Explainer: What you need to know about HIV and AIDS

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What is HIV?

HIV, or Human Immunodeficiency Virus, attacks and damages the human immune system. When left untreated, HIV kills a type of immune cell called a T-Cell.

As the condition progresses more T-Cells get attacked. This makes the body become increasingly susceptible to a range of illnesses and cancers.

HIV is not airborne, neither does it spread through water or casual, physical contact. Instead, HIV is transmitted via the following bodily fluids:

● Semen
● Blood
● Vaginal secretions
● Rectal fluids
● Breast milk

The virus does its work by inserting itself into the DNA of cells. Therefore, there is no known drug capable of removing it from the body, even as medical science strives for a cure.

At the moment, a treatment called antiretroviral therapy makes it possible for a person with HIV to live with the virus for many years. Without such therapy, a person infected with HIV is likely to develop the condition known as Acquired Immunodeficiency Syndrome, or AIDS.

What is AIDS?

AIDS is when the immune system is weakened to the point where it is unable to properly and sufficiently counteract infections. If left untreated, people with end-stage AIDS have about 3 years to live. This is why antiretroviral therapy is important for people who have HIV, as it enables them to live as long as people who do not have HIV.

A person can also be diagnosed with AIDS if they have HIV and develop an opportunistic infection or cancer.

When AIDS develops, a person is seriously susceptible to illnesses like:

  • Tuberculosis
  • Cytomegalovirus
  • Toxoplasmosis
  • Cryptosporidiosis
  • Various cancers

These illnesses can become severe, and shorten the lifespan of a person.

How does HIV progress to AIDS?

While related, HIV and AIDS are different things. It takes a period of time for HIV to progress to AIDS, which means that when action is taken, there is a possibility of preventing HIV’s progress to AIDS.

HIV cases progress through 3 distinct stages:

First Stage: Acute stage – First few weeks after infection

Second Stage: Chronic Stage

Third Stage: Progress to AIDS

As HIV progresses, the CD4 cell count slowly goes down. While an uninfected adult’s CD4 cell count runs between 500 to 1500 per cubic millimeter, a person with AIDS has a CD4 cell count that is sub-200 count per cubic millimeter.

The speed of HIV progression from stage 2 to stage 3 depends on the person. Some people can stay in stage 2 for a decade without treatment. However, with treatment, they can stay in stage 2 indefinitely. As mentioned above, there is no cure for HIV. However, antiretroviral therapy can give a near-normal life expectancy.

Similarly, there is no way to cure AIDS. However, treatment that can increase the CD4 count above 200 per cubic millimeter of blood exists. This means that they can be considered to no longer have AIDS.

The facts of HIV transmission

No one is immune to HIV, and anyone can contract the virus. Here are some ways that HIV can be transmitted between people:

● Unprotected vaginal or anal sex — This is the most common route of transmission
● Sharing drug paraphernalia
● Unsterilized tattoo equipment
● Pregnancy, labor, or delivery from a pregnant person to their baby
● Breastfeeding
● Premastication – the act of chewing a baby’s food before feeding it to them

Very rarely, HIV is transmitted via blood transfusion or organ donation.

It is extremely rare for HIV to be transmitted through:

● Oral sex
● Being bitten by a person with HIV
● Contact between broken skin, wounds, or mucous membranes and the blood of someone living with HIV

HIV does NOT transmit through:

● Unbroken skin-to-skin contact
● Casual contact like shaking hands
● Air or water
● Sharing food or drinks, including drinking fountains
● Saliva, tears, or sweat (unless mixed with the blood of a person with HIV)
● Insect bites

It’s important to note that if a person living with HIV is being treated and has a persistently undetectable viral load, it’s virtually impossible to transmit the virus to another person.

Early symptoms of HIV

In the acute infection stage, there can be symptoms. At this stage, the virus is reproducing rapidly. The person’s immune system responds by producing HIV antibodies, which are proteins that take measures to respond against infection.

During this acute infection stage, some people have no symptoms, while others might have the following symptoms:

● fever
● chills
● swollen lymph nodes
● general aches and pains
● skin rash
● sore throat
● headache
● nausea
● upset stomach

These symptoms are similar to the common flu. This is why infected people might not think that they need to see a doctor.

During this acute infection stage, the HIV viral load in the person is high, and this means that the virus can be easily passed on to another person during this period.

The acute stage symptoms resolve themselves within a few months as the person enters the chronic stage of HIV, which can last for decades with the appropriate treatment.

How can we diagnose HIV?

There are a few tests that can be used to diagnose HIV.

Antibody/antigen tests

Antibody/antigen tests are the most commonly used tests. They can show positive results typically within 2 to 4 weeks after someone initially contracts HIV.

These tests check the blood for both HIV antibodies and antigens. An antibody is a type of protein the body makes to respond to an infection. An antigen, on the other hand, is the part of the virus that activates the immune system.

Antibody tests

These tests check the blood solely for HIV antibodies. 3 weeks to 3 months after transmission, most people will develop detectable HIV antibodies, which can be found in the blood or saliva.

These tests are done using blood tests or mouth swabs, and there’s no preparation necessary. Some tests provide results in 30 minutes or less and can be performed in a clinic.

If someone suspects they’ve been exposed to HIV but tested negative in a home test, they should repeat the test in 3 months. If they have a positive result, they should follow up with their doctor to confirm.

HIV Viral RNA PCR or Nucleic acid test (NAT) – HIV Test

Viral PCR or NATs are expensive, and used for those who have early symptoms of HIV or have a known risk factor. This test looks for copies of the virus itself.

It takes from 5 to 21 days for HIV to be detectable in the blood. This test is usually accompanied or confirmed by an antibody test.

If you have queries, or think that you need a HIV screening test, please reach out to any of our DTAP clinics for a confidential and professional diagnosis. Anonymous HIV testing and rapid HIV test is also available.

Treatment options for HIV

Treatment should begin as soon as possible after a diagnosis of HIV, regardless of viral load.

The main treatment for HIV is antiretroviral therapy: a cocktail of daily medications that stop the virus from reproducing. Antiretroviral therapy protects CD4 cells, keeping the immune system strong enough to respond to disease.

