or not attending, HIV-related clinical appointments in person at this time. Factors to consider include the extent of local transmission of COVID-19, the health needs that will be addressed during the visit, and the status at that time of the person's clinical HIV disease status, such as CD4 cell count. , HIV viral load as well as general health status.
• Telephone or virtual visits for routine or non-urgent care and adherence counseling can replace in-person meetings.
• For people with a suppressed HIV viral load and in stable health, routine medical and laboratory visits should be postponed as much as possible.

People with HIV and in opioid treatment programs such as methadone

• Clinicians caring for people with HIV enrolled in opioid treatment programs, typically pain clinics, should consult with these facilities initially by telephone or videoconferencing for up-to-date guidance on how to avoid (painful) interruptions in treatment. Monitoring methadone use can, and should, also provide additional guidance. 

Guidance for specific populations

Pregnant women with HIV:

• Currently, there is information regarding to COVID-19 and pregnancy and care for mothers who contracted COVID-19!.
• Immunological and physiological changes during pregnancy often increase a pregnant person's susceptibility to viral respiratory infections, possibly including COVID-19. As previously observed in other Coronavirus infections, but it implies informing that the risk of serious illness, morbidity or mortality with COVID-19 may be higher among pregnant women than in the general population.2
• Although limited, Currently available data do not indicate that pregnant women are more susceptible to COVID-19 infection or that pregnant women with COVID-19 have more severe illness.6,7 Adverse pregnancy outcomes, such as fetal distress and preterm birth, have been observed in a small series of pregnant women with COVID-19 infection and have been reported with COVID-XNUMX infections. SARS and MERS during pregnancy.3-5 
• Findings from a small group of pregnant women with COVID-19 found no evidence of vertical transmission of COVID-19, although at least one case of neonatal COVID-19 has been described.7-9

Children with HIV:

• Based on the available and very limited data, children seem less likely to become seriously ill from COVID-19 infection than older adults.10-12 
• However, there may be subpopulations of children at increased risk of more severe illness from COVID-19; in studies of coronavirus and non-COVID-19 infection in children, Younger age, underlying lung pathology, and immunocompromised conditions have been associated with more severe outcomes.13 (Do you understand Pedro Bó?)
• Babies and children with HIV should be up to date on all immunizations, including influenza and pneumococcal vaccines. 

Guidance for people with HIV self-isolating or quarantining due to exposure to healthcare workers on SARS-CoV-2

The professionals of health should:

• Ensure patients have adequate supplies of all medications and expedite medication refills as needed.
• Create a plan to evaluate patients if they develop symptoms related to COVID-19, including for possible transfer to a healthcare facility for care related to COVID-19 if necessary.

Perhaps you, recently diagnosed, will be surprised, but, within this pandemic, we also have duties.

The duty to take care of safety and minimize impacts in the transmission chain until the level zero, if level zero can be obtained.

We have to think about other people within clinics and other treatment centers, such as CRT-A and Casa da AIDS, for example, and “Lá em Casa”, a pioneering and excellent service when it comes to improving health. physical condition of people living with HIV.

But look: You should try to think like this: Each host (that's what we become) is, for a given virus, a kind of test tube. There, it replicates itself, encounters problems, or not, but if it encounters problems and sooner or later, you can bet on it, it will encounter difficulties! Do you know what he will try to do? Adapt, change (mutation). Maybe he can. Maybe not, I don't know. But I know that if it changes, and it could change a lot, it could become something even more dangerous! Our duty is to prevent the viral entity that is within you from finding, in another host, the opportunity that it, perhaps and fortunately, did not find in another host.

Sense 8 or Godless at home during the COVID-9 Pandemic?

And what's worse. You will only realize this hours and hours, even days after your final episode of Sense 8 cannot be seen by you, definitively.

Cable TV stations posted, in a red banner with a very large font, that the UN declared that this pandemic could reach apocalyptic proportions. I remember photographing this thing, but I'm not sure if it was on the crashed cell phone or the one I was forced to buy. If I find the image, I'll try to find it and see if I can publish it without being crucified by the TV station. So we arrived at this point:

People with HIV should:

• Contact your doctor to let them know that are self-isolating or in quarantine.
• Specifically, tell your doctor how many ART medications and other essential medications they have on hand.

