The following is a transcript of the conversation between Karl Schmid and Dr. Anu Seshadri.
KARL
Dr Anu and I talk HIV, COVID and where we stand today.
Hello there, welcome to Plus Talk on Plus Life where we are all about turning positive into a plus. And speaking of positive, it’s our favorite doctor, Dr. Anu Seshadri, she is back, she is here for a COVID update. Who would have thought we’d still be talking about this doc?
DR. ANU
I didn’t think this would be the case, but we’re here, we’re back at it again.
KARL
We are back at it. Now, you and I have spoken over the past year, we’ve talked about those of us like myself, living with HIV and what the COVID risks are. And I think it’s fair to say that we’ve been pretty uniform in saying that if you’re healthy and undetectable and you don’t have any other conditions like diabetes or high blood pressure or hypertension, then really we’re at no greater risk than any other generally healthy person, right? But there have been some headlines that have come out recently including the world health organization which I think is sort of, I know one looks to as an authority on these things and they say that the World Health Organization warns that HIV infection increases risk of severe and critical COVID-19. So have studies come out? What is the latest, what should we be worried about and what should we be paying attention to?
DR. ANU
Yeah, Karl, I would say at this point there are many studies that are being conducted regarding COVID and HIV. Thus, there’s a lot of uncertainty regarding this with conflicting outcomes and opinions. So studies that are being conducted on the effectiveness of COVID vaccines, medications used for HIV to combat COVID, COVID and its effect on HIV positive individuals, how mRNA technology can be used to make HIV vaccinations. I mean, there’s plenty of studies that are currently being conducted but I would say that with the WHO and what has been stated, you could say that there is an increased risk for those that have HIV but it needs to be further stratified, are those individuals that were being studied were there CD for our counselor, was their viral load high, did they recently have an opportunistic infection, what I mean by that is something like TB. Did they have an AIDS defining illness? Did they have other co-morbidities, meaning did they have, were they obese? Did they have high blood pressure? Did they have heart disease, all the other risk factors that you would just stated that increase your risk of COVID. So at this point, I’m gonna say, we just need to put, be patient like we have for the past year or so and see what further studies show to see if there is an actual increase risk and how much of an increased risk is there of having HIV when it comes to COVID and its effects just solely without any other confounding variable.
KARL
Right, so bottom line though then is much like the entire way through this pandemic. We’re still learning and things are changing on a daily basis. So probably the best and safest thing whether you’re living with HIV or not, that you can do is get the vaccine, right?
DR. ANU
Yeah, so I would say with the vaccine, there’s been a lot of news as well as a lot of talk when it comes to, is the vaccine safe, when it comes to HIV? Yes, it is been safe especially if, even if you’re on PREP or even if you’re on antiretroviral therapy, please do get the vaccine. I would say this though, if your counts are not high enough so that means if your CD4 count is low and your viral load is high, there is a question as to the effectiveness of the vaccine, is your immune system strong enough to mount a good enough response when you do get vaccinated? So for those individuals, I would say that I would recommend and it is being done that you want to place individuals on antiretroviral therapy or modified their therapy so that the counts can increase so that you can build a good enough immune response. So, I mean, we’re gonna talk about hopefully booster soon but we can talk about, yeah.
KARL
Yeah, that’s my next question. So what’s your take at the moment on booster shots? Do we need a booster shot? If so, when should it happen and third part of that is if I’ve had I’ve come from another country I’ve had AstraZeneca, is a Pfizer booster shot good. I’ve heard conflicting again. I’ve heard you’ve got to keep the same medicine or the same vaccine. But then I’ve also read articles that say, actually if you’ve had the AstraZeneca and then the Pfizer is great. So where are we at with boosters?