Antiretroviral therapy also prevents HIV from progressing to AIDS, and reduces the risk of transmitting HIV to others.

When treatment is effective, the viral load will be “undetectable.” The person still has HIV, but the virus is not visible in viral PCR test results.

However, the virus is still in the body. And if that person stops taking antiretroviral therapy, the viral load will increase again, and the HIV can again start attacking CD4 cells.

Types of HIV medications

HIV medications work to prevent reproduction of HIV, stopping it from destroying CD4 cells.
These antiretroviral medications are grouped into six classes:

● nucleoside reverse transcriptase inhibitors (NRTIs)
● non-nucleoside reverse transcriptase inhibitors (NNRTIs)
● protease inhibitors
● fusion inhibitors
● CCR5 antagonists, also known as entry inhibitors
● integrase strand transfer inhibitors

HIV Medication Side Effects

Antiretroviral therapy side effects differ, but may include nausea, headache, and dizziness. These side effects are not permanent, and will often get better over time.
However, serious side effects can include swelling of the mouth and tongue, as well as liver or kidney damage. If you encounter these side effects, speak to your doctor about adjusting medications.

Preventing HIV

There is no cure for HIV, or AIDS. That is why It is important to know how to prevent the transmission of HIV.

Safer sex

HIV is most commonly transmitted via unprotected vaginal or anal sex. Short of abstinence, the only other way to prevent transmission is through protection via condom or another barrier method.

If you are concerned about HIV risks:

● Get tested for HIV.
● Always use condoms. Be sure to know how to use them correctly, as incorrect usage can expose you to HIV risks.
● Take medication as directed if you have HIV. This lowers the risk of transmitting the virus to your sexual partner.
● Take medication called PrEP (Pre-Exposure Prophylaxis). This can be prescribed by your doctor.

Other prevention methods

There are a few other things you can do to prevent transmission of HIV:

● Do not share needles or other drug paraphernalia. Needle sharing can spread HIV through blood contact.
● Consider PEP. If you know that you have been exposed to HIV, talk to your doctor about getting post-exposure prophylaxis (PEP), which can reduce your risk of contracting HIV. It consists of three antiretroviral medications given for 28 days. PEP should be started as soon as possible after exposure. – HIV PEP Singapore

Is there a vaccine for HIV?

Currently, there are no vaccines to prevent or treat HIV.

HIV mutates quickly, and can often fend off immune system responses. Only a small number of people with HIV develop broadly neutralizing antibodies.

The good news is that in 2016, the first HIV vaccine efficacy study in 7 years was done in South Africa. This experimental vaccine is an updated version of one used in a 2009 trial that took place in Thailand. A follow-up after vaccination showed that the vaccine was 31.2 percent effective in preventing HIV transmission.

The study involved 5,400 men and women from South Africa.

How to check for HIV

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Human Immunodeficiency Viruses (HIV) are two species of Lentivirus that can infect humans. If left untreated in the body, over time, they cause progressive failure of the immune system. As a result, life-threatening opportunistic infections and cancers can occur. This late stage of HIV infection is termed Acquired Immunodeficiency Syndrome (AIDS).

HIV is spread through contact of infected bodily fluids through mucous membranes, broken skin or wounds. Most people who get HIV get it through anal or vaginal sex, or sharing needles, syringes, or other drug injection equipment. HIV can also be transmitted from a mother to her baby during pregnancy, birth, or breastfeeding. However, because of advances in HIV prevention and treatment, it is possible for spread and infection to be mitigated.

There are a few ways that a person can test for HIV.

The most common test that is done is an antibody test. The antibody to HIV is only produced if you have been previously exposed to HIV before. Therefore, if you have the antibody to HIV, it is likely that you have been exposed to HIV at some point in time in your life. We can test for the HIV antibody from a blood sample, or from a sample of cells taken with a swab from inside your cheek. The HIV antibody test is commonly done together with a p24 antigen test. This combination testing is commonly termed a 4th generation HIV test. The p24 antigen is a distinctive HIV antigen; a structural viral protein makes up most of the HIV viral core, or ‘capsid’. Again, it will only be present in your blood if you have previously been exposed to HIV. If the doctor sends your blood to a laboratory, it is likely they use a technique known as ELISA/EIA (enzyme-linked immunosorbent assay/enzyme immunoassay). An antibody test or a 4th generation test can also be done as a rapid, point-of-care test, where all we need is a small amt of blood and 20 minutes wait time.

You might also have heard of a western blot test. A western blot is a different technique that laboratories use to test for HIV antibodies in a person. A western blot is usually used to confirm a positive ELISA/EIA result.

There are also tests which test for the HIV virus itself. This is termed a HIV PCR RNA or HIV viral load. This test can tell the doctor the concentration of HIV virus in a person’s blood. This test is also used to monitor how effective medications are in a HIV-positive patient undergoing treatment. This test is usually more expensive than the other investigations.

Window Period For HIV

The window period is time between HIV infection and the point when the test will give an accurate result. During the window period a person can have HIV and be very infectious but still test HIV negative. It is difficult to say exactly when the best time to test for HIV is, but in general, we can test for HIV as early as 10 days after exposure with a viral load test. For combination antibody testing, the result is usually deemed definitive 4-6 weeks after exposure.

If you feel that you might have been exposed to HIV, see your doctor early and the doctor can advise you on your risk, the best time to test and the type of test that is necessary. Also remember to practice safe sex to reduce your risk of contracting not just HIV, but other sexually transmitted infections as well.

 

You Might Also Be Interested In:

HIV Test Singapore

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HIV PrEP & HIV PEP For HIV Prevention

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https://www.youtube.com/embed/LtzrEbeyxOw

 

Transcript from video:

Hi, I’m Dr. Jonathan Ti from Dr. Tan and Partners, and today I’d like to talk about HIV PrEP.

PrEP stands for Pre-Exposure Prophylaxis, and it has emerged in recent years as one of the most effective ways to prevent HIV infection. Individuals taking PrEP can reduce their risk of getting HIV by upwards of 95%. This type of medication must be taken before any risk exposure to be effective. It is different to Post-Exposure Prophylaxis, or PEP, which is taken immediately after a possible exposure and uses additional medications.

