COVID-19 Antiviral treatment

Getting your coronavirus (COVID-19) vaccination remains the best way to protect yourself from the virus.

There are additional treatment options for selected groups of people with coronavirus who are thought to be at greater risk. These additional treatments need to be given soon after you get a positive Lateral Flow Test (LFT) result to be most effective.

People who are eligible for antiviral treatment are also eligible to receive free LFTs – if you think you are eligible for antiviral treatment, based on the criteria below, contact your GP for an assessment. If you are assessed as eligible, you will receive a letter which you can use to demonstrate eligibility to receive free LFTs via your local pharmacy, and will be provided in packs of 3 tests which should be used if symptoms start to confirm or rule out a Covid-19 result.

Patient groups considered at high risk from coronavirus and eligible for antiviral treatment

The following patient groups were determined by a UK Department of Health and Social Care-commissioned group of clinical experts using the best available evidence on outcomes in coronavirus infection.

Down’s Syndrome

• All people with Down’s Syndrome

Patients with a solid cancer 

• Active metastatic cancer and active solid cancers (at any stage)
• All patients that have received chemotherapy within the last three months and certain patients that have received chemotherapy 3-12 months ago
• Patients receiving radiotherapy within the last 6 months

Patients with haematological (blood) diseases and stem cell transplant recipients

• All patients with sickle cell disease
• Allogeneic haematopoietic stem cell transplant (HSCT) recipients in the last 12 months or active graft vs host disease (GVHD) regardless of time from transplant (including HSCT for non-malignant diseases)
• Autologous HSCT recipients in the last 12 months (including HSCT for non-malignant diseases)
• Individuals with haematological malignancies who have received chimaeric antigen receptor (CAR)-T cell therapy in the last 24 months, or radiotherapy in the last 6 months
• Individuals with haematological malignancies receiving systemic anti-cancer treatment (SACT) within the last 12 months except patients with chronic phase chronic myeloid leukaemia (CML) in molecular response or first or second line tyrosine kinase inhibitors (TKI)
• All patients with myeloma (excluding MGUS) or chronic B-cell lymphoproliferative disorders (e.g. chronic lymphocytic leukaemia, follicular lymphoma) or myelodysplastic syndrome (MDS) who do not fit the criteria above
• Individuals with non-malignant haematological disorder (e.g. aplastic anaemia or paroxysmal nocturnal haemoglobinuria) receiving B-cell depleting systemic treatment (e.g. anti-CD20, anti thymocyte globulin [ATG] and alemtzumab) within the last 12 months.

Patients with a renal (kidney) disease

• Renal transplant recipients (including those with failed transplants within the past 12 months), particularly those who:
  • Received B cell depleting therapy within the past 12 months (including alemtuzumab, rituximab [anti-CD20], anti-thymocyte globulin)
  • Have an additional substantial risk factor which would in isolation make them eligible for nMABs or oral antivirals
  • Not been vaccinated prior to transplantation
• Non-transplant patients who have received a comparable level of immunosuppression
• Patients with chronic kidney stage (CKD) 4 or 5 (an eGFR less than 30 ml/min/1.73m2) without immunosuppression

Patients with liver disease

• Patients with cirrhosis Child’s-Pugh class B and C (decompensated liver disease)
• Patients with a liver transplant
• Liver patients on immune suppressive therapy (including patients with and without liver cirrhosis)
• Patients with cirrhosis Child’s-Pugh class A who are not on immune suppressive therapy (compensated liver disease)

Patients with immune-mediated inflammatory disorders (IMID)

• IMID treated with rituximab or other B cell depleting therapy in the last 12 months
• IMID with active/unstable disease on corticosteroids, cyclophosphamide, tacrolimus, cyclosporin or mycophenolate.
• IMID with stable disease on either corticosteroids, cyclophosphamide, tacrolimus, cyclosporin or mycophenolate.
• IMID patients with active/unstable disease including those on biological monotherapy and on combination biologicals with thiopurine or methotrexate

Immune Deficiencies

• Common variable immunodeficiency (CVID)
• Undefined primary antibody deficiency on immunoglobulin (or eligible for Ig)
• Hyper-IgM syndromes
• Good’s syndrome (thymoma plus B-cell deficiency)
• Severe Combined Immunodeficiency (SCID)
• Autoimmune polyglandular syndromes/autoimmune polyendocrinopathy, candidiasis, ectodermal dystrophy (APECED syndrome)
• Primary immunodeficiency associated with impaired type I interferon signalling
• X-linked agammaglobulinaemia (and other primary agammaglobulinaemias)
• Any patient with a secondary immunodeficiency receiving or eligible for, immunoglobulin replacement therapy

HIV/AIDS

• Patients with high levels of immune suppression, have uncontrolled/untreated HIV (high viral load) or present acutely with an AIDS defining diagnosis
• On treatment for HIV with CD4 <350 cells/mm3 and stable on HIV treatment or CD4>350 cells/mm3 and additional risk factors (e.g. age, diabetes, obesity, cardiovascular, liver or renal disease, homeless, those with alcohol-dependence)

Solid organ transplant recipients

• All recipients of a solid organ transplant not otherwise specified above

Rare Neurological Conditions

• Multiple sclerosis
• Motor neurone disease
• Myasthenia gravis
• Huntingdon’s disease

Accessing Treatment

If you fulfil all four criteria, you should contact your GP and inform them you have already been assessed as eligible to receive antiviral treatment.

Your GP will discuss the next steps of your treatment, which will involve being referred to the Antiviral Service at Noble’s Hospital. Please note a positive PCR test is no longer required to access the antiviral pathway.

The doctors at Noble’s may decide that an antiviral treatment taken orally (in tablet form) is the most appropriate based on your medical history.

Alternatively, you might have to receive a treatment called a monoclonal antibody treatment. This is normally given by intravenous infusion (in your vein). You'll get instructions on where to get the treatment and how to get there and back safely.