DR. ANU
I know isn’t this so frustrating even for me as a healthcare professional when I need to look for guidance? There’s so many conflicting studies and so many conflicting opinions that are out there. So this is why I need to remind myself to continue to stay patient until we have enough data. Again, I’m saying this unless we have enough data to show an actual safe and a positive outcome when it comes to studies in general. So what do we know right now? The vaccination is definitely showing protection against severe disease at about 97% and efficacy against symptomatic disease, unfortunately has been shown to decline at about 6% every two months after being vaccinated. But these are studies that were done mainly on other variants and now we’re currently studying the Delta variants. So these values may change but I think the general gist of them will still hold true. And as for what my colleagues in India have told me, those that were vaccinated definitely did not have severe disease compared to those that were unvaccinated. Whether a booster is recommended, it’s still being debated as I said and maybe recommended for some people such as those that are elderly or at high risk. We know that the booster shots are planning on being implemented in such a population for example in countries like Israel. So it’d be really interesting to note their data but we still need to get further data on can like a booster shot really be what is it really needed number one and when will it be needed? I know Pfizer and Moderna are currently studying booster shots and potentially it being implemented in the near future, but ultimately I think that given the fact that our population here in the United States only 50% or so have been vaccinated and with new variants emerging, unfortunately more than likely we’re gonna need some sort of booster shot at some point.
KARL
Do you think it matters then if I’ve had the Pfizer or Johnson and Johnson or the Moderna which booster I get?
DR. ANU
I would say at this point, it is recommended against getting a different brand or a booster at this point too. We don’t know how your immune system will respond or the adverse effects to potentially getting a different brand. We don’t know the efficacy of even mixing and matching these brands. That’s the reason why we had encouraged patients that when we got the initial round of vaccines whether you to stick with either Pfizer or Moderna because we didn’t know what the efficacy would be or the safety profile would be if you were to get another shot so my answer is no until we get more data and know about the effectiveness and more so the safety, the safety of mixing and matching, we shouldn’t be doing anything at this point.
KARL
So what would you say to someone who’s living with HIV, who is still not vaccinated?
DR. ANU
So I would say to continue to do what we know works, that would be wearing your mask and then socially distancing in crowded areas. If you’re indoors, try and be in an indoor area where it’s nice and well ventilated. Be safe and be extremely vigilant especially in situations where you don’t know if everybody in the crowd is vaccinated or not. Continue to practice your hygienic measures, clean shared surfaces, implement all the things that we’ve been encouraging people to do in general, there’s no difference. But what I do tell my own patients who do have HIV is this is really important to take your HIV medications and be compliant with them, take them on a regular basis, make sure that your CD4 counts are high enough and your viral load is low enough. It’s really, really important. Make sure that your medications that you have in a 30-day supply, if not at least a three months supply of medications. This is a great opportunity for us to refocus on just our lifestyle in general, making sure that we eat and exercise. So as to minimize the other risks that we talked about when it comes to COVID-19 such as obesity, high blood pressure, diabetes, liver disease, heart disease. So we wanna make sure that our lifestyle measures otherwise are also up to speed and the best that it can be. And ultimately, if you do have a nice dress, this constantly is, look at your mental health and seek support if you really need it.
KARL
Yeah, now we’re talking about medicines there. There have been some clinical trials that have been looking at where the HIV meds can treat COVID-19, where do we stand with that?
DR. ANU
Yeah, again, as of right now, I would say that we don’t have any definite data. There has been a study, I think that came out of Spain where Tenofovir was found to be protective against COVID. But then again, this isn’t documented or stated in multiple trials. But what we’re saying is if you are already taking antiretroviral, you can still get COVID and should take precautions to preventing the spread and reducing your own risk.
KARL
So bottom line to take away from this conversation, there is still a lot that needs to be figured out, this is constantly changing. And the key here I’m hearing is if you’re not vaccinated, get vaccinated, keep wearing your mask inside for now, practice those things that we’re tired of practicing, but we’ve gotten really good at for now. And hopefully we can get on top of this thing. Dr. Seshadri, it’s always a pleasure to see you. Thank you so much for taking the time out. The Plus Life scrubs look great on you by the way.
DR. ANU
Thank you, I love them.
KARL
That’s all We’ve got time for this episode of Plus Talk. If you wanna watch this again, more information on what Dr. Anu and I’ve talked about, go to the website pluslifemedia.com. And remember you can follow us across social media platforms, we are @PlusLifeMedia. Until next time, stay safe, wash your hands like always and take care of each other, see you.