PrEP is usually taken as a once daily tablet, a combination of antiviral drugs tenofovir and emtricitabine. Other types of dosing regimens are available as well, depending on the unique lifestyle of the individual. Studies have shown that PrEP is generally safe for long term use, but some may experience side effects such as a reduction in kidney function and bone density, especially with the older version of medication called Truvada. The US FDA recently approved a newer drug called Descovy for use as PrEP, which has shown to be equally effective in preventing HIV infection whilst touting an improved safety profile for kidney and bone toxicity. The main difference between Descovy and Truvada is the form of tenofovir drug present – the newer Descovy uses TAF, which enters target cells more efficiently than Truvada’s TDF, and means that a much lower dose of tenofovir is needed. This means that other tissues such as kidney and bone are exposed to a much lower dose of the drug and there is less risk of drug toxicity and side effects.

HIV PrEP is recommended for individuals who belong to a high-risk group for HIV infection, and who do not have any current established HIV infection. HIV high-risk groups may include:

  • Someone who has an HIV-positive partner
  • Someone who has multiple sex partners, a partner with multiple partners, or a partner whose HIV status is unknown and does not practice safe sex; there is higher risk in men who have sex with men or transgender women
  • Someone who has sex with commercial sex workers
  • Someone who has recently had a sexually transmitted disease
  • Someone who injects drugs, or has unprotected sex with someone who injects drugs

Both Truvada and Descovy are available in our clinics. They are only available by prescription. Please speak to our Doctors if you think PrEP is right for you.

WORLD AIDS DAY 2020

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On December 1st, the global community unites to commemorate World AIDS Day, showing support for those living with and affected by HIV, and to remember those who have lost their lives to AIDS. This year in particular, the COVID-19 pandemic has laid bare how critically interlinked our health is with issues such as social inequality, human rights, stigma and discrimination, economic security, and political will and stability.

The theme of World AIDS Day this year is “Global solidarity, shared responsibility”. The COVID-19 crisis has demonstrated that, during a pandemic, no one is safe until everyone is safe. We all have a part to play in addressing the dual pandemics of COVID-19 and HIV/AIDS, in order to successfully eliminate them both as a public health threat.

There were approximately 38 million people living with HIV/AIDS in 2019, with an estimated 1.7 million people acquiring HIV in the year, marking a 23% decrease in new HIV infections since 2010. In Singapore, latest figures released in June this year showed 323 new cases of HIV infection reported among residents in 2019, bringing the total number of HIV-infected residents to 8,618 as of end of 2019, of whom 2,097 had passed away. The annual incidence of new infections locally has decreased overall by about 25% when compared to 2007 to 2017.

This decrease of new HIV infections is a result of the concerted and coordinated efforts of both government and community-led initiatives, but there is still much that can be done. In 2014, UNAIDS set an ambitious goal of eradicating the HIV epidemic by 2030. This involved a set of targets called the “90-90-90” vision, which stated that by 2020:

  • 90% of people living with HIV would know their diagnosis
  • 90% of those diagnosed with HIV would be on antiretroviral therapy (ART)
  • 90% of those on treatment would have achieved viral suppression

Singapore has made significant improvements towards the last two goals, with approximately 89% of people diagnosed with HIV on treatment and 94% of those achieving viral suppression; however, we are still relatively lacking in our progress towards the first target, with only an estimated 72% of people living with HIV who have been diagnosed. 

We know that early diagnosis leads to early treatment and better outcomes. Knowing their HIV status early will also help to prevent the spread of infection to others. Providing access to better information and testing for HIV, increasing awareness and uptake of Pre-Exposure Prophylaxis (PrEP), and ensuring long term compliance to antiretroviral therapy (ART) by people living with HIV are some of the primary facets of eradicating the HIV epidemic.

As we approach the end of a tumultuous year, the impact of COVID-19 has forced us to view our global health responses, including the HIV/AIDS response, in a different way. We must now be more committed than ever to ensure no individual or community is left behind – healthcare must be funded and accessible to all, stigma must be eliminated and vulnerable populations offered social protections, and public health systems must be strengthened through investment and sound government policy.

As the WHO has so accurately and succinctly captured:

“Now is the moment for bold leadership for equal societies, the right to health for all and a robust and equitable global recovery. This World AIDS Day, join us in calling on countries to step up their efforts to achieve healthier societies. This World AIDS Day let us demand global solidarity and shared responsibility.”

Tags: HIV Test Singapore, HIV Test, Anonymous HIV Testing

Just got diagnosed with HIV? What is next?

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You have just been recently diagnosed with HIV. You’re likely experiencing a rollercoaster of emotions and have lots of questions which are understandable. As you go through these feelings, whether of anger, fear, sadness or guilt, it is important to first take a deep breath and begin the process of finding a health care provider and as much as possible, look for any form of support available. 

Finding Support

 

1. Friends & Family

As you are coming to grips with the new diagnosis, you may face difficulty as to what the next step will be. You may want to talk about it with a trusted friend or family member. Although you may feel uncomfortable with breaking the news, you may realize that shouldering the burden alone actually makes it more difficult to process the news and that telling someone you trust may be a positive experience as it can help you get the much-needed support and it may actually strengthen relationships. It is important to be informed of the condition yourself – it may be best to obtain information about HIV before telling others about the new diagnosis. There are many myths that surround HIV which contribute to the stigma attached to it but by knowing more about living with HIV can reassure your loved ones that with effective medications available, you can live a long and healthy life.

2. Telling your partner

It is important to let your current or former partners know that they may have been exposed. They then should be tested for HIV. It is encouraging to know that many people living with HIV continue to have relationships and can have children who don’t have HIV. The term ‘undetectable = untransmittable’ (shortened to U=U) was coined and is used as a campaign to prevent sexual transmission of HIV without the use of condoms based on numerous studies that demonstrated this. This is achievable by taking treatment daily and having undetectable viral load levels for at least 6 months. However, until U=U is achieved, the proper use of condoms must be done to prevent transmission. In addition, your partner may also want to consider PrEP, in addition, to use of condom before you achieve undetectable viral loads for at least 6 months.

