FORT LAUDERDALE, Fla. — South Florida’s vulnerable and large HIV-positive population are feverishly trying to keep their immune systems strong to fight off the new coronavirus.
People living with HIV could be at an increased risk of developing severe symptoms from the coronavirus, but much is still unknown, doctors say.
In the tri-county area, only six people of 357 who died from COVID-19 were HIV positive, and all had other underlying conditions such as asthma, cardiovascular disease and diabetes, according to medical examiner records as of Friday.
But vigilance in keeping HIV at undetectable levels is crucial to keeping the immune system strong at a time when access has been interrupted to medications, lab work and doctors.
“We are telling our patients that this is the time to make sure you are taking your medications every day,” said Dr. Vanessa Rojas, a family medicine physician with Broward Health who specializes in the care of HIV patients. “This is not the time to miss doses or experiment. You need to ensure you are protected as much as you can and doing everything possible to keep yourself from being immunosuppressed.”
Broward and Miami-Dade counties are home to one of the nation’s highest rates of new HIV diagnoses, as well as a population of more than 42,000 people who are living with HIV, according to the Florida Department of Health. The majority of the HIV-population in the South Florida region — nearly 70% — are older than 50, which creates an additional risk of the coronavirus.
“From what we know, there is not a higher rate of coronavirus in people living with HIV, but I’m not sure if it’s because of underreporting,” said Dr. Adam Carrico, an HIV expert and associate professor of public health with the University of Miami Miller School of Medicine. “I think we need more data.”
Researchers at the University of Missouri are studying COVID-19 in patients to better understand who survives the virus and responds to treatment. They are reaching out to doctors around the world to participate and have only begun seeking input.
The issue, Carrico said, is additional health factors that come with aging play a role in how HIV patients respond to the coronavirus. “In this older HIV population, they are starting to get other conditions like hypertension and cardiovascular disease at more rapid rates and that could make them more vulnerable.”
HIV researcher Dr. Paul Sax said he has seen no indication thus far that the HIV-positive population who have their disease well controlled are at any greater risk for succumbing to COVID-19 than the general public.
“The population that is at risk is not taking their medication, not yet diagnosed or suffering from other challenges more severe than their HIV,” said Sax, a professor of medicine at Harvard Medical School and clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital.
The same observation is true in Miami. Dr. Dushyantha Jayaweera, an infectious diseases specialist with the University of Miami Health System, said he sees no evidence that HIV positive patients are at higher risk.
“In my clinic, only one patient has been infected of 400 patients. The potential is high for complications from the coronavirus, but not because of HIV. It’s more the rest of the stuff.”
Could the medications taken for HIV protect people from the highly infectious new coronavirus? South Florida doctors say they get that question regularly, and they don’t have a definitive answer.
In various countries, HIV medicines are being used to treat COVID-19, and clinical trials are underway to determine their potential. But South Florida doctors are not advising patients to switch to those specific medicines.
The U.S. approved a drug combination sold under the brand name Kaletra in 2000 to treat HIV infections. Now, Kaletra, a combination of antiviral drugs lopinavir and ritonavir, is being studied to treat COVID-19.
In addition, a new clinical trial in Spain is underway to learn whether HIV medication Truvada can help prevent healthcare workers from getting the new coronavirus because it may affect the immune system’s activity and thus lower its inflammatory response. So far, neither has proven to have a benefit.
“There are theories that taking antiretroviral medications creates a stronger immune system against this virus, but there is no science behind it,” said Michael Ruppal, executive director of The AIDS Institute, headquartered at University of South Florida. “The immediate fear is there will be a shortage if any of them work. Already we are seeing some withholding from pharmacy benefit managers for the possibility of needing supply.”
As coronavirus cases spread in South Florida, the number of HIV-positive people who seek antiretroviral treatment is skyrocketing, doctors say.
“People with HIV who were not on anti-retroviral definitely are worried and want to get on meds or back on medications,” said Rojas at Broward Health. “My numbers started going up exponentially as the pandemic was worsening. They are all very worried about getting COVID-19 and now see the importance of virally suppressing their HIV.”
Joey Wynn, former chairman of the South Florida AIDS Network, worries about what lies ahead for the HIV-positive population in South Florida.
“The vast majority are on therapies that are effective and tolerable and we are fortunate for that scenario,” he said. “The challenge is three months later when they are out of medicine, they need to see a doctor or need lab work because of how the system may have changed from the pandemic.”
One change that could make it easier for the HIV community could come as a result of the COVID-19 response. South Florida agencies will get a share of the $90 million in federal COVID-19 response funding awarded earlier this month to Ryan White HIV/AIDS Programs.
In South Florida, some of the money is earmarked for boosting telehealth services. Wynn said if that happens, it will be a major advancement. “Even when the worst of the epidemic is over, they won’t have to go get what they need. It will come to them.”
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