A brief thread on COVID-19, gay men and HIV. When COVID-19 arrived many HIV positive gay men were particularly concerned. For years people living with HIV have been advised to get an annual flu jab. The reasoning was simple: reduced immunity meant increased risk to infections.
2./ Since advice has been those who require an annual flu jab are especially vulnerable to COVID-19 many positive guys have been fearful. Yet, rumours abound (and I don't mean those nutjob ones about 5G) that challenge the assumption people living with HIV really are at more risk
3./ No one can definitively say, so PLEASE this thread is NOT health advice. It's merely a walk through published studies and reports and it will end in questions not suggestions. It all starts in early January with a glimmer of hope....
4./ It was then a leading clinician at Beijing University Hospital's pulmonary and critical care medicine department reported he'd treated himself with a well-known anti-HIV drug and had quickly recovered. That drug was Kaletra.
5./ Kaletra is a combination of two active ingredients, lopinavir and ritonavir. The first targets a crucial enzyme HIV uses to replicate itself, protease. By inhibiting protease it stops HIV taking over more cells and wreaking havoc. Ritonavir increases the efficacy of lopinavir
6./ Kaletra is a wonder of the pharmaceutical industry and it's helped turn HIV from the terrifying nightmare it once was to a manageable condition. A trial of kaletra was announced and the manufacturer AbbVie flew $10M worth of the drug to China. fiercepharma.com/pharma-asia/ch…
7./ A clinical trial like this could be done because doctors already (roughly) know the safety profile of drugs that have been widely used. It's the reason why hydroxychloroquine, Trump's so-called miracle cure can go straight to trials too. Don't expect much from that by the way
8./ Here's a brilliant takedown article that traces the legend of hydroxychloroquine from kooky local doctor to Fox News. A French doctor who likes to vlog his own pet theories to the public has also promoted that treatment. nytimes.com/2020/04/02/tec…
9./ But the latest trials for hydroxychloroquine show no benefit and actually higher risks of heart failure. Who knew something Marine Le Pen and Trump promoted would turn out to be rubbish. And Kaletra? That trial failed too. cebm.net/covid-19/lopin…
10./ This peer-reviewed paper reported there was no difference of outcome between 99 patients treated with kaletra and 100 who were not. There was though an intriguing question left hanging: those treated earlier seemed to fare slightly better. nejm.org/doi/full/10.10…
11./ Here's a less academic take on the results that lays out the dissenting view. Kaletra continues to be studied but increasingly something else is beginning to overshadow the story of that drug and its potential role or otherwise. fiercepharma.com/pharma-asia/do…
12./ Across the world...and it is only VERY tentative at the moment... some clinicians and some gay men living with HIV themselves are beginning to report an unusual phenomenon. Fewer people with HIV than were expected appear to have been showing up in hospitals or ICUs.
13./ This may be explained by increased fear but I've lost count of mates who are living with HIV who say they're not sticking to the strictest lockdown and came into contact with people who were not HIV positive who succumbed to COVID-19 yet they themselves remain unaffected.
14./ Now since testing isn't being widely done this is impossible to verify. But it does at least VERY tentatively suggest that perhaps living with HIV does not make people especially vulnerable. So is this all hail kaletra? It appears not.
15./ The phenomenon is being witnessed in countries where kaletra is not routinely prescribed nor other protease inhibitors. Here's a fascinating discussion led by Dr Josep M Libre in which he explores what might (..MIGHT...) be going on. clinicaloptions.com/hiv/conference…
16./ Some clinicians have reported another drug Tenofovir may be playing a role. It's claimed that some of those who do succumb aren't on it. If you're living with HIV you'll know this as the brand Truvada. It's a powerful anti-viral used in Hep B as well as HIV treatment.
17./ Ironically as so often in pharmacology tenofovir was discovered before HIV was even isolated. It then proved to be useful. It was the great Czech researcher Antonín Holy who discovered it. Here's a lovely tribute to his life and work. radio.cz/en/section/cur…
18./ No one can yet say if tenofovir DOES play any role at all. Clinical trials would need to be carried out. Even if it does it is too early to opine on whether it's protective taken long in advance as a form of PREP or would make any difference given once symptoms take hold.
19./ It may even be some other clinical effect of tenofovir that plays some protective role. Or the whole story ...like kaletra...could just turn out to be mist in the morning. What doesn't seem to be in doubt though is some good news for people living with HIV....be less afraid.
20./ They don't appear to be at greater risk than the general population from COVID-19. That matters because anxiety can make us unhealthy in itself. Remember, though everyone (whatever their HIV status) should continue to follow the guidelines on social distancing, etc
21./ So here's some questions. They are highly unscientific but who knows they might be interesting. If you're living with HIV have you experienced symptoms that convince you you had COVID-19?
22./ Do you know people who are living with HIV who came down with COVID-19 symptoms?
23./ If you're living with HIV have you come into close contact with people who had COVID-19 or succumbed very soon after you met them yet you have remained healthy?
24./ I hope this thread has been of interest or even useful to anyone living with HIV whether they're LGB or T or Q or Straight for that matter. Whatever our differences, the virus isn't interested in our sexuality or our identity. 😉