3. Clinics & Support Groups

As HIV is a chronic medical condition that requires lifelong follow-up and treatment, it is essential to establish a relationship with an HIV health care provider that is as honest and open as possible. You may either be managed at the clinic where the HIV diagnosis was made or referred to an HIV specialist and their team for HIV management. 

Among other tests, the key ones that will be done at the first clinic visit as well as during subsequent visits are HIV viral load as well as CD4 counts. The HIV viral load is a measure of the amount of virus detectable in the blood and the CD4 count is the amount of CD4 cells, which are white blood cells that play an important role in the immune system. The goal for everyone living with HIV is to reach an undetectable HIV viral load as quickly as possible.

Many guidelines recommend that HIV treatment be started immediately after the diagnosis is made. This is because studies have shown that immediate treatment can lower the risk of long term effects on the immune system and reduce the risk of HIV transmission.  

There are many support groups available where you can be a part of, to obtain further information from or would simply like to reach out for a listening ear as you may not be ready to tell your friends or family about the new diagnosis.

Here is a list of support groups available in Singapore & Malaysia:

Action for AIDS (AFA) (Singapore)

Oogachaga (Singapore)

GayHealth.sg (Singapore)

PT Foundation (Malaysia)

CD4 Count VS Viral Load – What do you need to know?

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The Immune system is made up of a large network of cells that work together to combat infections. Helper T Lymphocytes are a particular type of immune cell that expresses a molecule called the Cluster Determinant 4 (CD4). Helper T lymphocytes are hence commonly known as CD4 cells. The Human Immunodeficiency Virus (HIV) selectively targets CD 4 cells and uses them as hosts for viral replication. As the virus replicates, it destroys its host cell as it releases new copies of the virus. Therefore, as the viral load (which is a measure of the amount of virus present in the body) increases and the host CD 4 cells will decrease. 

HIV Pro Viral DNA Test

HIV Infection

During the early stages of a HIV infection, viral replication occurs at a very fast rate at the expense of CD 4 host cells. A vicious cycle occurs, wherein an increase in HIV viral load attracts more CD4 cells which get infected and become hosts to further increase the viral load. Within the first few weeks of a HIV infection, the CD 4 count falls precipitously. Such a sharp fall in CD4 cells is the hallmark of a HIV infection. 

Upon diagnosis of HIV, it is crucial that the patient’s CD 4 and viral load are measured. The CD 4 count allows the medical team to determine the state of the immune system and plan the appropriate treatment. If the CD 4 count is below 200 units, the diagnosis of Acquired Immunodeficiency Syndrome (AIDS) is established. AIDS is a serious complication of HIV infection and can be fatal, therefore, if the patient is diagnosed with AIDS he/she requires immediate medical attention in a hospital.The viral load will give an indication of how fast the virus is replicating. Current medication used to treat HIV infection targets different parts of  viral replication and interfere in the process of new viruses being produced. Therefore, a fall in viral load after commencing medication is an indicator that the medication is working. 

People Living With HIV

For People Living with HIV (PLHIV), the main goal of therapy is to increase CD4 cell numbers and decrease the viral load to an undetectable level. Monitoring these 2 parameters will guide the treatment regime. In general viral load is measured 2 weeks after starting medications for HIV, then at 4 to 8 week intervals. The expected fall in viral load should be to approximately < 500 copies/ml by week 8 – 16 and < 50 copies /ml by week 16- 24. CD 4 recovery is slower, the first CD4 test is done 3 months after commencing treatment and every 6 months after. In general, a CD 4 count > 300 cell/uL with a low viral load is a good level to ensure that PLHIV does not encounter any opportunistic infections.

Also read: U=U: Science, Not Stigma

CD 4 and Viral load measurements are essential parameters in guiding the medical therapy for PLHIV. Regular check of these parameters ensure that PLHIV are able to maintain an active lifestyle and avoid any infections that may occur due to a lowered immunity.

HIV Screening Singapore

 
 
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Common STD Incubation Periods

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STD Incubation Period. The incubation period for the various STIs (Sexually Transmitted Infections) is a common question asked by patients in our clinics. It refers to the time between acquiring the infection and the presentation of symptoms. This is different from the window period, which refers to the period after infection in which no current available tests are sensitive enough to detect the infection. The window period for the various STIs depends on which tests are used. 

As different STIs have different incubation periods, it is not easy to answer the question when symptoms will appear after a particular risky exposure. I will list below the common STIs tested for, their incubation and window period as well as possible initial presentation. 

The following are the Common STDs and their incubating periods:

#1 STD Incubation Period – Human Immunodeficiency Virus (HIV)

Early HIV infection refers to approximately 6 months after initial acquisition. It is estimated that 10 to 60 percent of all early HIV infections are asymptomatic, or without any symptoms. For early symptomatic HIV infection, the usual incubation period is around 2 to 4 weeks, although incubation periods as long as 10 months have been observed.

Acute symptomatic HIV infection present with a collection of signs and symptoms known as Acute Retroviral Syndrome (ARS). The most common findings for ARS are fever, sore throat, rash, swollen lymph nodes, body aches and pains. However, all these symptoms are not specific to acute HIV infection, hence please do not panic if you observe these symptoms after a risky encounter. See your doctor for further advice and testing

The Window period for HIV testing depends on the test that is conducted. The initially 10 days after exposure is known as the eclipse period, for which there are no tests that can pick up any infection. The earliest tests that can be done with conclusive results are the HIV ProViral DNA test or the HIV RNA PCR test, which can pick up possible acute infections 10 days after exposure.

4th Generation HIV tests will be conclusive around 28 days after exposure, while 3rd Generation HIV tests will be conclusive around 90 days after exposure. 

Anonymous HIV Testing is available at our Robertson Walk Branch. HIV Test results in 20 mins.

#2 STD Incubation Period – Syphilis

Approximately 50% of patients diagnosed with syphilis do not have any symptoms. This is because syphilis has 3 stages of infection: Primary, Secondary and Tertiary Syphilis and Primary and Secondary syphilis might have symptoms that are so mild that they are ignored by the patient.

