Coronavirus — Its Impact on HIV and the LGBTQ Community

Is the LGBTQ Community at Increased Risk?

Over 100 national and local LGBTQ organizations signed an open letter addressed to health professionals and media outlets, outlining how COVID-19 may pose an increased risk to the LGBTQ population. The letter offers protocols "to ensure no population is further stigmatized by a virus."

A coalition of six organizations spearheaded the letter: the National LGBT Cancer Network; GLMA Health Professionals Advancing LGBTQ Equality; Whitman-Walker Health; SAGE; New York Transgender Advocacy Group; and National Queer Asian Pacific Islander Alliance.

"As the media and health communities are pushed into overdrive about COVID-19, we need to make sure the most vulnerable among us are not forgotten. Our smoking rates alone make us extremely vulnerable, and our access to care barriers only makes a bad situation worse," noted Dr. Scout, the Deputy Director for the National LGBT Cancer Network in the press release.

"As an organization dedicated to the health and well-being of LGBTQ communities, we urge LGBTQ individuals to practice measures recommended by public health experts, such as frequent handwashing, to prevent the spread of this virus," said GLMA President Scott Nass, MD, MPA. "We call on public health officials to ensure the LGBTQ community is considered and included in the public health response to COVID-19 based on potential risk factors that exist in our community."

What About the HIV+ Population?

Are there unique concerns regarding LGBTQ and specifically the HIV+ community? Are they really "more likely to catch and suffer from coronavirus than the rest of the population."

The CDC states that "older adults" are at "higher risk" of becoming gravely ill from COVID-19. Combined with higher smoking rates and lower access to health care within the LGBTQ community, its impact could be unprecedented.

According to the Williams Institute, 23 percent of the U.S. LGBTQ population is over the age of 50. And according to the CDC, nearly half of the population in the U.S. living with HIV/AIDS are over the age of 50.

People with compromised immunity are at higher risk of contracting coronavirus and developing severe COVID-19 symptoms. Those with low CD4 T-cell counts or advanced immune fall int this category.

"When you look at who's been most profoundly ill, it tends to be older people, in their 60s, 70s and 80s. As you get older, your immune system doesn't function as well," Steve Pergam, MD, MPH, of the Vaccine and Infectious Disease Division at Fred Hutchinson Cancer Research Center, told POZ magazine.

"For an HIV patient who is on stable antiretroviral therapy and has a normal CD4 count, their risk may be slightly increased. People often lump HIV patients with other immunosuppressed patients, but HIV is a different disease than it was years ago. For people who have a reconstituted immune system because of treatment, I think the risk is not going to be tremendously different," said Dr. Pergam.

Anyone with HIV who is not virally suppressed, or has a low CD4 count, should consider HIV to be a "significant comorbidity" and should avoid public transport, Professor Sheena McCormack, a global expert in HIV and epidemiology, told BuzzFeed News UK

"Cancel any plans to travel," Dr. McCormack advised, including flying, and regions with high numbers of coronavirus infections. Older HIV patients, she warned, are more likely not to be virally suppressed and more likely to have a low CD4 count. According to Dr. McCormack, there would be an "increasing level of concern as the CD4 falls below 350."

A majority of people with coronavirus have mild symptoms including fever, cough and shortness of breath. Around 20 percent develop severe respiratory illness, including pneumonia, which may require intensive care and mechanical ventilation.

Medical experts have not yet ascertained if the virus lurks in the body, causing relapse, whether the patient is immune after the illness or able to become infected again.

HIV Drugs Are Being Used For Coronavirus

Bloomberg reported that China is using AbbVie Inc's HIV drugs as an ad-hoc treatment for pneumonia brought on in some coronavirus victims.

China's National Health Commission in Beijing said that a combination of lopinavir and ritonavir (brand name Kaletra), is part of its latest treatment plan for patients infected by the virus.

Medical journal Lancet reported that a clinical trial is underway using ritonavir and lopinavir to treat cases of coronavirus as a vaccine is months, if not years, away.

A respiratory expert at Peking University First Hospital in Beijing who was infected by the virus after visiting patients in Wuhan told China News Week that his doctor recommended he take the HIV drugs to fight the new virus and they worked on him. It is not known if the popularity of this treatment will create a global shortage of the medication.

What You Should Do to Avoid the Virus

In addition to getting a flu shot every year, people living with HIV should take the same everyday preventive actions recommended by the CDC for everyone, including covering coughs, washing hands often, avoiding people who are sick, and self-isolating if feeling ill.

While flu shots are approved for use in people with HIV and other health conditions, Live Attenuated Influenza Vaccine [LAIV], a nasal spray vaccine, should not be used in people with HIV and AIDS. LAIV (FluMist�) contains a weakened form of the live influenza virus and is not recommended for use in people with weakened immune systems (immunosuppression). But because the flu vaccine is not 100 percent effective, people living with HIV who have flu symptoms, especially those with low CD4 cell counts not receiving ART, should be treated with influenza antiviral drugs right away.

Howard Brown Health's Chief Clinical Officer Magda Houlberg, MD, AAHIVS, says, "it appears that HIV positive patients are not more susceptible" to coronavirus and emphasizes that prevention is better than cure.

"What we know tells us that it is transmitted through the air, so any proximity with others who may be ill is a risk factor," Dr. Houlberg told EDGE. "For all individuals and community groups, we are emphasizing the need to stay home if you are experiencing flu-like symptoms, wash your hands often, and avoid touching your face."

While Dr. Houlberg said that Howard Brown Health was "always making efforts to increase education and awareness around communicable diseases in the communities we serve, LGBTQ people need to follow the same precautions as everyone else" in the case of coronavirus.

"For any flu-like illness, Howard Brown Health would recommend talking to a healthcare provider and getting advice if you are safe to stay at home and let it run its course. Influenza is very common, so generally, in the case of the flu, if your symptoms started more than five days ago, antiviral flu medication wouldn't be helpful, but it would need to run its course," she says.

And even though coronaviruses cases are increasing worldwide, the illness is not yet common. "At this time, if someone was hospitalized, they might test for [coronavirus] if there is no other explanation for severe respiratory illness. Wearing a mask when you are ill to protect others, practicing good respiratory hygiene practices, and staying home if you are ill and appear stable are all good practices. Washing hands is still the best defense!' says Dr. Houlberg.

The Human Rights Campaign provides an annual Healthcare Equality Index, an LGBTQ benchmarking tool that evaluates healthcare facilities' policies and practices related to the equity and inclusion of their LGBTQ patients, visitors and employees. Click here to find a facility near you. The CDC recommends staying home except to get medical care.

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