Recently, the Dutch Association of People with HIV (Hiv Vereniging) has received a great many questions about HIV and the novel coronavirus. Our Medical Officer is keeping up with developments and issuing updates when there is news. Below we answer some of the most frequently asked questions.
Please note: this article was published on june 3. We try to keep our recommendations as up-to-date as possible, but always consult the RIVM (Dutch National Institute for Public Health and the Environment) for the most recent recommendations. Click here to access the RIVM’s most current information. You can also call 0800-1351 if you have a question. When you are in foreign country you can call +31 20 205 1351.
English is not my first language. Where can I find reliable information on the novel coronavirus in my first language?
- The Rijksoverheid website contains information in Arabic, English, French, German, Papiamento, Papiamentu, Polish, Spanish and Turkish.
- The Pharos website contains information in Arabic, Chinese, English, Farsi, Papiamento, Polish, Somali, Spanish, Tigrinya and Turkish
- Youtube clips by the Public Health Service (GGD) in Arabic, Berber, English, Farsi, French, Kurmanji, Polish, Romanian, Somali, Tigrinya and Turkish.
What are the symptoms of COVID-19?
People who contract the novel coronavirus can develop the COVID-19 disease. Most people will get respiratory complaints (coughing or difficulty of breathing) and high fever. In addition, you can suffer from a sore throat, sneezing and a mild cough. Some people feel very sick, others feel fine. If you feel better and did not have any symptoms for 24 hours, you can go outside again. You are cured if you feel better and have had no health problems for 24 hours. This means: no fever, no nose cold and no cough.
I think I am infected with the novel coronavirus. What should I do?
See the website of RIVM for more questions and the most up to date measures.
People with respiratory problems and/or fever must stay at home. You may only go outside if you have had no symptoms for 24 hours. This means: no fever, no nose cold and no cough. Follow the general advice provided at present in the Netherlands over school and work. For more information visit ‘government.nl’.
Contact your GP by telephone if you require medical help, for example, if you have a high fever and have difficulty breathing.
What can I do to prevent coronavirus from spreading?
See the website of RIVM for more questions and the most up to date measures.
You can get COVID-19 when you have been into contact with (somebody carrying) the novel coronavirus. It’s important that people consistently take these precautions:
- Wash your hands often with soap and water
- Cough and sneeze into your elbow
- Use paper tissues to blow your nose and discard them after use
- Do not shake hands
- Stay 1.5 metres (2 arms lengths) away from other people
- Work from home as much as possible.
- Stay at home if you have mild cold-like symptoms, such as a sore throat, a runny nose, sneezing, a mild cough or a fever below 38 degrees Celsius
- If you have a fever above 38 degrees Celsius or shortness of breath, you and anyone you live with should stay at home. If you feel better and have not had any symptoms for 24 hours, you can go outside again.
- If you over the age of 70 or do you have underlying health problems: Take extra care. It is a good idea to stay at home as much as possible for now.
Are people with HIV at a greater risk of getting the novel coronavirus?
There has so far been no evidence that people with HIV are more susceptible to the novel coronavirus.
Will COVID-19 be worse if you have HIV?
It’s good to remember that most people who get COVID-19 have mild symptoms or none at all. A small portion become very ill, and some of these people die. How being infected with the novel coronavirus will develop in someone cannot be predicted in advance.
There has so far been no evidence that COVID-19 makes people with HIV with adequate resistance more ill than those without HIV. Therefore, it is important that you continue to take your HIV medication as prescribed, so that the virus remains suppressed. In the Netherlands, most people with HIV have a well-functioning immune-system, as effective medications are available.
A small portion of people with HIV in the Netherlands do not have a strong immune system. They have few CD4-cells, for example, fewer than 200. Those people are at increased risk of developing severe COVID-19. It is known that people with HIV with lowered resistance are less resilient to outside infections. For these people, COVID-19 could have more severe effects. Also people with an untreated HIV infection are at increased risk.
Furthermore, you might also have an additional condition, such as COPD. This other condition could put you in a higher risk group. People with a chronic respiratory condition, a chronic cardiovascular disease, diabetes, a severe kidney disease or an immune disorder (following chemotherapy, for example) have a greater risk of becoming more seriously ill from the novel coronavirus or of dying from it.
