World AIDS Day, which is celebrated globally on 1 December, is a day to generate more awareness about HIV/AIDS- a viral infection that makes people chronically sick by reducing immunity. 

With advent of effective research based antiretroviral drugs and increased awareness among people regarding HIV/AIDS, improved HIV related health services down to health care level, prevalence of HIV has been significantly reduced in Rwanda and some other countries as well. 

The outbreak of Covid-19, a practically new, hitherto unknown infection, has disrupted lives of people worldwide in multiple ways. Sudden sickness, lock downs, loss of jobs and trades, non-availability or lack of adequate health personnel has come with a lot of stress.   

It also put people with HIV/AIDS at enhanced risk of acquiring Covid-19 infection and in a more severe form.  As per World Health Organisation report published in July 2021, people living with HIV/AIDS( PLHIV), had 30% greater the risk of developing severe and more fatal form of Covid-19 infection, as compared to people without HIV.  The virus has been identified as an independent risk factor for severe Covid-19 disease.

Those on anti-retroviral therapy (ARV) for HIV infection, tend to develop chronic illness like hypertension and diabetes as adverse effects of ARV drugs. Apart from this, advancing age, use of alcohol, tobacco, mental and or physical stress are factors that enhance risk of these comorbidities, which further significantly increase risk of more severe Covid-19 infection.  

People affected by Covid-19 but were seemingly on way to recovery have died suddenly due to heart attacks, strokes, kidney failure,  as coronavirus was found to cause clots in blood vessels, thus obstructing blood flow to vital organs, resulting in their failure.  

Covid-19 pandemic has put a load on health services worldwide, due to multiple factors.  Sheer load of affected individuals, increased load on every aspect of health services which practically broke down even in countries with advanced health systems like western nations, this affected HIV/AIDS services as well. 

People had difficulty in reaching health centres for their regular tests and treatment, which would have caused interruption of continuity of antiretroviral treatment as well.  

As such, Rwanda’s response to the pandemic, since its beginning in March 2020, has received international praise for its effectiveness. 

Despite limited resources, the country’s well organised health care system, rapid deployment of testing procedures and good vigilance and care of Covid-19 positive patients, have led to a successful public health response. To date, Rwanda has the highest number of people fully vaccinated in East Africa.

Now with reduction in new Covid-19 positive cases, easing of lockdown, onus is on residents to be careful so that the number of Covid-19 cases does not increase. 

People living with HIV/AIDS have to be extra vigilant to take precautions against acquiring Covid-19, as they are already immune supressed. Use of face masks and hand sanitisers, frequent hand washing, maintaining a distance of about 2 meters from others, avoiding crowded places, are still effective and advisable measures to prevent Covid-19 infection. 

Those taking antiretroviral drugs should continue taking them uninterrupted. Trials are being conducted to assess efficacy of antiretroviral used for HIV, in Covid-19 infection, but up to now, no significant effect has been documented. The HIV positive person affected by Covid-19 as well should inform his health care provider about his HIV status and also the drugs he is taking. The health care provider should be careful to see that there is no drug interactions among medicines he prescribes and antiretroviral which the person is taking, so as not to reduce its efficacy or augment its toxicity.

As per WHO guidelines, all HIV positive persons should be vaccinated against Covid-19, irrespective of viral load or CD4 count. Health care providers should be consulted for taking booster dose.

People living with HIV now have a better quality of life and longevity, due to strengthening of HIV/AIDS health care system, as compared to a decade or so before. Let not that weaken due to Covid-19.

Dr. Rachna Pande is a specialist in internal medicine