COVID-19 disease in people living with HIV and/or TB

NATIONAL NEWS - The National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service, has surveillance systems in place to rapidly collect information related to HIV/TB and COVID-19 in South Africa and will provide updated information and guidance once data are available.

Note: SARS-CoV-2 is the name of the virus while COVID-19 refers to the disease.

Background: HIV and TB in South Africa

There are about 7.7 million people living with HIV in South Africa, of whom over 5.1 million are on antiretroviral therapy (ART).
South African HIV guidelines encourage all people in South Africa to get tested for HIV, and if positive, to access care and treatment including ART. If you are on ART ensure that you continue to take your medication regularly, remain virally suppressed and stay healthy.
TB is an important cause of respiratory symptoms (e.g. cough and fever). People with signs and symptoms consistent with TB, that are in close contact with known TB patients should be investigated for TB. Highly sensitive and rapid tests are available to diagnose TB which are available free of charge in the public sector. Approximately 600 people are diagnosed with active TB every day in South Africa. TB is curable, early diagnosis and completing the prescribed treatment saves lives.
In 2018 there were an estimated 301 000 cases of TB in South Africa. More than half (60%) of the TB patients in South Africa occur in people living with HIV (PLHIV). There are between 11 000 and 12 000 cases of drug resistant TB cases each year. Approximately 20 000 to 30 000 people are reported to die due to TB every year, this translates to 2 to 3 deaths every hour.
Influenza kills approximately 4 000 to 10 000 people every year in South Africa and HIV positive pregnant women are at high risk. The influenza vaccine is safe and effective, prevents deaths and is recommended for all pregnant women, PLHIV, infants and young children, TB patients, individuals with chronic diseases e.g. COPD, cardiac failure, diabetes, etc.

Are people with HIV and/or TB at higher risk for COVID-19?

It is not yet know whether people living with HIV and/or TB have a higher, lower or similar risk for acquiring SARS-CoV-2 or have greater disease severity. At this point we can only relate to what is known about other viral infections such as the influenza virus in these populations. It must be stressed, however, that SARS-CoV-2 is a different virus and may have different effects in these populations.
While data on the risk of PLHIV to acquire influenza infections are limited, it appears that these individuals do not have a higher risk of acquiring the influenza virus. That is, they have the same risk as everyone else.
People with HIV, even those on ART, are at higher risk of developing serious health complications following influenza infection. The risk is especially high in those who have very low CD4+ counts or those who are not taking ART. The flu vaccine is efficacious and recommended for all PLHIV.
Available evidence suggests that people with active TB who are infected with influenza may have more severe illness and indicates that a dual infection increases risk.
High prevalence of chronic lung damage is well described amongst people previously successfully treated for TB. These individuals have poorer lung function than the general population and are thus at a greater risk for severe disease.
Since both COVID-19 and TB are transmitted through respiratory secretions there is the possibility that symptomatic individuals with both COVID-19 and TB may transmit TB or COVID-19 more readily. Adherence to preventative measures are therefore important.
Early reports indicate that some antiviral agents used to treat HIV have an effect on SARS-CoV-2 under laboratory conditions. However, the implications of this finding in preventing infection with SARS-CoV-2 or decreasing the severity of COVID-19 amongst people living with HIV/AIDS (PLWHA) or in the general population, are not yet known. These studies are purely experimental at this stage.

Prevention and general recommendations

People with HIV and/or TB should practise the same preventative actions that are recommended for everyone.

These include:

Get the flu vaccine before this flu season, particularly if you are among the recommended groups. Individuals caring for patients are strongly advised to vaccinate.
Wash hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitiser.
Avoid touching eyes, nose, and mouth with unwashed hands.
Avoid close contact with people who are sick.
Stay at home when sick and try and keep a distance of at least 1m from others at home.
Cover coughs or sneezes with a flexed elbow or a tissue, and discard the tissue in the bin.
Clean and disinfect frequently touched objects and surfaces.
Social distancing – avoid crowded spaces unless absolutely necessary.

Avoid handshakes or hugging.Specific recommendations – get tested, get treated, act now and stay safe

HIV testing and treatment: If you don’t know your HIV status, get tested now. If you are HIV positive and not on treatment – start anti-retroviral treatment urgently.
ART adherence: If you are on ART make sure you take it regularly and if you have interrupted ART, return for re-initiation as soon as possible.
Virally suppressed and on ART: Ask about multi-month dispensing (CCMDD) thereby reducing the number of clinic visits required and the exposure to crowds.
TB Testing: TB can affect PLHIV as well as HIV negative individuals. If you have respiratory symptoms (e.g. cough, fever, etc.) you could have COVID-19 or TB or both – get tested for TB now, TB is common in South Africa.
TB treatment and adherence: TB is curable with 6 (or 9 months) of treatment in the majority of cases. Start treatment immediately once diagnosed, don’t delay and complete your treatment.
Prevent TB: TB prevention treatment (TPT) is available, get protected, start TPT if you don’t have TB, and are a household contact of someone with TB or a PLHIV.

COVID-19 public hotline: 0800 029 999

Article: Caxton publication, Alberton Record