COVID-19 and the threat to people living with HIV

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COVID-19 and the threat to people living with HIV

Officials urge treatment for those not already on a programme

BY KIMBERLEY HIBBERT
Senior staff reporter
hibbertk@jamaicaobserver.com

Sunday, March 29, 2020

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IN light of the increasing confirmed cases of the coronavirus disease (COVID-19) in Jamaica, people living with HIV (PLHIV) are being urged to remain compliant or get on treatment now.

The charge came from Dr Jennifer Brown Tomlinson, medical director at Jamaica AIDS Support for Life (JASL), who told the Jamaica Observer that without treatment PLHIV will not have a decent chance at fighting the COVID-19.

“A compromised immune system may not be able to function at its optimum to fight against coronavirus. People on antiretroviral therapy (ART) must take their medication every day,” Dr Brown Tomlinson said. “People living with HIV who are on their antiretroviral medication have the same risk as the normal population. All of the precautions that are being advised for the general population also apply to people living with HIV who are adherent to their antiretovirals. There is no increased risk of contracting the virus and there is no increased risk of acquiring complications of the infection if the patient is adherent to their antiretroviral therapies.”

The ultimate goal for PLHIV is to reach viral suppression. This occurs when they remain on their medication and the virus in the blood gets so low, that it is undetectable. PLHIV, who are on their medication, with a suppressed viral load are less likely to have a compromised immune system, are generally healthy and will stand a fighting chance against COVID-19.

Currently, there are 30 confirmed cases of COVID-19 in Jamaica. There are currently 32, 617 PLHIV in Jamaica. Similarly, to coronavirus, HIV is not a death sentence and the advice from JASL is to eliminate fear and adhere to the recommended treatment by the doctor and care team.

But for PLHIV who are not adherent, Dr Brown Tomlinson asserted there is an increased risk of developing the complications of COVID-19, should they contract the virus.

She said: “The advice we have for patients who are either not on medication or not adhering to their medication is that they get on antiretroviral therapy as quickly as possible and become adherent to their medication. This is the best way for them to optimise their immune system or to make sure they are not immunocompromised.”

Added to that, Dr Brown Tomlinson mentioned that non-compliant PLHIV have been turning up to JASL clinics to start treatment.

“Normally we would have to be calling and encouraging persons to come in for treatment, now we have a few persons calling us and coming in to get on treatment. There is a sense urgency to take control of their health and that is something we welcome,” she said.

To bolster the appeal, the Sunday Observer spoke to two PLHIV about their preparations for COVID-19. For confidentiality purposes they will be referred to as Client One and Client Two.

“What I did was to go to the pharmacy and to JASL and get medication to keep me for a month. My supply was running out so I didn't want to wait until it was done. So, I went and stocked up. Hopefully we will have a better idea of the possible impact or the effect the virus has on people living with HIV by then (coming months), so that we can know how best to act. I'm part of another group — Jamaica Network of Seropositives (JN+). That group called me and asked if I have medication, if I am OK and so on, so that was very helpful. I'm just doing the regular exercises and stuff I've been told to do to get my immune system up and firing. My CD4 (T-cell count) level's pretty good. I was undetectable. So, it's just a matter of doing all I can to keep it there, so if I was to contract the virus, my immune system would be strong enough to help to fight,” Client One said.

To PLHIV who are aware of their status and non-compliant with treatment, Client One said, “Your best chances against COVID-19 is to get onto your medication because you want your immune system to be at its best. If your immune system is not what it can be because of your fears and failures to make it what it should be, COVID-19 may be an opportunistic virus and may cause your death. There's a lot that you can still offer and give, so just go on your meds. There is support out there – JASL, JN+ and many others provide support,” Client One said.

Client Two shared similar sentiments and asserted that he had no fear and it's all about preparation and taking care of yourself.

“It's like taking the necessary precautions that the Government has put out like washing your hands with soap, have your sanitiser, your disinfectant. I always had those things, maybe I'm using it more now. Ensure you have your meds, whether you visit the pharmacy as anything can happen. What if you're quarantined and can't get out? If you are not on medication, get in touch with JASL,” Client Two said.

Like Client One, Client Two also encouraged the non-compliant to get on treatment immediately.

“Take a look in the mirror and compare yourself to where you are now and where you used to be and see for yourself if you wouldn't want to go back to where you were originally. Not being on meds will change your lifestyle entirely, but being on meds will probably let you remain on the path you were on before contracting the virus. In terms of your physical appearance, before having the virus, you were probably looking cute and all. If you are on the treatment, you still look the same cute way. Go and get the treatment, go in, speak to someone. You can even talk to a psychiatrist there at JASL,” Client Two said.

Regarding COVID-19, Client Two added: “If you are on your meds, your immune system will be at a much better stage to fight any other bacteria. I can attest to be on treatment. I haven't had flu in eons, I hardly have a cold symptom. It helps to build and enhance your immune system and fight off viruses. It's not a cold medication, but it strengthens your immune system.”

Further, Dr Brown Tomlinson said PLHIV are being encouraged to follow a healthy diet to help maintain their immune system.

“We are not recommending anything additional to be added to the diet because our patients are always being advised to follow a healthy diet and if they've not been following a healthy diet, now is the time for them to follow a healthy diet. It's not a matter of any specific addition that we are going to make to the diet. We want them to be following their healthy diet to make sure that they maintain their immune system,” she said.

For PLHIV who might be worried about their fate in the event they contract COVID-19, Dr Brown Tomlinson advised that they remain vigilant and continue following the guidelines of the Ministry of Health and Wellness.

“Wash your hands frequently, avoid touching the face, practise good cough hygiene and maintain your social distancing. It's all so very important that if you are feeling ill, you stay home. Everyone is anxious but we need to just follow the guidelines as set out by the Ministry of Health and Wellness and ensure we are doing everything possible to maintain the best personal hygiene and that's the best way to prevent infection with this virus,”she said.

Additionally, Dr Brown Tomlinson urged people to get tested and know their HIV status as ignorance in this regard is detrimental.

“There is no way to know your immune system is compromised if you don't know that you have HIV. So it's important during this time for people who have not been tested to get tested. Get tested, and if you are positive get on medication and give yourself the best possible chance of maintaining a healthy immune system by getting on treatment. If they are on treatment, stay on treatment. Regular treatment is key,” she said.

With regards to organisational adjustments due to COVID-19, Nilfia Hazle Anderson, regional programmes director at JASL, said they have reduced the number of people coming into the clinic and developed a screening tool, which is administered via telephone to minimise crowding.

“We would normally have about 15 persons per clinic session, now we have about six to 10 persons coming. We created a survey to ask if they are experiencing symptoms of the COVID-19 and once they come to the office we test their temperatures. This wasn't normally done routinely, now it is done. We also teach different hygiene practices and have information sessions on COVID-19 where they are also provided with the hotline number they can call if they are experiencing any of the symptoms,” Hazle Anderson said.

In addition, Hazle Anderson said elderly persons over 60 are not allowed to come to the clinic, instead, JASL sorts out their prescription and engages a caregiver on their behalf.

Similarly, Kandasi Levermore, executive director of JASL, shared that, “Organisations that provide treatment and care for people living with HIV will need to continue serving their clients during these trying times. JASL's doors are still open, because if there was ever time that we need to continue serving our clients, it is now.”


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