How To Survive COVID-19 With HIV/AIDS – HIVMA & IDSA Guidelines.

How To Survive COVID-19 With HIV/AIDS
If you are or you know someone who is living with HIV/AIDS, the following information are best practices in areas that have been heavily impacted by the outbreak and is vital to surviving COVID-19.

 

If you or you know someone living with HIV/AIDS, the following information based on best practices in areas that have been heavily impacted by COVID-19. Email HIVMA with questions and visit the IDSA COVID-19 Resource Center for additional resources, including COVID-related policies and protocols developed by institutions and health systems to help you survive the COVID-19 outbreak.

 

Social Distancing 

It is important to educate all patients on the importance of social distancing, such as avoiding crowds and public places, as a public health strategy to reduce spread of the virus. Clinic and clinical protocols should be adjusted without compromising the patient’s health to support social distancing. Please see the White House’s 15 Days to Slow the Spread guidelines and the IDSA and HIVMA response to the administration’s guideline for more information on social distancing. 

 

Routine Office Visits 

For stable patients, or patients with non-urgent appointments, schedule a telephone or telehealth encounter if that is an option. For patients with non-respiratory urgent concerns, consider keeping the appointment or offering a telehealth or telephone visit if those are options. Information on Medicare and Medicaid telehealth coverage is available in the IDSA COVID-19 Resource Center’s Coverage & Payment Section. For protocols for telehealth and in person appointments, please see the Clinical Policies & Protocols section of the resource center. 

 

Prescription Drug Refills 

Patients should maintain at least a 30-day supplemental supply of their medications to prevent the possibility of treatment interruptions. A number of health insurers and state AIDS Drug Assistance Programs are allowing early medication refills and lifting quantity limits in addition to making other changes to their coverage policies. HIVMA is compiling information on drug policies of large health insurers in the IDSA COVID-Resource Center. Please contact your patients’ health insurers to request an early refill or a 60-to-90-day supply and encourage your patient to use mail order if that is an option for them. If you have not heard from your state AIDS Drug Assistance Program, contact the local ADAP regarding its prescription fill and refill policies in response to COVID-19. Visit the NASTAD COVID-19 Updates & Resources web page for information on the antiretroviral drug supply chain and additional guidance for State AIDS Drug Assistance Programs. 

 

HIV Viral Load Monitoring 

For patients presently with viral suppression and no concerns for non-adherence, consider delaying routine viral load monitoring for up to an additional six months. Patients who have recently initiated ART and are not yet virally suppressed and patients with adherence or drug resistance concerns should be prioritized for viral load testing. By deferring RNA testing in people who are virologically suppressed on antiretroviral therapy, we can lessen the burden on clinical virology laboratories and the health-care workforce. 

 

Diagnostic Testing 

Due to high rates of cardiovascular disease and lung disease and a high prevalence of smoking, people with HIV who are experiencing fever or signs/symptoms of a lower respiratory tract illness should be prioritized for diagnostic testing (see IDSA’s COVID-19 Prioritization of Diagnostic Testing) regardless of their viral load status or CD4+ T cell count. We have insufficient data in people living with HIV at this time to suggest what laboratory parameters comprise increased immunologic risk for severe disease. 

 

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