Primary syphilis presents with a painless ulcer on the genitalia, known as a chancre. The incubation period for a chancre appears to range from 3 to 90 days, with an average of around 21 days. The chancre will heal within 3 to 6 weeks even without treatment. Within weeks to a few months after the chancre appears, around 25 percent of untreated individuals will develop Secondary Syphilis.

Secondary Syphilis can present with a widespread rash, ulcers, patchy hair loss, swollen lymph nodes, weight loss and fatigue. The infection subsequently goes into a latent phase lasting for years for which there are no signs or symptoms. This is the reason why the majority of syphilis picked up on routine screening are asymptomatic.

Neurosyphilis occurs when the infection reaches the central nervous system i.e. the brain or spinal cord. Neurosyphilis can occur at any stage of infection, but tends to occur in tertiary syphilis. Therefore, neurosyphilis can occur within a few months, but could also develop after 10 to 30 years, of a syphilis infection. 

The window period for syphilis testing depends on the stage of syphilis infection. The blood tests (FTA-ABS and TPPA) will be positive around 1 to 2 weeks after chancre formation. 

#3 STD Incubation Period – Hepatitis B and C

The majority of hepatitis B and C infection are asymptomatic. It has been estimated that around 30 percent of acute hepatitis B infection and less than 25 percent of acute hepatitis C infection are symptomatic. Symptoms of acute infection tend to be very mild and may include the following: Fever, Fatigue, Nausea/vomiting, Dark Urine, Pale stools and abdominal pain. 

The incubation for acute hepatitis B infection is estimated to be around 1 month to 4 month, while the incubation period for acute hepatitis C infection is estimated to be from 2 weeks to 3 months.

The window period for both hepatitis B and C testing for antibodies is on the average about a month. It will be much shorter if alternate tests such as the Hepatitis C RNA PCR test for Hepatitis B Viral Load are used instead.

#4 STD Incubation Period – Genital Herpes

Genital herpes is caused by both Herpes Simplex Virus 1 or 2 (HSV1/2). Genital herpes infections often do not have symptoms or mild symptoms that go unrecognized. It is estimated that one third of patients with new infections do not have symptoms. The initial presentation of symptoms range from severe with painful genitalia ulcers, painful urination, painful lymph node swellings and fever. However, patients also can have mild or no symptoms as well. The initial presentation does not depends on the type of virus (HSV1 vs HSV2)

The incubation period for genital herpes is around 4 days, with a range from 2 days to 12 days.

For asymptomatic infections, HSV 1/2 Antibodies will start appearing in the serum starting from 3 weeks and majority of patients would have antibodies by 16 weeks. The window period for testing for asymptomatic patients is hence from 3 weeks to 16 weeks. For patients with symptoms of the painful genital ulcers, the test of choice is Nucleic Acid Amplification Testing (NAAT) for which a swab of the ulcer is taken and tested for HSV DNA. There is no window period for NAAT.

Rapid Herpes Testing with Next Day Results is available in all DTAP Clinic in Singapore.

#5 STD Incubation Period – Gonorrhea

Gonorrhea causes different symptoms for men and women. For women, the cervix is the most common site of infection and the common symptoms are vaginal itch and discharge. Some women also have heavier periods or bleeding in-between periods. If the infection has ascended beyond the cervix into the uterus, this is a potentially more dangerous condition known as Pelvic Inflammatory Disease (PID) for which abdomen pain and fever are common symptoms. Up to 70 percent of patients with cervical gonorrhea infection are asymptomatic. 

For men, urethritis is the most common presentation of gonorrhea infections. It is characterised by purulent urethral discharge and painful urination. In contrast to infections in women, the majority of infections in men are symptomatic. 

In women, the incubation period for genital infection is around 10 days. In men, the incubation period for symptomatic infected men is around 2 to 5 days, with 90 percent of these individuals with symptoms of urethritis by 2 weeks.  

The accepted standard for testing for gonorrhea infection is NAAT, a urine sample for men and a cervical swab for women. As NAAT is able to detect low numbers of organisms with good accuracy, there is no window period for NAAT testing.

Rapid Gonorrhea & Chlamydia Testing with Next Day Results is available in all DTAP Clinic in Singapore.

#6 STD Incubation Period – Chlamydia

Chlamydia causes similar symptoms as gonorrhea in both men and women. In women, the cervix is also the most common site of infection with a proportion of patients having a urethra infection as well. However the majority of infected women, around 85 percent of patients are asymptomatic with neither signs or symptoms.

Symptoms of chlamydia infection are similar to gonorrhea in men as well, with a clear to mucoid penile discharge and painful urination. The proportion of asymptomatic infection varies as well in men, ranging from 40 to 96 percent with no symptoms. 

The incubation period for symptomatic infection ranges from 5 to 14 days after exposure for both men and women.

The gold testing for testing for chlamydia infection is NAAT as well. There is no window period for NAAT testing.

Rapid Gonorrhea & Chlamydia Testing with Next Day Results is available in all DTAP Clinic in Singapore.

  Asymptomatic/Mild Infections (%) Incubation Period Sample Types Window Period
HIV 10 to 60 2 to 4 weeks Blood Proviral DNA : 10 days
RNA PCR : 12 days
4th Generation Ag/Ab :28 days
3rd Generation Ag : 90 days
Syphilis 50 3 to 90 days
Average 21 days		 Blood FTA-ABS : 1 to 2 weeks after chancre
Hepatitis B Majority Asymptomatic 1 month to 4 month Blood HbsAg : 1 month
Hepatitis C Majority Asymptomatic 2 weeks to 3 month Blood Anti-HCV Ab : 1 month
Herpes 70 2 to 12 days
Average 4 days		 Blood/
Swab		 HSV 1/2 IgG : 3 to 16 weeks
HSV DNA PCR : No window period
Gonorrhea Women: 70
Men: Majority Symptomatic		 Women:10 days
Men: 2 to 5 days		 Swab/
Urine		 Gonorrhea DNA PCR: No window period
Chlamydia Majority Asymptomatic 5 to 14 days Swab/
Urine		 Chlamydia DNA PCR: No window period

If you like to speak to our doctors on your STD concern, please visit any of our clinics in Singapore & Malaysia.

