Before the outbreak of Covid-19, India has the third largest number of HIV patients in the world. As per government estimates, India has around 23.49 lakh people living with HIV/AIDS in 2019, though, the epidemic saw a decreasing trend with estimated annual new infections declining by 37 per cent between 2010 and 2019.
While the Covid pandemic is challenging the health infrastructure and systems across the globe, it has caused uncertainty among people living with HIV. Commenting on this, Rajiv Gandhi Super Speciality Hospital Medical Director Dr B.L. Sherwal said, "The number of HIV patients seems to have shrunk during the Covid pandemic as immunity plays an important role in both diseases - HIV AIDS and Covid and people have become more aware of building immunity".
"Outdoor activities and other reasons that may contribute for HIV infections like contact with infected blood, semen, or vaginal fluids or others have largely reduced during the lockdown", Dr Sherwal cites another reason for decreasing trend of HIV infections during the pandemic.
Talking about the HIV-positive people undergoing treatment during the pandemic, he advised that such people need to take extra care of their health and must avoid taking treatment into home isolation as they have a higher risk of developing severe complications like pneumonia, Septicemia, ARDS and various infections.
He said that HIV infection causes immunity deficiency; hence, chances are more to get a severe infection. He recommended parallel treatment of Covid with AIDS in case of infection.
Dr Vineeta Singh Tandon, Consultant, Internal Medicine at PSRI Hospital, said, HIV is an immuno-suppressive disease and hence patients will have an increased risk of acquiring any infection including SARS CoV-2. They have a higher risk of developing Covid related complications like pneumonia, septicemia, ARDS and various other infections and are associated with a higher risk of mortality.
Several factors like patients' commitments to adhere to ART therapy, CD4 count and viral load, determine the possibility and the risk of acquiring Covid-19 infections.
On being asked about treatment protocol, she said, "They should continue their ARV as previously and should not change or stop it in order to prevent Covid-19. For hospitalized patients also, ARV is important. The same Covid treatment regime protocol based on categories of severity is followed for them as for people without HIV infection. Special focus is being given on potential drug interactions, possible overlapping of drug toxicities and managing opportunistic infections".
She agreed that decreasing tendency has been seen for HIV patients during the first and the second Covid wave as hardly 10 patients visited the hospital during the pandemic.
No evidence has been put forward yet to substantiate the claim that people with HIV will have more side effects due to vaccination than people with no underlying health conditions. With the emergence of effective prevention and treatment strategies, the risk to people with HIV in clinical trials will decline over time.
Also, more contagious and pathogenic Covid variants are emerging across the globe and may continue to pose new challenges to all including those with HIV. "In such a situation, people with HIV positive must avoid outdoor activities that may contribute to spreading the infection", counsels Dr Sherwal.
(Avinash Prabhakar can be reached at firstname.lastname@example.org)
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