HIV and Opportunistic Infections, Coinfections, and Conditions

COVID-19 is caused by a virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and can be spread from person to person. Transmission of SARS-CoV-2 primarily occurs when a person inhales respiratory droplets or particles that contain the virus or when a person touches their mucous membranes with hands that have been contaminated with the virus.

Anyone can get infected with SARS-CoV-2 and become severely sick or die from COVID-19. However, people with underlying medical conditions or those who are immunocompromised or have a weakened immune system are more likely to get very sick, be hospitalized, need intensive care, require a ventilator to breathe, or die from COVID-19. People with HIV have higher rates of certain underlying medical conditions. The human immunodeficiency virus (HIV) weakens the immune system and can cause a person to be immunocompromised.

Currently, there are a lot of unknowns about COVID-19 and how it affects people with HIV. However, people with HIV, especially those with advanced HIV or untreated HIV, may have an underlying condition or a comorbidity that can make them severely sick if they become infected with SARS-CoV-2.

You should follow CDC recommendations regarding symptoms of COVID-19 and get tested immediately if you think you might be infected with SARS-CoV-2. A person can be infected with SARS-CoV-2 but show only few symptoms or no symptoms at all (also known as asymptomatic infection). Testing is the only way to know that someone has been infected with SARS-CoV-2. Testing also ensures that people are not spreading the virus to others.

Most health care providers offer COVID-19 testing. Contact your health care provider if you are experiencing COVID-19–related symptoms or have come in contact with an infected person. People can also get tested for COVID-19 at their local pharmacies by making scheduled appointments or drive throughs or by purchasing at-home rapid tests over the counter at local pharmacies. Residential households in the United States can now order free at-home testing kits from the U.S. Postal Service. Visit CDC website for more information about self-testing and visit your state or local health department’s website for information on additional testing sites.

People with HIV should immediately contact their health care provider if they test positive for COVID-19. People with HIV should also continue taking their HIV medicines as prescribed. HIV medicines are known as antiretroviral drugs.

There are three COVID-19 vaccines that are Food and Drug Administration (FDA)-approved or authorized for emergency use in the United States. CDC recommends that people with HIV who are eligible should get a COVID-19 vaccine primary dose (also known as initial dose), as well as a booster dose, regardless of viral load or CD4 T lymphocyte cell count. The COVID-19 vaccines approved or authorized for use in the United States have one or two initial doses. The number of initial COVID-19 vaccine dose you need will depend on the type of vaccine you receive.

CDC also recommends that people with advanced or untreated HIV get an additional primary dose to boost their immune response. An additional primary dose is the dose given after a person receives the initial dose of a COVID-19 vaccine. People with HIV should talk to their health care provider whether they need an additional primary dose.

People who are vaccinated against COVID-19 can still get infected with SARS-CoV-2 but getting vaccinated decreases the risk of severe illness, hospitalization, and death from COVID-19.

COVID-19 vaccines are safe for people with HIV. People with HIV were included in COVID-19 vaccine clinical trials. COVID-19 vaccines meet the FDA’s standards of safety, effectiveness, and quality. According to CDC, there is no evidence that COVID-19 vaccines interfere with medicines to treat or prevent HIV. HIV medicines that treat HIV are called antiretroviral drugs while HIV medicines that prevent HIV are called pre-exposure prophylaxis.

There are drugs that are FDA-approved or authorized for the treatment of COVID-19. You should talk to your health care provider about potential drug-drug interactions if you are taking HIV medicines and COVID-19 treatment. To learn more about drug-drug interactions, read the What is a Drug Interaction HIVinfo fact sheet.

People with HIV should follow the general CDC protocols on how to protect yourself and others from COVID-19. Getting fully vaccinated against COVID-19 can protect you and others from COVID-19. People with HIV can also protect themselves from COVID-19 by—

• Maintaining a healthy lifestyle.
• Continuing to take antiretroviral drugs to strengthen the immune system.
• Ensuring that all vaccinations, including vaccination against the flu, are up to date.
• Maintaining adequate supply of antiretroviral drugs (at least 30 days’ supply) and other drugs needed to manage HIV; you can talk to your health care provider about getting your HIV medicine by mail.
• Keeping all medical appointments and observing safety protocols during in-person medical visits; people with HIV should opt for telemedicine when possible.

From CDC:

• HIV and COVID-19 Basics
• Self-Testing at Home or Anywhere
• How to Protect Yourself and Others

From U.S. Department of Health and Human Services:

• Guidance for COVID-19 and People with HIV

From National Institutes of Health:

• Coronavirus Disease 2019 (COVID-19) Treatment Guidelines
  • Special Considerations in People with HIV
• COVID-19 Testing

Also see the HIV Source collection of HIV links and resources.