You can also email us at hello@dtapclinic.com.sg, or call any of our clinics for an appointment

Also on this site: HIV Screening, HIV Test Clinic Singapore, STD Clinic Singapore

 
 
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Common Medical Conditions That Are Asymptomatic

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Signs and Symptoms are technical terms to describe the extent of disease in a patient. A sign is an effect of the disease that can be observed by another person or elicited through certain manoeuvres while a symptom is an effect that is experienced only by the patient. 

What does being asymptomatic mean?

Being “asymptomatic” is when the patient does have the disease but does not experience any effects of the disease. In this article, we will be discussing 5 diseases where patients are usually asymptomatic in the early stages of the disease but as the disease progresses, it adds an increased burden on the body leading to more pronounced signs and symptoms.

The 5 diseases were selected because while there is no way for patients to know if they have the disease early on due to the lack of symptoms these diseases can be easily detected during health screening with your General Practitioner. Therefore, we hope to highlight the importance of your health screening in allowing your doctor to detect these diseases early and prevent the disease from progressing to a more severe state.

So just before you brush off that health screening appointment because “I feel OK” , have a read to see the benefits or early detection and treatment.

5 Diseases where patients are asymptomatic

Human Immunodeficiency Virus (HIV)

What it is?

HIV infection is a disease in which the virus attacks specific cells (CD4) in the immune system and uses the cells to create more copies of the virus, killing the host cells in the process. In the early stages of HIV, the rate of CD 4 cell production can still cope with the loss from the viral infection, therefore patients are mostly asymptomatic.

Over time as the virus replication picks up pace, the CD 4 cell numbers dwindle and the immune system becomes less effective in responding to environmental insults such as bacterial or fungal infections. Major risk factors for HIV infection include, IV drug use, unprotected casual sex and anal intercourse.

How do you test for it?

Point of Care testing can be done at most clinics in Singapore, this involves taking a sample of blood from a finger prick and placing it into a test kit. Currently, the earliest you can be tested for HIV is 30 days after infection. Early treatment of HIV prevents the virus from replicating and thus prevents the disease from worsening and progressing to Acquired Immunodeficiency Syndrome (AIDS).
HIV Testing Singapore
Anonymous HIV Testing Singapore

Chlamydia

What it is?

Chlamydia is a common bacterial infection in both Men and Women. Infection is usually found in the genital tract but also in the rectum, throat and even eyes. Up to 70% of women and 50% of men are asymptomatic. Left untreated, the bacteria can replicate further to eventually lead to an inflammatory state in the pelvis. This results in severe discomfort and particularly in women the risk of infertility is especially raised if chlamydia is untreated.

How do you test for it?

Chalmydia Rapid testing can be carried out to detect the presence of Chalmydia within 24 hours. A sample is taken from the region, a vaginal swab for women and a urine sample for men, and a Polymerase Chain Reaction is used to detect any chlamydial genetic material. Treatment of chlamydia can be as simple as a single dose of antibiotics if detected at an early stage.
Rapid STD Testing Singapore

Chronic Illnesses

High cholesterol

What it is?

Cholesterol can be thought of in 2 forms, a high density form (HDL) and a low density form (LDL). HDL lowers the total cholesterol in the body while LDL increases it. An increase in cholesterol and triglycerides (both from fatty foods) results in plaques developing within your blood vessels (Atherosclerosis). As the plaques increase in size, blood flow to your vital organs like your heart and brain are compromised thus increases the risk of heart attacks and strokes.

How do you test for it?

A blood test usually done at your health screening enables your doctor to determine the cholesterol levels in your body. Not all elevated cholesterol has to be treated with  medications because changes in diet and lifestyle can also lower cholesterol in some cases. 

Hypertension

What it is?

Hypertension is when your blood pressure is persistently elevated, the normal blood pressure should be below 140 systolic and 90 diastolic. There are myriad of causes for elevated blood pressure including, high salt intake, stress or kidney disease.

However, many people have Essential hypertension, which is when the blood pressure is found to be elevated for no particular cause. Even though the cause may not be determined in most cases of hypertension, patients with an elevated blood pressure have a higher risk of strokes. This is because, the increased pressure in the blood adds additional strain to the blood vessels, eventually, the blood vessels become weaker and are more likely to break, resulting in a stroke.

How do you test for it?

The diagnosis of hypertension in an asymptomatic patient involves a Blood Pressure diary where the patient measures her blood pressure at the start and end of the day for 2 weeks. A persistently elevated blood pressure may prompt the doctor to start treatment, however there are also non-pharmacological means of lowering blood pressure.

Diabetes

What it is?

Diabetes, in particular Type 2 Diabetes, is a condition where the body is unable to regulate carbohydrate metabolism. This results in wide spread effects on the patient because sugar derived from carbohydrate metabolism is essential to many cellular activities in the body. Although patients are mostly asymptomatic in the early stages of the disease, patients can eventually have a variety of pathologies as the disease progresses such as loss of sensation in the hands and feet, poor wound healing, reduced immunity and even blindness.

How do you test for it?

Testing for diabetes also involves a blood test to measure the sugar levels in a fasting state to gauge the current level of sugar metabolism in your body and the Haemoglobin A1c (HbA1c) which is a gauge of the long term extent of sugar metabolism in your body. Depending on the extent of your disease, treatment of diabetes can range of lifestyle modification to injectable medications.

Having a disease in its early stages sometimes means that you still feel “fine” and not experience any symptoms. However, if left untreated, these diseases can progress and lead to severe complications in your health. Getting checked regularly is essential for detecting disease in the asymptomatic phase and treating it early. This prevents the disease from progressing to a more severe state and allows us to lead better, healthier lives. Speak to your doctor today!

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Other Asymptomatic Medical Conditions:

Also on this site: Wart Removal Singapore, STD Check Singapore

Why you should not be embarrassed to get tested for HIV

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Many people are still not getting regularly tested for HIV.

In my line of work as a Family Physician, I frequently assist patients in performing Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infection (STI) screening. I would like to share a story of a patient I recently treated. 

