Information on COVID-19 for People Living with HIV

Common Questions/Answers on COVID Vaccines:

  1. When will people living with HIV be able to get the vaccine?  PLWH are considered part of the Ontario Phase 2 priority group.  You may also be eligible based on other criteria, such as age or where you live.
  2. How will I know when it is my turn to get the vaccine?  There are a number of ways to stay up to date on vaccine eligibility and appointment bookings.

Please go to the Ontario Vaccine website and enter your postal code to see what options are available in your neighbourhood:  https://covid-19.ontario.ca/book-vaccine/

Sign up for Twitter/Facebook/Discord updates from Vaccine Hunters https://vaccinehunters.ca/ Or text your postal code to 1-833-356-1683 to receive an instant reply of nearby vaccination sites.

Eligibility criteria will continue to evolve over time, so please follow the news. 

  1. Will I be able to get vaccinated at the Immunodeficiency Clinic?  The Immunodeficiency Clinic has not been designated as a vaccine site to date.  As vaccine rollout expands, vaccines will be available at multiple sites.   Information will be posted on this site when it is available.  
  2. Which vaccine should I get?  You may get any approved vaccine. All vaccines approved for use in Canada are extremely effective at preventing severe COVID-19 disease, hospitalization, and death.
  3. Do antiretrovirals interact with the vaccines?  There is no evidence that antiretrovirals will enhance or impair to response to the vaccine.
  4. How long will the vaccine be effective?  It is not known if the vaccine will be as effective in those with HIV but research is ongoing. The vaccine will likely work better in those with higher CD4 cells and suppressed viral loads so be consistent with taking your antiretrovirals. 
  5. What else can I do to protect myself?  Even if you get the vaccine you still need to follow the public health recommendations on masking and safe distancing. It is important to continue to take your HIV therapy and keep your viral load suppressed.

1. COVID-19 and HIV infection:  what are the risks?

Current evidence indicates that the risk of severe COVID illness increases with age, male sex, obesity and with certain chronic medical problems such as cardiovascular disease, chronic lung disease and diabetes. While early reports suggested no evidence of higher COVID-19 infection rate or different disease course in people living with HIV (PLWH) than in HIV-negative people, more recent studies have shown higher risk of poorer outcomes in people living with HIV who develop COVID disease, primarily in people with immune suppression indicated by a low CD4 T-cell count (<200 cells/µL), or those not receiving antiretroviral treatment.  Although people living with HIV who are on treatment with a normal CD4 T-cell count and suppressed viral load may not be at an increased risk of serious illness, many people living with HIV may have other conditions that increase their risk. Indeed, almost half of people living with HIV in Canada are older than 50 years and chronic medical problems, such as cardiovascular and chronic lung disease, are more common in people living with HIV.

For patients with low CD4-counts (<200 cells/uL), or who experience a CD4-decline during a COVID-19 infection, remember to initiate opportunistic infection (OI) prophylaxis against PJP in attempt to avoid superinfection.
Please continue to take your antiretroviral medications without interruption. 
Smoking is a risk factor for respiratory infections; smoking cessation should therefore be encouraged for all patients. Influenza and pneumococcal vaccinations should be kept up to date.

2. COVID-19 treatment: antiretrovirals & further options

There are a number of clinical trials ongoing around the world in attempts to find therapies to help manage COVID infection. Many TGH HIV clinic doctors and research staff have lent their expertise and are involved in the design and conduct of these studies taking place in Toronto.  HIV infection is not an exclusion criteria for participation in these clinical trials. 

Remdesivir is an antiviral drug which was originally developed for Ebola therapy. Remdesivir has broad in vitro antiviral activity against SARS-CoV-2.  Remdesivir has been approved by Health Canada for treatment of severe COVID-19 illness for certain patients in a hospital setting.  Remdesivir is given by injection.

Dexamethasone is a corticosteroid which has been shown to improve outcomes in hospitalized patients with COVID-19 who require supplemental oxygen.  Dexamethasone is given once a day by mouth or by injection.

Our clinic doctors are watching these and other studies closely. Dr. Alice Tseng has updated her HIV/HCV drug therapy app to include any potential drug interactions with these experimental therapies and HIV medications.

Currently there is no evidence is available to justify switching a patient from their usual antiretroviral therapy. Switching could be associated with adverse outcomes such as new side effects or loss of viral control. Additionally there is no evidence to support HIV-negative people taking antiretrovirals outside the context of pre-exposure prophylaxis (PrEP) to prevent HIV acquisition – PrEP should be taken as directed and there is no current evidence that PrEP is effective against COVID-19.

It is important to be in contact with your treatment team if you have any questions and to ensure that you have an adequate supply of your medication as we are unsure how long the epidemic and the restrictions will last. Follow the recommendations of the public health authorities on maintaining social distancing and keep well.

3. Should people living with HIV receive vaccines for SARS CoV-2? 

Yes. Vaccines for SARS CoV-2 bring the same benefits to people living with HIV as they bring to all individuals and communities—prevention of severe disease due to SARS-CoV-2 and potentially reduced transmission of the SARSCoV-2 virus.

Please see this statement by UNAIDS on COVID-19 Vaccine and HIV:
https://www.unaids.org/sites/default/files/media_asset/covid19-vaccines-and-hiv_en.pdf

BHIVA, DAIG, EACS, GESIDA, Polish Scientific AIDS Society and Portuguese Association for the clinical study of AIDS (APECS)
Statement on risk of COVID-19 for people living with HIV (PLWH) and SARS-CoV-2 vaccine advice for adults living with HIV:
https://www.bhiva.org/joint-statement-on-risk-of-COVID-19-for-PLWH-and-SARS-CoV-2-vaccine-advice


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