COVID-19 has put a strain on people all over the globe. In the U.S., healthcare systems are struggling to keep up with increased patient demand and limited resources. It’s no secret that other public health concerns have taken a backseat to COVID-19, and for good reason, but on World AIDS Day 2020, the infectious disease experts at ID Care would like to remind everyone that HIV cannot be ignored.
As a global community we must unite in the fight to end the HIV epidemic, support people living with HIV, and honor those who have lost their lives. During this pandemic that means strengthening the capacity and resilience of communities and health systems to address HIV prevention and treatment services despite the strains COVID-19 has put upon healthcare professionals and those living with HIV. It also means becoming educated on the history of HIV and using the lessons learned to better combat all infectious diseases, including COVID-19.
In this article, HIV expert and ID Care specialist Dr. Ajay Mathur discusses HIV – from the evolution of its treatments to its parallels with COVID-19, and most importantly, the things HIV patients and healthcare organizations need to know about HIV care during the COVID-19 pandemic and moving forward.
The Evolution of HIV Treatment and the Impact on Infectious Diseases
HIV stands for human immunodeficiency virus. This sexually transmitted infection (STI) damages the immune system of an affected person, hindering their body’s ability to fend off disease-causing organisms. Although it is classified as an STD, HIV can also be spread by contact with infected blood, including by sharing needles.
HIV progresses in phases, causing different signs and symptoms to manifest in each – such as fever, fatigue, and weight loss. If left untreated, HIV can develop into acquired immunodeficiency syndrome, otherwise known as AIDS.
When HIV first hit the world in the 1980’s, it was essentially a death sentence for those who contracted it. “Very similar to coronavirus, there were very few if any treatment options available,” said Dr. Mathur. “However unlike coronavirus, HIV was universally fatal. In the earlier days of HIV, much like COVID-19, all we could do was try to find out who was at risk, what was the mode of transmission, and ultimately what were our treatment options. And sadly, at the time, there were none.”
Thanks to modern HIV treatment breakthroughs, most patients in the United States will not develop AIDS, and can still have a normal life expectancy. Over the past several decades, antiretroviral drugs have been used to alter the natural progression of HIV infection. This type of treatment, known as highly active antiretroviral therapy, or HAART , has turned a once a fatal diagnosis into a chronically managed disease.
HAART is a customized combination of medications that a physician prescribes based on such factors as the patient’s viral load (how much virus is in the blood), the particular strain of the virus, the CD4+ cell count, and other considerations (e.g., disease symptoms). “Today, we’re talking about multiple medications that are more effective, better tolerated, and keeping people alive for years and years,” said Dr. Mathur.
And perhaps, moving forward, this type of therapy will help inform the way the medical world treats COVID-19.
HIV and COVID-19 Parallels: What Can Be Learned
COVID-19 and HIV are similar in that they’re both novel illnesses for humans. The way HIV is treated, using the HAART method of multiple medications, could prove to be useful in the treatment of COVID-19. Whereas both viruses are slippery, or have the ability to mutate, a multi-hit hypothesis could be used to hinder the spread of coronavirus from different spots using multiple medications.
“COVID-19, like other viruses, has receptors that need to connect to our human cells in order to get into our bodies and cause a problem,” said Dr. Mathur. “So we might impact that receptor by inactivating it so it can no longer connect to the human cell. However, if the virus does connect to the cell, then we can try to prevent the virus from entering the cell and causing any problems once inside. And if that doesn’t work, we will attempt to prevent replication or duplication of the virus. And this is how we treat HIV, using multiple medications to the hit the virus at different spots.”
By hitting these spots simultaneously there is a better chance of creating milder symptoms. “This could ultimately become the way COVID-19 is treated,” Dr. Mathur explained.
The parallels between all infectious diseases are fascinating and give specialists invaluable information when it comes to dealing with pandemics like the one the world is going through right now. However, a pandemic is more than just science; it’s a public health concern that requires the right treatment to get to a patient at the right time. While research and testing of vaccines and therapies for COVID-19 are of the upmost importance, at this moment, from a public health perspective, HIV patients need better access to care – and that’s where a network of infectious disease specialists, like the physicians at ID Care, come into play.
Better Access to HIV Treatment During the Pandemic
ID Care has been providing effective HIV treatment and services for New Jersey residents and healthcare organizations since 1996. It is not uncommon for a patients to come into a hospital setting with an unrelated condition, and after initial testing, find themselves diagnosed with HIV. In this instance, those patients would become ID Care patients moving forward, utilizing the infectious disease experts at ID Care to help manage their symptoms and treatment.
However, more often than not, people get screened in an outpatient setting at one of our ID Care’s offices. “It’s recommended that every adult get tested at some point,” said Dr. Mathur. “However, this is not always the case. Often times we see people come in to get tested for a life insurance policy or other times a good astute internal medicine doctor might run an HIV test as part of a patient’s evaluation and HIV is found. When that happens, our ID Care experts essentially become HIV specialists and primary care physicians for that patient moving forward.”
Do to HAART therapy, HIV has essentially become a chronic condition, similar to hypertension or diabetes, and it’s ID Care’s job to decide what the right treatment choice is for a given patient, and then manage that treatment. Yes, there are therapeutic options that improve the life expectancy for patients with HIV. But without continued treatment, that life expectancy goes down and complications rise. The COVID-19 pandemic has put particular stress on people all over the world, HIV patients included, and recently, the proper treatment has seemed to take a back seat. “This has happened to three or four of the patients I take care of,” said Dr. Mathur. “Because of the lockdown or the fear of going out, some of my patients skip treatments, miss bloodwork, or fail to refill a vital medication they are on.”
It’s understandable that some are afraid to leave their homes and go to a pharmacy or receive treatment. As medical professionals, it is important to create solutions for HIV patients to receive the care they need during this time. “What we try to convey to patients is if there’s an issue we’ll work around it,” said Dr. Mathur. “There are several measures we’ve taken in our offices to maintain a sanitized environment with staggered appointments and minimal human contact. Convenient telehealth options are also very important. Beyond that, we like to let patients know that blood work can be done remotely, by mailing a blood slip. All of these options are so important for making sure our patients HIV stays under control.”
The bottom line is patients still need care, despite the pandemic. The healthcare community and patients living with HIV can’t let the proper care fall to the wayside because of what else is happening in the world. There are safe ways to administer and receive treatment, and we all must come together to ensure the proper measures are taken.
As stated earlier, during this pandemic we must work together to strengthen the capacity and resilience of communities and health systems to address HIV prevention and treatment services despite the strains COVID-19 has put upon healthcare professionals and those living with HIV. ID Care is the largest independent infectious disease practice on the East Coast, and the second largest in the United States. With leading-edge infectious disease services , this World’s AID Day, we’d like to help more healthcare organizations and patients provide and receive the very best HIV care during this difficult time. If you want to learn more about how ID Care can help, call 908-281-0610 to schedule a consultation with an ID Care expert or visit the ID Care partner page to learn more.