Does HIV increase your risk for COVID-19?

Most people living with HIV probably do not have an increased risk of contracting COVID-19 or complications of COVID-19 when compared to the general population. HIV patients who are clinically and immunologically stable on HIV treatment are assumed to have the same general risk as people unaffected by HIV. But (there is always a but!), people living with HIV who still have a compromised immune system should be extra cautious to avoid contracting COVID-19.

These include people with HIV:

• With a low CD4 count (<200 copies/cell).
• With a high viral load.
• Not taking antiretroviral treatment.
• With a recent opportunistic infection (like TB, pneumocystis pneumonia (PCP), cryptococcal infection, etc.)

We know that people living with HIV are more vulnerable to respiratory infections when their HIV is not managed well. It is therefore very important to always take your antiretroviral treatment, but more so during this time.

Some people living with HIV may also have known risk factors for COVID-19 complications, such as an age above 65 years, diabetes and hypertension and therefore may have increased risk of COVID-19 unrelated to HIV.

There is no available data yet on how COVID-19 impacts people co-infected with HIV and TB. People living with HIV who are also living with TB, or who are TB survivors, often have lung damage; therefore they may be more susceptible to COVID-19 and may develop serious illness.

We will actively learn more about how HIV and COVID-19 together impact on people living with HIV.  If you are HIV positive and not on treatment yet, please visit one of the MSH doctors to start on treatment as soon as possible. It could save your life!

Preventing COVID-19 when HIV positive:

COVID-19 is prevented in people living with HIV by applying all the same measures that are applicable to the general public.  COVID-19 is a serious disease and all people living with HIV should take all recommended preventive measures to minimize exposure to, and prevent infection by, the virus that causes COVID-19.

Until more is known, people living with HIV – especially those with advanced or poorly controlled HIV disease – should be extra cautious and pay special attention to the prevention measures and recommendations. We know that this is a scary and uncertain time, more so if you are already living with a disease that decreases your immunity. Things people living with HIV can do to protect themselves and others from COVID-19 include:

• Washing hands frequently with soap and water (for at least 20 seconds) OR use an alcohol-based hand sanitizer where access to soap and water is restricted.
• Cough etiquette (into the elbow or a tissue that is then thrown away and hands washed).
• Physical distancing and wear a facemask when you have to go out in public.
• Seek medical care if you are coughing, have a fever or experience shortness of breath.
• Avoid touching your face as this is the main way the virus enters your body.
• Ensure that your vaccinations are up to date (especially your flu and pneumonia vaccines).
• Continue to take your HIV treatment regularly, as prescribed, to keep your immune system as strong as possible.
• People living with HIV who know their status and are not yet on antiretroviral treatment should start treatment without delay (contact MSH today to make a virtual appointment with one of our highly trained doctors to help you start treatment as soon as possible).
• Self-isolation if in contact with someone with COVID-19.
• Always remember safe sex practices. Read more about this in our latest blog on Sex & COVID-19.
• Other actions as per the government response.

HIV treatment be used to treat/prevent COVID-19:

HIV treatment has not been sufficiently proven to treat or prevent COVID-19.  Currently, there is insufficient data to assess the effectiveness of any type of antiretroviral (HIV treatment) for treating or preventing COVID-19.

It is important to note that the studies done using lopinavir boosted with ritonavir (LPV/r) or commonly known as Kaletra/Aluvia in South Africa had important limitations. The studies were small, timing, duration and dosing for treatment were varied and most patients received co-interventions/co-treatments which may have contributed to the reported outcomes.

To date, there is no proven vaccine or antiviral medicine to prevent or treat COVID-19. Please look out for the latest information on treatment and preventions at https://www.who.int OR https://www.cdc.gov.

Currently no evidence is available to justify switching from your usual antiretroviral therapy. Moreover, there is no evidence to support HIV-negative people taking antiretrovirals outside the context of pre-exposure prophylaxis (PrEP) to prevent HIV – PrEP should be taken as directed and there is no current evidence that PrEP is effective against COVID-19.

Extra supply of your HIV medication:

Multi-month supply of HIV drugs during the COVID-19 pandemic might benefit clinically stable adults, children, adolescents and pregnant and breastfeeding women as well as members of key populations (people who inject drugs, sex workers, men who have sex with men and people living in prisons and closed settings). This will reduce the frequency of visits to clinical settings and ensure continuity of treatment during disruption of movements during the coronavirus outbreak.

Persons for whom a regimen switch is planned should consider delaying the switch until close follow-up and monitoring are possible.

HIV Check-ups during the COVID-19 pandemic?