Guidance for people with HIV who have a fever or respiratory symptoms and who seek assistance and assessment 

The professionals of health should:

• Follow the guidelines of the Ministry of Health and the governors of your state. And from our President-elect, Jair Messias Bolsonaro, when he is being sensible!, as well as the guidance from health departments on infection control, screening, diagnosis and management.

People with HIV should:

• Follow those of the Ministry of Health. In a perfect world, it should be like this and, for now, we are well covered by the Minister of Health Luiz Henrique Mandetta, an island of sobriety in the middle of a turbulent ocean!
• If the Minister is replaced, I'll come back here!
• If they develop a fever and symptoms (e.g., cough, difficulty breathing), they should call their doctor for medical advice.
• Call the clinic in advance, before showing up, to the care providers.
• Use respiratory and hand hygiene and cough etiquette when presenting at the healthcare facility and request a face mask upon arrival.

If you need to attend a clinic or emergency department without calling in advance, you should alert registration staff immediately upon arrival of symptoms so that steps can be taken to prevent transmission of COVID-19 in the hospital. healthcare environment. Specific actions include putting a mask on the patient and quickly placing them in a room or other space separated from other people.

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Guidelines for managing people with HIV who develop COVID-19 disease

When hospitalization is not necessary, a person with HIV should:

• Manage symptoms at home with supportive care for symptomatic relief.
• Maintain close communication with your doctor and report if symptoms progress (e.g., prolonged fever for >2 days, new shortness of breath).
• Continue ART therapy and other medications as prescribed.

When a person with HIV is hospitalized:

• ART must and must continue. If antiretroviral medications are not on the hospital formulary, administer medications from patients' home supplies. My personal experience recommends that if you are conscious, clear-headed and can control your medication, do so. Hospital nurses in general are unable to understand that there is a reason for prescriptions to be made in one way, as they insist on doing it in “their way”.”.ARV drug substitutions should be avoided. If necessary, doctors can consult recommendations on ARV medications that can be switched by contacting the outpatient clinics where patients with HIV+COVID-19 receive care.
• For patients receiving ibalizumab (IBA) intravenous infusion (IV) every 2 weeks as part of their ARV regimen, doctors must arrange with the hospital doctor so that the patient can continue taking this medication without interruption.
• For seriously ill patients who require tube feedings, some ARV medications are available in liquid formulations. and some, but not all, tablets can be crushed. Clinicians should consult with a specialist, an infectious disease specialist with expertise in HIV, and/or a pharmacist to evaluate the best way for a patient with a feeding tube to continue an effective ARV regimen. Information may be available on the medication label or in this document from the Toronto General Hospital Immunodeficiency Clinic.

When receiving investigational (research) or unlabeled treatment for COVID-19:

• Currently, there is no approved treatment for COVID-19. Several investigational and marketed drugs are being evaluated in clinical trials to treat COVID-19 or may also be available via compassionate use or off-label use.

What is an off-label material or medicine? Can a joint be made for medication or material classified as off-label? (art. 3 of RN 424/2017)

A so-called off-label medication is one whose indication from the treating professional differs from what appears on the leaflet. Off-label material is material whose indication of assistant professional differs from what appears in the material's usage manual. There is no medical or dental committee, as medicine and material whose clinical indication is different from that of the registration carried out by Anvisa are not covered by operators.. See more here, in another tab!

• For patients receiving treatment for COVID-19, clinicians should evaluate the potential for drug interactions between treatment with COVID-19 and ART of the patient and other medications. Information about possible drug interactions can be found in product labels, drug interaction resources, clinical trial protocols, or investigator brochures.

When available, doctors may consider enrolling patients in a clinical trial that evaluates the safety and effectiveness of experimental treatment for COVID-19 contamination. People with HIV should not be excluded from these studies.

