Extremely vulnerable populations and shielding

Wednesday 25 March 2020

The British HIV Association (BHIVA) and the Terrence Higgins Trust (THT) have updated their 23 March 2020 COVID-19 statement for people with HIV in the light of the latest UK Government advice: https://www.gov.uk/government/publications/full-guidance-on-staying-at-home-and-away-from-others

Everyone is advised to stay at home and:

• Only go outside for food, health reasons or work (where this absolutely cannot be done from home);

• Stay 2 metres (6 feet) away from other people;

• Wash your hands as soon as you get home.

The guidance includes how to reduce risk if you must go outside.

There is separate guidance for people or households who are isolating and ‘shielding’ for people with conditions considered extremely vulnerable, which does not include HIV: https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19.

Although there remains no evidence to determine whether people with HIV are at greater risk of getting COVID-19 or severe disease, BHIVA and THT advise that people with a CD4 less than 50, or who have had an opportunistic illness (a serious illness due to suppression of the immune system) within the last 6 months, should be encouraged to follow the shielding advice for the extremely vulnerable. As this advice is not part of the official PHE guidance, clinicians do not need to contact these individuals with the formal letter that has been circulated to Trusts but may choose to contact them on a case by case basis.

In summary:

1. People with CD4 ≥200 and undetectable on ART are considered at no greater risk than the general population; follow general advice.

2. People with CD4 <200, detectable viral load or not on ART may be at higher risk of severe illness; follow general advice.

3. People with a CD4 count <50 or opportunistic illness in last 6 months; follow shielding advice for extremely vulnerable.

For further information, please contact [email protected] or for media enquiries, please contact Jo Josh at [email protected] or +44 (0)7787 530922.