HIV Infection/ AIDS

Background Information :

HIV ( Human Immunodeficiency Virus ) is the cause of AIDS( Acquired Immunodeficiency Syndrome ) which is the end-stage of this infection. HIV infection is a major global public health problem and there are more than 35 million infected individuals at the end of 2012, with the majority living in SubSaharan Africa ( 69 % ). Less than a third of all infected patients in the world are receiving anti-retroviral drugs in the middle to low income countries where ongoing transmission rates are high.

Epidemiology :

There were 6229 residents who had been notified with HIV infection/AIDS in Singapore by the end of 2013. The average number of new cases is about 441 – 469 per year in the last 6 years (2008 to 2013). Majority of the infected are males ( 93% ). Modes of transmission include :

  • Heterosexual ( 47% )
  • Homosexual ( 45% )
  • Bisexual ( 6% )
  • Intravenous Drug Users ( 0.04 % )
  • Others ( mother-to-child, contaminated blood products, organ transplantation, unknown route )

The majority ( 90% ) are aged between 20 – 59 years old.

Clinical :

When a patient is infected by the HIV virus, it may take up to 10 years before he develops symptoms that bring him to the attention of a doctor. It is therefore recommended that individuals with high risk lifestyle be tested regularly so that the disease detected early and treatment is instituted early. Early treatment has the advantage of having a better response to drug therapy and alsominimising transmission of the infection to their close contacts. The HIV virus acts by depleting the body of immune cells, known as CD4 cells which are responsible for fighting infections. HIV patients are also more prone to cancers due to immune dysfunction, which has a role in the pathogenesis of certain cancers. The CD4 counts are surrogate markers of the integrity of the immune system. In general, when the CD4 counts are below 500 cell/ul, the patient should be started on anti-HIV treatment. Early stage HIV infection often has no symptoms. Only a small number of patients will exhibit “seroconversion illness” which is a short febrile illness with rash and lymph node enlargement which occurs about 4-6 weeks after the initial infection. This is the time when the body starts making antibodies. The period between infection and the appearance of antibodies is about 4-6 weeks , which is called the ‘window period’ because blood test cannot detect the antibodies at this time.

Untreated AIDS, which is the final stage of the infection , carries a life expectancy of 1 – 3 years, and the infected patients will mostly succumb to severe infections or cancers. The signs and symptoms of late infections include :

  • Unexplained fever
  • Oral thrush ( fungus spots in the mouth )
  • Tiredness
  • Weight loss
  • Diarrhoea
  • Skin rash
  • Recurrent Infections ( pneumonia, shingles, gastroenteritis, etc )

Treatment:

The treatment of HIV infection is with anti-retroviral drugs. There is no cure for HIV and treatment is life-long control with drugs. You should never stop taking these drugs because they keep the virus under control and patients can live for a long time with normal health as long as they remain on drug therapy.The treatment regimen is individualised according to each patient’s characteristics. This is best discussed with your infectious disease physician.

Every drug has possible side effects and you should discuss them with your doctor. The follow-up with your doctor is life-long.

Points to Note :

HIV is considered to be a chronic infection and at this time, there is no known drug (s) that can eradicate the virus. There are several reports of “cure” but these are very rare cases and they are “1 in many millions’’ occurrences.HIV is a notifiable disease in Singapore. Do not worry about restriction of travel if you are a Singaporean, the notification is for statistics purposes. However, if you are a foreigner, you may face a travel entry ban unless your physician applies for a permit for you to re-enter Singapore for treatment.

There are also anonymous testing facilities in Singapore if you are concerned about HIV notification.
For more information, please see MOH ( Ministry of Health ) or HPB ( Health Promotion Board ) websites.

Click here for Appointment