40-year-old Melvin (not his real name) came by one day for a clinic consultation. His friendly and cheerful demeanour was accompanied with a mild level of anxiety. He shared with me his background: he was a gay man, in a monogamous relationship with a long term partner. Like many people, he had had several previous partners – past relationships, and the occasional casual fling. However, he had never undergone any screening tests to evaluate his sexual health. The last time he had been tested for HIV was over 20 years ago, when he enlisted for National Service.

“The honest truth is I am embarrassed and also fearful of seeing a doctor to do these tests. In fact, it took me a lot of courage to come to visit you today!”, said Melvin rather sheepishly.

“I have always had this avoidance mentality towards HIV. I felt that I would rather not get tested, and just live my life more peacefully. And really, what are the chances? I have always used condoms and compared to other people, I don’t think I have had many sex partners in my life,” he added.

He lets on further that it was after a lot of encouragement from his partner that he decided to bite the bullet and visit a clinic.

The news came as a complete shock to him – he had unfortunately tested positive for HIV. It took some time for him to come to terms with the result, and the fact that his life was never going to be exactly the same again. The silver lining was that Melvin was still in the early stages of the infection. He has since promptly started on treatment and is doing regular follow-up monitoring of his condition. The good news is that by doing so, he will likely be able to keep the virus in check and thus maintain a healthy immune system. 

Melvin’s case highlights a perennial problem in mankind’s fight against HIV. Despite continuous  efforts by health organisations to educate the public on HIV and increase awareness on the importance of regular screening, many people are still not getting regularly tested for HIV. It is estimated that 15% (1 in 7) of people in the United States are presently living with HIV and unaware that they have the infection. In an update on the HIV situation in Singapore earlier this year, the Ministry of Health (MOH) stated that only 14% of newly reported HIV cases in 2018 were detected by self-initiated, or voluntary, screening.

Common reasons that deter people from getting tested for HIV

1. I am scared of getting tested positive for HIV

Fear and anxiety are probably the biggest reasons why people avoid getting tested. The truth is, living in the unknown is worse and often scarier. It is far better to get the testing over and done with. If it is negative, it will bring much relief. If unfortunately the result is positive, all is not lost. Knowing your status early is the first step to getting support and receiving treatment in order to stay healthy. 

2. If I test positive for HIV, people will find out

Medical clinics and testing centres endeavour to keep all patient records strictly confidential. Under the Infectious Diseases Act in Singapore, a positive test for HIV is notifiable to the Ministry of Health (MOH). This is mainly for public health purposes, such as disease surveillance, monitoring the HIV infection situation, conducting contact tracing and assessing disease prevention and management measures. Healthcare professionals and MOH do not inform the patient’s employer, insurance provider and certainly not family and loved ones.

3. I am afraid of being judged or being embarrassed 

Healthcare professionals are trained to provide professional and non-judgmental consultation. If you do not wish to visit your regular doctor, take some time to do a search online as there are plenty of alternative options that you can consider. It is important to find a sexual health clinic or testing centre that you feel comfortable with. 

4. I trust my partner

If two HIV-negative people are in a monogamous relationship, then certainly there is no risk of HIV, but we are all human and no one is perfect. If one member slips up outside of the relationship, then both parties could be at risk of HIV, especially if engaging in unprotected sex. It is important to have open and honest communication with your partner. If you or your partner has had sex with any casual partner, or if there is any doubt about your HIV status, then do get tested.

5. I am not at risk of HIV

Even if you think that there is no chance that you have been exposed to HIV, as long as you are sexually active, it is recommended to do HIV testing at least once a year, or more frequently if your behaviour puts you at higher risk.

6. Who should test for HIV?

It is recommended by the United States Centre for Disease Control and Prevention (CDC) that everyone between the ages of 13 to 64 should undergo HIV testing at least once as part of routine health care. However, if your behaviour still puts you at risk even after getting tested, you should consider getting tested again at some point later on. People who engage in higher risk activity should get tested regularly.

Also read: HIV SYMPTOMS – WHAT YOU NEED TO KNOW

If you answer ‘yes’ to any of the questions below, you should get an HIV test if not done recently:

  • Are you a man who has had sex with another man?
  • Have you had sex – anal or vaginal – with an HIV-positive partner?
  • Have you had more than one sex partner?
  • Have you injected drugs and shared needles or works (for example, water or cotton) with others?
  • Have you exchanged sex for drugs or money?
  • Have you been diagnosed with, or sought treatment for, another sexually transmitted disease?
  • Have you been diagnosed with or treated for hepatitis or tuberculosis?
  • Have you had sex with someone who could answer “yes” to any of the above questions or someone whose sexual history you don’t know?

What are some of the HIV tests available?

There are three types of HIV tests available. 

1. Nucleic Acid Test (NAT) 

Also known as an HIV viral load test, this test looks for the actual virus in the blood. If the result is positive, the test will also show the amount of virus present in the blood. NAT is very expensive and thus not routinely used to screen individuals unless they recently had a high-risk or possible exposure and there are early symptoms of HIV infection. NAT is usually considered accurate during the early stages of infection. However, it is best to get an antibody or antigen/antibody test at the same time to help in the interpretation of a negative NAT result. Taking pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) may also reduce the accuracy of NAT. (All our clinics provide HIV PrEP & PEP services.)

A NAT is able to detect HIV in the blood as early as 1 to 4 weeks (7 to 28 days) after infection.

2. Antigen/antibody test

Also known as a fourth-generation or combination test, this test looks for both HIV antibodies and antigens. Antibodies are produced by the immune system when one is exposed to bacteria or viruses like HIV. Antigens are foreign substances that cause the immune system to activate. In early HIV infection, an antigen called p24 is produced even before antibodies develop.

The fourth generation test is able to detect HIV in the blood 2 to 6 weeks (13 to 42 days) after infection, and is most accurate after a 28-day window period.

3. Antibody test

This is also known as a third-generation test. As mentioned before, antibodies are produced by the immune system upon exposure to bacteria or viruses like HIV. 

The antibody test is able to detect HIV in the blood in approximately 97% of people within 3 to 12 weeks (21 to 84 days) of infection. If a positive HIV result is obtained from any type of antibody test, a follow up test is required to confirm the result. 

