COVID guidance evolves rapidly. Please check the NHS and GOV.UK websites for the latest advice
Friday 17 December 2021
New COVID treatments
There are now several COVID treatments available. At the moment there are three main types:
1) Antivirals: target SARS-CoV-2 (the virus that causes COVID-19) to stop it reproducing:
a. Remdesevir: by injection into a vein and used in some hospitalised people only;
b. Molnupiravir: given as a course of tablets and available through the PANORAMIC trial or routine NHS care, more detail below.
2) Neutralising monoclonal antibodies (nMAB): are proteins designed to ‘mop up’ SARS-CoV-2 so that it can’t infect cells. They reduce the risk of hospital admission if given early and of dying from COVID.
a. Casirivimab + imdevimab: injection into a vein, this combination treatment is less effective against the Omicron variant, so it is only used in some hospitalised people;
b. Sotrovimab: given by injection into a vein, used in some hospitalised people and also available for non-hospitalised people (see below).
3) Anti-IL-6 monoclonal antibodies: these are used to reduce levels of inflammation in some hospitalised people. There are two types, tocilizumab and sarilumab
PANORAMIC Trial: https://www.panoramictrial.org/
This trial is open to ALL people with HIV with symptoms and a positive PCR test. You can sign up on the website. The trial compares the antiviral molnupiravir to usual care alone, with a 50:50 chance you will get the drug. Being on the trial does not stop you getting other recommended treatment.
Routine NHS outpatient treatment
Some people are eligible for community COVID treatment with a nMAB or molnupiravir if an nMAB is not suitable. You are eligible if:
You have symptoms PLUS positive SARS-CoV-2 PCR test within the last 5 days and
You are a member of a high-risk group, which includes the following people with HIV
- Uncontrolled/untreated HIV or acute AIDS defining diagnosis
- On stable treatment for HIV with CD4 <350
- On ART with CD4 >350 + additional risk factors (eg age 55 or older, on treatment for diabetes, obesity, heart failure, liver cirrhosis, kidney disease, homelessness or alcohol dependence)*
Eligible people should be contacted by the NHS by letter and/or text. Ideally, if you meet the criteria above, you should have a PCR test kit at home – speak to your GP, call 119 or get a test online: https://www.gov.uk/get-coronavirus-test. If you are not contacted within 24 hours of a positive test, call your GP or 111. If you have not heard from the NHS and think you are eligible, your GP or HIV service may be able to refer you for treatment if you have a positive COVID PCR test.
You may be contacted by the NHS but then advised you are not be eligible as the system is likely to initially over-estimate the number of people who need treatment. It is also very likely that who is eligible will change over time. The first guidelines were based on predicted number of COVID cases that are lower than we are seeing. It is important that those at the very highest risk get treatment so some people considered eligible now may not be over the coming weeks.
Arrangements will be different across the home nations. If you have not shared your HIV status with your GP or are recently diagnosed you may not be contacted – speak to your HIV clinic.