Older people (70+) are also at increased risk. Additionally, people who smoke and people who are overweight are at risk of more severe disease.
This does not mean that people with lowered resistance or people in a higher risk group will get COVID-19 or will become severely ill as a result. But in general, the odds are greater.
Why does the RIVM guideline state that people with HIV are a risk group?
The RIVM Q&A states the following:
“People who belong to a risk group are people who have a higher risk of becoming seriously ill if they are infected with the novel coronavirus. The risk groups are:
- People with an HIV infection who are not (or not yet) being treated by a doctor, or with an HIV infection with a CD4 below 200/mm3.
The expectation is that there is no difference between how COVID-19 affects people with HIV with adequate resistance and those without HIV. So this guideline points out people with HIV with a weak immune system, not people with HIV in general.
A small portion of people with HIV in the Netherlands do not have a strong immune system. They have few CD4-cells, for example, fewer than 200. Since people with HIV are affected differently (depending on their immune system), the HIV treating physician can determined whether a person with HIV has an increased risk to becoming ill. Next, people with an untreated HIV infection are at increased risk.
What should I do if I am in a higher risk group?
The higher risk groups include the elderly (70+) and people with a chronic respiratory condition, a chronic cardiovascular disease, diabetes, a severe kidney disease or an immune disorder (following chemotherapy, for example) . When you have a compromised immune system (less than 200 CD4-cells) or an untreated HIV infection, you’re part of the higher risk group too.
If you are in a higher risk group, it is even more important that you pay attention to your health. Avoid physical contact with other people, and follow the standard hygienic measures.
HIV medications ensure that HIV is suppressed and that your resistance becomes higher. If you are not taking any HIV medications, we recommend you to do so. This will keep your resistance as high as possible. There could also be other reasons why you fall into a higher risk group. You might have other conditions, in addition to HIV, or be older.
People who smoke and people who are overweight are at risk of more severe disease. It is always a good idea to smoke less or quit smoking and eat healthy.
How do I know if my resistance is high enough?
During your HIV consultation, you are told how well your immune system is functioning, and the doctor or counsellor will tell you if your resistance is lowered. If you are unsure whether you have a lowered resistance (under 200 CD4-cells, for example), contact your HIV treatment center. But most people in the Netherlands living with HIV have high resistance.
How many people with HIV have or had COVID-19?
In the Netherlands, the RIVM does not collect data on how many people with COVID-19 have HIV. The RIVM collects data on COVID-19 and the following underlying conditions: pregnancy, cardiovascular disease and hypertension, diabetes, liver disease, (neuro) muscular disease, immune deficiency, kidney disease, lung disease, malignancy and other. Someone who is immune deficiency has a immune system who doesn't work or badly because of a disease or medication. Immune deficiency may be caused by an untreated HIV infection, but there many other and more common reasons for immune deficiency (e.g. chemotherapy, auto-immune disease). A well treated HIV infection, which is very common in the Netherlands, does not result in immune deficiency. Thus, there is no way to get such data from the RIVM.
To determine how many people with HIV had or get COVID-19 in the Netherlands, the Hiv Vereniging started a study in collaboration with the Erasmus MC in Rotterdam and the Radboud MC in Nijmegen. The study contains of 8 questionnaires (in English). Interested in participating? Here you find more information. The results will be shared on the website of the Hiv Vereniging.
Do people with HIV get tested for COVID-19 early?
No, people with HIV do not get tested early. From the 1st of June, everybody with COVID-19 symptoms can get tested. Call 0800-1202 for more information .
People with an HIV infection who are not (or not yet) being treated by a doctor, or with an HIV infection with a CD4 below 200/mm3 can get tested when this is benificiary for their treatment. This can be done by the general practitioner (GP) or by a medical specialist.
May people with HIV be admitted to the ICU?
Yes, people with HIV are admitted to the ICU. HIV is no reason to be denied ICU care. People with well controlled HIV have similar intensive care outcomes to HIV-negative individual. HIV is not a predictor of mortality in people with acute lung injury admitted to intensive care.