What does the test involve?

In the clinic setting, all the tests are typically performed using blood samples. Laboratory testing can be performed for all three types of HIV tests, whereby blood is drawn from a vein and collected in a tube. Rapid testing is available for only the fourth-generation test and the antibody test, whereby a few drops of blood are obtained via finger prick, and the results are ready in 20 minutes. 

The rapid HIV antibody test can also be performed using oral fluids collected from the mouth and gums with a swab stick. Similarly, the results are ready in 20 minutes. This option is available in some clinics and community testing programs, such as Action for AIDS (AFA) Singapore. 

HIV Screening Singapore

Regardless of the test you choose, the process is simple and fuss-free, and no prior preparation is required – all you need to do is show up at the clinic. Pre and post-test counselling is always conducted professionally and non-judgmentally. 

Despite all this, there are many who still feel extremely self-cautious about approaching a doctor to discuss HIV testing, for fear of stigma and discrimination. This is where Anonymous HIV Test (AHT) comes in. AHT is offered as a means to encourage more individuals who suspect they might be at higher risk to step forward to do testing. There are only 10 clinics in Singapore that are licensed to offer AHT. AHT does not require any name, contact number or form of identification. Instead, a number is usually assigned to the patient for the purposes of providing the result later on. The patient is then required to fill up an anonymous questionnaire to provide some information on his/her sexual behaviour. When seeing the healthcare provider, he/she may be asked some further questions before undergoing the test. AHT is performed using rapid testing only. The entire process throughout is kept confidential and strictly anonymous, even if the test result is positive.  

Anonymous HIV Testing is available in our Robertson Walk Branch only.

What happens after the test?

If your healthcare provider uses a fourth-generation antigen/antibody test, you should get tested again 45 days after your most recent exposure. For other tests, you should test again at least 90 days after your most recent exposure to tell for sure if you have HIV.

If your last HIV test was negative, you can only be sure you are still negative if you have not had a potential HIV exposure since then. If you are sexually active, continue to take actions to prevent HIV, like using condoms the right way every time you have sex and taking PrEP if you are at high risk.

Please get tested if you have not done so recently!

The worst part about the prospect of HIV and/or AIDS is living in the unknown. Do not avoid getting tested simply out of fear. Understanding your health and having a solid plan to stay on top of it – regardless if you are HIV-positive or negative – is the best way to live a long and healthy life.

Next read: HIV WINDOW PERIOD – TIMELINES FOR ACCURATE HIV TESTING

 
 
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U=U: Science, Not Stigma

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Sexual transmission of HIV can be stopped. While there are many barriers to ultimately reaching this goal, one of the most exciting and recently validated concepts resulting from large-scale studies is that of U=U, or Undetectable = Untransmissible.

U=U means that people living with HIV (PLHIV) with a suppressed/undetectable viral load have effectively no risk of transmitting the virus to their sexual partners. The landmark trial of HPTN 052, and subsequent PARTNER, and Opposites Attract studies showed that no linked HIV transmissions were detected between thousands of serodiscordant couples (where one partner is known HIV-positive and one is HIV-negative) as long as the viral load remained undetectable throughout the relationship. This was demonstrated for both heterosexual and homosexual couples, and the greater acceptance of the science has potentially vast implications for personal and public health, social and behavioural norms, and even legal matters.

In order for someone living with HIV to reach undetectable viral load, they will need to be on daily antiretroviral therapy (ART) for at least 3-6 months, and must continue on the medication to maintain viral suppression. Treatment as Prevention (TasP) has been strongly advocated for many years now by HIV specialists and other healthcare providers, but the science and messaging has finally caught up. And for PLHIV, growing awareness and acceptance of U=U will hopefully serve to reduce stigma and discrimination, as well as improve compliance to treatment and follow up.

In 2014, UNAIDS launched the 90-90-90 program which aims to diagnose 90% of all HIV-positive individuals, provide antiretroviral therapy to 90% of the people diagnosed and achieve viral suppression for 90% of those treated by 2020. Current estimates from the Ministry of Health are that only 72% of people living with HIV in Singapore know their status, out of which 89% are on treatment, with the proportion of people on treatment who had achieved viral suppression fairly high at 94%. While the latter two figures are encouraging, more needs to be done to improve HIV testing and diagnosis. Local data shows that only 23% of HIV cases are currently being detected via voluntary screening, while 41% of HIV cases are diagnosed in a late stage.

With over 6,000 people in Singapore currently diagnosed as living with HIV, this means that close to 2,500 are estimated to have the infection without knowing their status. With U=U being a reality, getting at-risk individuals tested and on treatment as early as possible is essential in our fight against HIV. For those who already know their HIV-positive status, there is now additional cause to adhere to ART, as doing so will protect potential future partners from potential transmission.

While U=U is great news overall, there are certain caveats we must remember. For U=U to be considered effective, PLHIV must have an undetectable viral load for a duration of at least 6 months on follow up. Furthermore, studies which have shown that over a quarter of HIV-positive gay and bisexual men in a serodiscordant relationship did not have an accurate understanding of their current viral load, with around 20% of men who believed they were undetectable actually having a detectable viral load. As such, regular condom use and testing is still strongly recommended, as is the wider uptake of Pre-Exposure Prophylaxis (PrEP). It’s also important to note that U=U only applies to HIV infection, so precautions should still be taken against other more common sexually transmitted infections (STIs) such as chlamydia, gonorrhea, and syphilis.

U=U is a simple but important message based on a foundation of scientific evidence. The campaign makes a strong case for adherence to treatment and follow up, and allows PLHIV and the community to understand that they can live long, healthy lives, have children, and enjoy relationships without having to fear passing the infection to others. It will hopefully bring us a few steps closer to achieving the UNAIDS’ 90-90-90 target and help to reduce the stigma still faced by many living with HIV today.

Dr. Jonathan Ti is a GP at DTAP @ Robertson clinic. He has a special interest in sexual health and HIV, and is a co-author of the Community Blueprint to End HIV-transmission and AIDS in Singapore by 2030, and part of the National PrEP Taskforce.

 
 
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