The need for HIV-related checks-ups or follow-ups during the COVID-19 pandemic should be discussed with your healthcare provider.  The risk and benefit should be weighed. Factors to consider include the extent of local COVID-19 transmission, the health needs that will be addressed during the appointment and the person’s HIV status (e.g. CD4 cell count, HIV viral load) and overall health.

Telephone or virtual visits for routine or non-urgent care and adherence counseling may replace face-to-face encounters. For persons who have a suppressed HIV viral load and are in stable health, routine medical and laboratory visits should be postponed to the extent possible.

PrEP in the time of COVID-19:

PrEP stands for Pre-Exposure Prophylaxis – taking medication to protect you agains becoming HIV positive.  It is interesting to note that many people are stopping their PrEP during this time, purely because they are not having sex! It makes sense, but it could also be dangerous if people resume sexual activity without protectecing themselves.  Read this interesting article about PrEP in the time of COVID-19.  The articel is from very useful website about HIV: thebody.com.

We know that it is very scary to live with HIV in the midst of this COVID-19 pandemic. We are here to help you! Please contact My Sexual Health for more information.

Please find below links to Do’s and Dont’s of COVID-19 in four of the South African languages, from the University of Cape Town, Department of Medicine:

• Xhosa
• Zulu
• English
• Afrikaans

Flattening the Curve in English and Afrikaans:

• English COVID19, Flattening the Curve
• Afrikaans COVID19, Flattening the Curve

Written by Dr Larisse Badenhorst – General practitioner with a special interest in sexual health and HIV
011 706 7006
www.drlarissebadenhorst.co.za
www.mysexualhealth.co.za

What is sexual pleasure?

 

Sexual pleasure as defined by the World Association for Sexual Health (WAS) is the physical and/or psychological satisfactionand enjoyment derived from shared or solitary erotic experiences, including thoughts, fantasies, dream, emotions and feelings.

Do men and women experience sexual pleasure in the same way?

 

Men and women differ immensely in the way they experience sexual pleasure. In sexual health, there are response cycles described to explain how men and women respond sexually. Most men associate with the linear Kaplan’s model, as depicted in the picture, where they experience desire spontaneously, followed by arousal and then orgasm and resolution.  Some just go straight to arousal and some do not relate with this graph at all! There are men who will start sexual activity without any desire and then only develop it after sexual stimulation – we are all different!

What is crucial for sexual desire and pleasure in men?

 

Testosterone is crucial for sexual desire and pleasure in men. Sex is integrated into real life and real life is integrated into sex. Sex is not an isolated fragment of one’s life. If you experience decreased desire (low libido) or decreased ability to perform sexually, please contact one of our doctors to be assessed. Sexual dysfunction can hide underlying disease.

Does ejaculation and orgasm mean the same thing?

 

Orgasm and ejaculation is not the same thing. Orgasm is a complex, subjective sensation, mostly experienced with pleasure and concentrated in the pelvic region spreading across the whole body systems. It is an integrated process between the brain (centrally) and local sensations (originating from the internal genitals, urethra and pelvic floor muscle contractions). Ejaculation is the release of seminal fluid. Ejaculating does not always mean that a man reached orgasm.  A man can also have an orgasm, but not ejaculate

Is pleasure only dependent on penetrative sex?

 

Pleasure is not only dependent on penetrative sex. The man’s perception of himself as a desirable sexual partner is traditionally linked to his skill as a lover. Such skills may include ability to maintain an erection, delay ejaculation and ideally reading the partner’s sexual needs and responding behaviorally. Sensual touch and emotional pleasure are as valuable as performance. Read about how to enjoy this in our blog on Sensate Focus Therapy

Written by Dr Larisse Badenhorst

Head of My Sexual Health Johannesburg

 

What is prostate specific antigen (PSA)? 

Prostate Specific Antigen (or PSA) is an enzyme exclusively produced by the epithelial cells of the prostate gland. It is released in very small amounts into the bloodstream. When there is a problem with the prostate (like cancer, enlargement or infection) more and more PSA is released. It eventually reaches a level where it can be easily detected in the blood.

What is the function of PSA?

The function of PSA is for the ejaculate to liquefy semen to allow sperm to swim freely. It is also believed to create the correct pH balance for sperm to survive and also instrumental in dissolving cervical mucus, allowing easy entry of sperm into the uterus.

 

When do you do a PSA screening on your blood?