There are various reasons why people are not admitted to the ICU. Because being in the ICU is very burdensome for both the body and the mind for any patient, doctors and patients always need to consider if ICU care is the right choice.
People often have to recover for months or years from a stay at the ICU, and frequently die in the year after an ICU stay. Doctors discuss the chance of survival of the stay on the ICU and the quality of life afterwards. Some older people choose to not go to the ICU, because the consequences for the physical fitness are too big. Also, some terminally ill patients are too ill to be admitted to the ICU. Sometimes doctors decide that a patient has a very poor chance of survival or a decent life after a stay in the ICU. In this case, a patient will not be admitted to the ICU.
When someone has AIDS and cannot be treated with HIV medication because he or she has a virus that is resistant to all HIV medication (this would be very rare in the Netherlands), this could be a reason not to admit someone to the ICU. But as said before, this would be an extremely unlikely scenario.
When a person is on the ICU and gets artificial respiration, they get a nasogastric canule. HIV medication can be given through this canule. So people with HIV will still get their HIV medication when they stay at the ICU.
Will my medical data be shared when I have COVID-19?
Because of the novel coronavirus, healthcare professionals working at the emergency department and the ‘huisartsenpost’ are allowed to see medical data of patients. This is a temporary measure to facilitate the healthcare system. Normally patients have to give a one-time only consent before a healthcare professional can view medical data.
For people who already gave consent not much changes. However, if you have not made a choice yet, your medical data can be shared when you are admitted to the emergency department. Through this link you can read more, and register your preference.
Will my HIV care be continued?
Yes, HIV care will be continued. The HIV treatment centers are open, but your appointments are remote (either by phone or online video). Sometimes it is necessary to visit the hospital, for example when the HIV treating physician is not sure whether your successfully treated, or when you just got your HIV diagnoses.
When you are successfully treated and your virus is suppressed, you will probably be asked to skip your blood test. When you go to the HIV treatment center six months later, a blood test will be done. If you really want to get your blood checked the coming appointment, let your HIV care provider know. Sometimes they can make an exception.
If you just started taking HIV medication, or if there is another reason your viral load is not stably suppressed, you probably do have to get your blood checked. You will be called about the result, and based on the result an appointment will be made.
If you want to know the exact protocol in your HIV treatment center, it is best to get into contact with your HIV care providers. They can tell you what is applicable to your personal situation. The HIV treatment centers are open, so you can call them or send them an email. You do not have to worry about them being too busy, feel free to contact them if there is anything you want to know or if you are worried about your situation.
Will I run out of my HIV medications?
The novel coronavirus has temporarily reduced production of medicine and made transport more difficult. Companies are working hard to keep the medicine supply steady. The Hiv Vereniging is in close contact with the CBG (Dutch Medicines Evaluation Board) and follows up on the stock of HIV medication. Scarcity of HIV medication in the Netherlands is not expected at this moment. Also, Gilead, Janssen, MSD en ViiV state that they to not expect a shortage of HIV-medication in the Netherlands. No shortages of HIV medication are expected in the Netherlands.
Pharmacists are required by law to report any expected shortages to the CBG. The CBG also maintains contact with its colleagues at the European Medicines Agency (EMA) and colleagues worldwide. Naturally, the Hiv Vereniging is keeping an eye on any possible shortages (now and in the future), and will inform the community if these arise.
In any case, it is always important not to wait till the last minute to pick up new medications, but to be sure to allow some leeway so that you have your new medications in time.
Due to the novel coronavirus, we advise you to pick up your medications as soon as they are ready and/or when you get a new prescription. If you should fall ill, it would be very inconvenient to have to go to the pharmacy to pick up your HIV medications. Following your initial period of adjustment to the drugs, you can always get your medications for the next three months.
Does the novel coronavirus contain HIV?
No. There is absolutely no evidence of this.
Does HIV medication protect against the novel coronavirus?
At present, various treatment methods for people with COVID-19 are being researched. However, there is no scientifically proven evidence that HIV medication successfully treat or prevent COVID-19. HIV medication that was tested in the Netherlands is Lopinavir/Ritonavir (brand name: Kaletra). However, initial results do not indicate that this medicine is effective in treating COVID-19, so this medication is not tested anymore.