Additional guidance for HIV clinicians

• During the COVID-19 outbreak, doctors should ask healthcare professionals to waive medication quantity restrictions. Whenever possible, Health Centers should provide patients with a supply of at least 90 days.
• People with HIV may need additional assistance with food, housing, transportation, and child care during times of crisis and economic fragility. To improve care engagement and ART continuity, clinicians should make every effort to assess their patients' need for additional social assistance and connect them to resources, including navigation services whenever possible.
• During this crisis, social distancing and isolation can exacerbate mental health and substance use issues for some people with HIV.
• Physicians should assess and address these patient concerns and arrange additional consultations, preferably virtual, as appropriate and/or necessary.
• Disk AIDS in 0800 16 2550 it's working.

More information about ART management in adult, pregnant, and pediatric patients, as well as recommendations for prophylaxis and treatment of specific opportunistic infections, can be found in the HIV/AIDS medical practice guidelines.

ANVISA provides information about COVID-19 for people with HIV.

This interim guidance was prepared by the following working groups of the Office of AIDS Research Advisory Council:

• HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
• HHS Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV
• HHS Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission
• HHS Panel on Guidelines for Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV
• HHS Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children

I have already finished this text.

If you have found any typos, spelling errors or even a grotesque error in Portuguese, send an email to seropositivewebsite@gmail.com and I will fix it as quickly as possible.

Thank you

Last updated: March 20, 2020; Last: March 20, 2020

Translated by Cláudio Souza from the original in Interim Guidance for COVID-19 and Persons with 

Definitive review pending

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This document is constantly being updated at the source and I advise you to sign up to follow the blog!

This interim guidance was prepared by the following working groups of the Office of AIDS Research Advisory Council:

• HHS Panel on Antiretroviral Guidelines for Adults and Adolescents
• HHS Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV
• HHS Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission
• HHS Panel on Guidelines for Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV
• HHS Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children

Last updated: March 20, 2020; Last: March 20, 2020

 

References

1. Cao B, Wang Y, Wen D, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19. N Engl J Med. 2020. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32187464.
2. Society for Maternal-Fetal Medicine, Dotters-Katz S, Hughes BL. Coronavirus (COVID-19) and Pregnancy: What Maternal-Fetal Medicine Subspecialists Need to Know. 2020. Available at: https://s3.amazonaws.com/cdn.smfm.org/media/2267/COVID19-_updated_3-17-20_PDF.pdf.
3. Siston AM, Rasmussen SA, Honein MA, et al. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA. 2010;303(15):1517-1525. Available at: https://www.ncbi.nlm.nih.gov/pubmed/20407061.
4. Alfaraj SH, Al-Tawfiq JA, Memish ZA. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection during pregnancy: Report of two cases & review of the literature. J Microbiol Immunol Infect. 2019;52(3):501-503. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29907538.
5. Wong SF, Chow KM, Leung TN, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004;191(1):292-297. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15295381.
6. Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect. 2020. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32145216.
7. Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809-815. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32151335.
8. Li Y, Zhao R, Zheng S, et al. Lack of vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China. Emerg Infect Dis. 2020;26(6). Available at: https://www.ncbi.nlm.nih.gov/pubmed/32134381.
9. Wang S, Guo L, Chen L, et al. A case report of neonatal COVID-19 infection in China. Clin Infect Dis. 2020. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32161941.
10. Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2,143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020. Available at: https://pediatrics.aappublications.org/content/pediatrics/early/2020/03/16/peds.2020-0702.full.pdf.
11. Cruz AZ, S. COVID-19 in children: initial characterization of pediatric disease. Pediatrics. 2020. Available at: https://pediatrics.aappublications.org/content/pediatrics/early/2020/03/16/peds.2020-0834.full.pdf.
12. Shen K, Yang Y, Wang T, et al. Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts' consensus statement. World J Pediatr. 2020. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32034659.
13. Ogimi C, Englund JA, Bradford MC, Qin X, Boeckh M, Waghmare A. Characteristics and outcomes of coronavirus infection in children: The role of viral factors and an immunocompromised state. J Pediatric Infect Dis Soc. 2019;8(1):21-28. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29447395.

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