PSA screening does not lower your risk of having prostate cancer; it merely increases the chance that you will find out that you have it, before it is too late to treat. PSA testing can detect early-stage cancers that a digital rectal examination (DRE) would miss. PSA is done from the age of 50 in conjunction with a digital rectal exam (DRE) for prostate cancer screening. PSA is done from the age of 40 or 45 if you have a strong family history of prostate cancer and from the age of 45 in black men, who have a higher risk to develop prostate cancer.

What does an elevated PSA result mean?

Elevated levels of PSA in blood are associated with prostate cancer, but it is not a perfect test for cancer. The PSA level also tends to rise in men with benign prostatic hyperplasia or BPH (enlargement of the prostate) and is a good marker for prostate volume. PSA levels are usually also elevated in men with acute bacterial prostatitis (inflammation of the prostate). Recent ejaculation can also increase levels, as well as prolonged bike riding.

Pitfalls of a PSA:

Pitfalls of a PSA test is that a “normal” PSA level of 4 ng/ml or below does not guarantee that one is cancer-free; in about 15% of men with a PSA below 4 ng/ml, a biopsy will reveal prostate cancer. Another pitfall of a PSA is that some men with prostate cancer may even have low levels of PSA. PSA can also be diluted in men who are overweight or obese, due to a larger blood volume.

What other tests can be done with a PSA?

The PSA blood test and the digital rectal exam (DRE) are done in conjunction for prostate cancer screening.  During a DRE, the medical doctor inserts a gloved, lubricated finger into the rectum and examines the prostate for any irregularities in size, shape, and texture.

Watch this video: – it conveys both the seriousness and the slightly ridiculousness of the procedure. At My Sexual Health we also know that everybody finds it a bit weird and uncomfortable, but we do it, because it is in your best interest to detect cancer early!

In conclusion, prostate cancer is a treatable condition these days, if it is detected early enough.  Please ask your doctor to do a PSA level on you annually and don’t shy away from those rectal exams – it could save your life!

All of the MSH doctors offer prostate cancer screening, but you can have it done by any doctor.  You do not need to see a urologist for a prostate check, unless your primary care doctor has picked up something suspicious or you have concerns that cannot be resolved by your GP.

 

Written by Dr Larisse Badenhorst

Head of My Sexual Health Johannesburg

What is PrEP (Pre-Exposure Prophylaxis)?

PrEP is medicine people at risk of HIV infection take to prevent them from becoming infected with HIV. It is mainly used to prevent getting HIV from anal and vaginal sex. PrEP is not effective against protecting against other STIs (Sexually Transmitted Infections)

 

Is PrEP safe?

PrEP is safe. Side effects like diarrhea, nausea, headache, fatigue and abdominal pain occur. These side effects usually subside within about 2 weeks.  The medication used for PrEP (Truvada or one of its generics) can be harmful for your kidneys and certain very rare circumstances.  Never start PrEP before seeing a doctor and having your kidneys tested.  Your kidneys also need to be tested every three to six months when you are taking PrEP.

 

How effective is PrEP?

PrEP is highly effective for preventing HIV. It reduces the risk of getting HIV from sex by more than 90%. It reaches maximum protection for receptive anal sex at about 7 days of daily use and 21 days for receptive vaginal sex.

What medication is used for PrEP?

The medication used for PrEP is a combination of 2 drugs, Emtricitabine 200mg & Tenofovir Disoproxil Fumarate 300mg. This combination is commonly known as Truvada. Generic forms are also available which contain the same active drugs. You take one tablet per day.

Other forms of treatment are also being investgated, for instance long acting injectable PrEP as well as PrEP in vaginal preparations.

Can PrEP can taken on demand? 

Yes, PrEP can be taken on demand! If taken correctly, the results from the Prevenir study show that it is just as effective as when it is taken daily.  It is easy to remember how to do it: 2:1:1 – You take two tablets 24 to 2 hours before the anticipated sexual contact.  You then take one tablet per day until 1 day after the last sexual contact.

Who can take PrEP?

PrEP can be taken by people who are HIV negative. It can be used by men and women, both trans- and cis-gender.  Any person at any risk to become HIV positive.

 

What monitoring is needed while using PrEP?

While using PrEP you need to monitor the following:

• HIV (baseline and then every 3 months of treatment)
• Kidneys (baseline and then every 3 to 6 months)
• Hepatitis B (baseline)
• STI screening and treatment (with every follow up)

PrEP is a safe and effective way of protecting yourself agains HIV.  We highly recommend it! Please do remember that it does not protect you agains any other sexually transmitted infections!  We offer PrEP as well as other HIV and STI services at all our branches. Please reach out to us if you need help!

 

Dr Larisse Badenhorst

MSH Johannesburg