Does PrEP protect against the novel coronavirus?
PrEP contains Emtricitabine/Tenofovir (brand name: Truvada). There is no reason to assume it is effective against COVID-19. No evidence has shown that PrEP can prevent the coronavirus or that PrEP could help you to recover more quickly.
Is the normal flu vaccine effective against the novel coronavirus?
The normal flu vaccine helps to prevent the flu, but this vaccination does not help prevent COVID-19. Nonetheless, it is a good idea to get a flu jab. If you were to get the flu and COVID-19 at the same time, you could become more ill than if you only get COVID-19.
The flu vaccine is recommended for all people with HIV. If you haven’t received an invitation or you haven’t received your flu jab yet, get in touch with your general practitioner (GP).
Is the pneumococcal vaccine effective against the novel coronavirus?
The pneumococcal vaccine helps to prevent pneumococcal infection, but the vaccine does not help to prevent COVID-19. There is no evidence that the pneumococcal vaccine has a positive effect on the disease progress of COVID-19.
In some countries, the pneumococcal vaccine is routinely recommended for people with HIV, but this is not the case in the Netherlands. At present here, the pneumococcal vaccine is only recommended for people with HIV if they previously have had an invasive pneumococcal disease, such as COPD, of if they have used intravenous drugs. Therefore, it is possible that you read advice from other countries which states that all people with HIV should get the pneumococcal vaccine. However, this is not in the Dutch guidelines.
What should I do if I can’t get back to the Netherlands and I’m almost out of my HIV medications?
Check the ‘Special Assistance Abroad’ website whether it is possible to travel back to the Netherlands (for information in English, click the link and look at the bottom).
Call your health insurer or travel insurer’s emergency services number right away. They can arrange to get your prescription from your hospital and find out where to get the medications in the country you are visiting. The emergency service that you contact first (from your health care insurer or travel insurer) will arrange the assistance and processing of the costs. They will determine among themselves who will pay the costs. The quickest way is to buy new HIV medications locally and declare the costs to the health care insurer when you get home.
Therefore, it is important to save the receipts for the HIV medications. If the HIV medications in the country you are visiting are more expensive than in the Netherlands, your travel insurance will reimburse these higher costs if you have coverage for medical costs. Your basic Dutch health insurance will reimburse your costs up to the maximum Dutch price.
If you are in a country where it appears to be impossible to get your HIV medications or if you know that you will temporarily be without your HIV medications, contact your HIV practitioner or case officer to ask what your best course of action is. Do not start taking a different type of HIV medication without consulting your practitioner. Take your last pill as prescribed and stop all at once – do not try to stretch your supply by taking your pills every other day. When you get back to the Netherlands, you can restart your HIV medication in consultation with your HIV practitioner.
What can I do if I am now unsure about my income?
Information for employees can be found here. Information for entrepreneurs and the self-employed can be found here. Unfortunately this information is not available in English, so we recommend using Google Translate.
If you are a sex worker and your income has become uncertain, we advise you to contact the Dutch Emergency Fund.
Where can I ask questions about (chem)sex and the novel coronavirus?
Soa Aids Nederland has answers to all your questions about sex and the novel coronavirus, click here. Here you find information on chemsex and the novel coronavirus. Unfortunately this information is not available in English, so we recommend using Google Translate.
Can I keep using recreational drugs?
Information on recreational drugs and the novel coronavirus can be found here.
What can I do if I’m lonely or worried?
- Keep in touch with friends and acquaintances via telephone or internet. For instance, you could make a WhatsApp group, or call people more often.
- The Red Cross has opened a special telephone line for vulnerable people and people in quarantine. The Red Cross is available to talk about your concerns, give advice for your specific situation and, if necessary, to refer you to the proper assistance. The phone number is 070 – 44 55 888. They can be reached from 9.00 to 17.00 on Monday – Friday, and from 13.00-16.00 on Saturday and Sunday.
Are the activities of the Hiv Vereniging continuing?
Our activities have been discontinued for the present period. It is not yet known when our activities will begin again. We will keep you informed via this Q&A.
How do I get or stay into contact with other people with HIV?
Have you still got questions that haven’t been answered here?